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Sample records for random multiple tunnel

  1. Multiple Ligament Reconstruction Femoral Tunnels: Intertunnel Relationships and Guidelines to Avoid Convergence.

    Science.gov (United States)

    Moatshe, Gilbert; Brady, Alex W; Slette, Erik L; Chahla, Jorge; Turnbull, Travis Lee; Engebretsen, Lars; LaPrade, Robert F

    2017-03-01

    Knee dislocations often require multiple concurrent ligament reconstructions, which involve creating several tunnels in the distal femur. Therefore, the risk of tunnel convergence is increased because of the limited bone volume within the distal aspect of the femur. To assess the risk of tunnel convergence and determine the optimal reconstruction tunnel orientations for multiple ligament reconstructions in the femur. Descriptive laboratory study. Three-dimensional knee models were developed from computed tomography scans of 21 patients. Medical image processing software was used to create tunnels for each of the primary ligamentous structures, replicating a surgical approach that would be used in multiple ligament reconstructions. Thereafter, the tunnel orientation was varied in surgically relevant directions to determine orientations that minimized the risk of tunnel convergence. The orientation of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tunnels was held constant throughout the study, while the orientation of the fibular collateral ligament (FCL), popliteus tendon (PLT), superficial medial collateral ligament (sMCL), and posterior oblique ligament (POL) tunnels was varied to avoid convergence. A high risk of tunnel convergence was observed between the FCL and ACL tunnels when the FCL tunnel was aimed at 0° in the axial and coronal planes. Aiming the FCL tunnel 35° anteriorly minimized convergence with the ACL tunnel. No tunnel convergence was observed for the PLT tunnel aimed 35° anteriorly and parallel to the FCL tunnel. To avoid convergence between the sMCL and PCL tunnels, the sMCL tunnels should be aimed 40° proximally in the coronal plane and 20° to 40° anteriorly. During concomitant POL reconstruction, the sMCL should be aimed 40° proximally and anteriorly and the POL 20° proximally and anteriorly. The PLT and POL tunnels aimed at 0° in both the coronal and axial planes had an increased risk of violating the

  2. N-state random switching based on quantum tunnelling

    Science.gov (United States)

    Bernardo Gavito, Ramón; Jiménez Urbanos, Fernando; Roberts, Jonathan; Sexton, James; Astbury, Benjamin; Shokeir, Hamzah; McGrath, Thomas; Noori, Yasir J.; Woodhead, Christopher S.; Missous, Mohamed; Roedig, Utz; Young, Robert J.

    2017-08-01

    In this work, we show how the hysteretic behaviour of resonant tunnelling diodes (RTDs) can be exploited for new functionalities. In particular, the RTDs exhibit a stochastic 2-state switching mechanism that could be useful for random number generation and cryptographic applications. This behaviour can be scaled to N-bit switching, by connecting various RTDs in series. The InGaAs/AlAs RTDs used in our experiments display very sharp negative differential resistance (NDR) peaks at room temperature which show hysteresis cycles that, rather than having a fixed switching threshold, show a probability distribution about a central value. We propose to use this intrinsic uncertainty emerging from the quantum nature of the RTDs as a source of randomness. We show that a combination of two RTDs in series results in devices with three-state outputs and discuss the possibility of scaling to N-state devices by subsequent series connections of RTDs, which we demonstrate for the up to the 4-state case. In this work, we suggest using that the intrinsic uncertainty in the conduction paths of resonant tunnelling diodes can behave as a source of randomness that can be integrated into current electronics to produce on-chip true random number generators. The N-shaped I-V characteristic of RTDs results in a two-level random voltage output when driven with current pulse trains. Electrical characterisation and randomness testing of the devices was conducted in order to determine the validity of the true randomness assumption. Based on the results obtained for the single RTD case, we suggest the possibility of using multi-well devices to generate N-state random switching devices for their use in random number generation or multi-valued logic devices.

  3. Multiple internal reflections method in the description of tunneling evolution of nonrelativistic particles and photons

    CERN Document Server

    Maidanyuk, S P; Zaichenko, A K

    2002-01-01

    The non-stationary solution method for a problem of tunneling of nonrelativistic particles and photons through a barrier on the basis of multiple internal reflections of wave packets in relation of barrier boundaries is submitted. The method is described and proved in solving an one-dimensional problem of tunneling of the particle through a rectangular barrier. For problems of tunneling of the particle through a spherically symmetric barrier and the photon through an one-dimensional barrier the amplitudes of transmitted and reflected wave packets in relation to the barrier, times of the tunneling and the reflection are found using of the method. Hartman's and Fletcher's effect is analysed.

  4. Comparison of Force and Moment Coefficients for the Same Test Article in Multiple Wind Tunnels

    Science.gov (United States)

    Deloach, Richard

    2013-01-01

    This paper compares the results of force and moment measurements made on the same test article and with the same balance in three transonic wind tunnels. Comparisons are made for the same combination of Reynolds number, Mach number, sideslip angle, control surface configuration, and angle of attack range. Between-tunnel force and moment differences are quantified. An analysis of variance was performed at four unique sites in the design space to assess the statistical significance of between-tunnel variation and any interaction with angle of attack. Tunnel to tunnel differences too large to attribute to random error were detected were observed for all forces and moments. In some cases these differences were independent of angle of attack and in other cases they changed with angle of attack.

  5. Quantum tunneling recombination in a system of randomly distributed trapped electrons and positive ions.

    Science.gov (United States)

    Pagonis, Vasilis; Kulp, Christopher; Chaney, Charity-Grace; Tachiya, M

    2017-09-13

    During the past 10 years, quantum tunneling has been established as one of the dominant mechanisms for recombination in random distributions of electrons and positive ions, and in many dosimetric materials. Specifically quantum tunneling has been shown to be closely associated with two important effects in luminescence materials, namely long term afterglow luminescence and anomalous fading. Two of the common assumptions of quantum tunneling models based on random distributions of electrons and positive ions are: (a) An electron tunnels from a donor to the nearest acceptor, and (b) the concentration of electrons is much lower than that of positive ions at all times during the tunneling process. This paper presents theoretical studies for arbitrary relative concentrations of electrons and positive ions in the solid. Two new differential equations are derived which describe the loss of charge in the solid by tunneling, and they are solved analytically. The analytical solution compares well with the results of Monte Carlo simulations carried out in a random distribution of electrons and positive ions. Possible experimental implications of the model are discussed for tunneling phenomena in long term afterglow signals, and also for anomalous fading studies in feldspars and apatite samples.

  6. Multiple frequency generation by bunched solitons in Josephson tunnel junctions

    DEFF Research Database (Denmark)

    Lomdahl, P. S.; Sørensen, O. H.; Christiansen, Peter Leth

    1981-01-01

    A detailed numerical study of a long Josephson tunnel junction modeled by a perturbed sine-Gordon equation demonstrates the existence of a variety of bunched soliton configurations. Thus, on the third zero-field step of the V-I characteristic, two simultaneous adjacent frequencies are generated...

  7. Quantum optics in multiple scattering random media

    DEFF Research Database (Denmark)

    Lodahl, Peter

    Quantum Optics in Multiple Scattering Random Media Peter Lodahl Research Center COM, Technical University of Denmark, Dk-2800 Lyngby, Denmark. Coherent transport of light in a disordered random medium has attracted enormous attention both from a fundamental and application point of view. Coherent...... quantum optics in multiple scattering media and novel fundamental phenomena have been predicted when examining quantum fluctuations instead of merely the intensity of the light [1]. Here I will present the first experimental study of the propagation of quantum noise through an elastic, multiple scattering...

  8. Cooperation evolution in random multiplicative environments

    Science.gov (United States)

    Yaari, G.; Solomon, S.

    2010-02-01

    Most real life systems have a random component: the multitude of endogenous and exogenous factors influencing them result in stochastic fluctuations of the parameters determining their dynamics. These empirical systems are in many cases subject to noise of multiplicative nature. The special properties of multiplicative noise as opposed to additive noise have been noticed for a long while. Even though apparently and formally the difference between free additive vs. multiplicative random walks consists in just a move from normal to log-normal distributions, in practice the implications are much more far reaching. While in an additive context the emergence and survival of cooperation requires special conditions (especially some level of reward, punishment, reciprocity), we find that in the multiplicative random context the emergence of cooperation is much more natural and effective. We study the various implications of this observation and its applications in various contexts.

  9. Treatment of multiple gingival recessions adopting modified tunnel subepithelial connective tissue graft technique

    Directory of Open Access Journals (Sweden)

    Jagmohan Singh

    2014-01-01

    Full Text Available Gingival recession related to periodontal disease or developmental problems can result in root sensitivity, root caries, and esthetically unacceptable root exposures. In the past, multiple surgical procedures have been proposed to obtain root coverage on exposed buccal root surfaces. There has been great interest in the treatment of gingival recession defects, especially with subepithelial connective-tissue grafting (SCTG. Recent advances have focused on SCTG by the tunnel technique. This article highlights the esthetic results obtained by adopting a modification of the tunnel technique using a single vertical incision along with autologous SCTG in the management of multiple adjacent Miller Class-II gingival recessions. A single vertical incision was used along with tunnel preparation for the facile placement of SCTG into the prepared tunnel. After 6 months of follow-up, the clinical condition was stable with satisfactory root coverage outcome. An excellent esthetical outcome was achieved and the patient was satisfied with the result.

  10. Reducing the computational requirements for simulating tunnel fires by combining multiscale modelling and multiple processor calculation

    DEFF Research Database (Denmark)

    Vermesi, Izabella; Rein, Guillermo; Colella, Francesco

    2017-01-01

    in FDS version 6.0, a widely used fire-specific, open source CFD software. Furthermore, it compares the reduction in simulation time given by multiscale modelling with the one given by the use of multiple processor calculation. This was done using a 1200m long tunnel with a rectangular cross...... processor calculation (97% faster when using a single mesh and multiscale modelling; only 46% faster when using the full tunnel and multiple meshes). In summary, it was found that multiscale modelling with FDS v.6.0 is feasible, and the combination of multiple meshes and multiscale modelling was established...

  11. Analyzing crash frequency in freeway tunnels: A correlated random parameters approach.

    Science.gov (United States)

    Hou, Qinzhong; Tarko, Andrew P; Meng, Xianghai

    2018-02-01

    The majority of past road safety studies focused on open road segments while only a few focused on tunnels. Moreover, the past tunnel studies produced some inconsistent results about the safety effects of the traffic patterns, the tunnel design, and the pavement conditions. The effects of these conditions therefore remain unknown, especially for freeway tunnels in China. The study presented in this paper investigated the safety effects of these various factors utilizing a four-year period (2009-2012) of data as well as three models: 1) a random effects negative binomial model (RENB), 2) an uncorrelated random parameters negative binomial model (URPNB), and 3) a correlated random parameters negative binomial model (CRPNB). Of these three, the results showed that the CRPNB model provided better goodness-of-fit and offered more insights into the factors that contribute to tunnel safety. The CRPNB was not only able to allocate the part of the otherwise unobserved heterogeneity to the individual model parameters but also was able to estimate the cross-correlations between these parameters. Furthermore, the study results showed that traffic volume, tunnel length, proportion of heavy trucks, curvature, and pavement rutting were associated with higher frequencies of traffic crashes, while the distance to the tunnel wall, distance to the adjacent tunnel, distress ratio, International Roughness Index (IRI), and friction coefficient were associated with lower crash frequencies. In addition, the effects of the heterogeneity of the proportion of heavy trucks, the curvature, the rutting depth, and the friction coefficient were identified and their inter-correlations were analyzed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Method of multiple internal reflections in description of tunneling evolution through barriers

    CERN Document Server

    Olkhovsky, Vladislav S

    2000-01-01

    A method of a non-stationary description of tunneling of a particle through the one-dimensional and spherically symmetric rectangular barriers on the basis of analisis of multiple internal reflections of wave packets in relation on the barrier boundaries, named as the Method of multiple internal reflections, is presented at the first time. For the one-dimensional problem the applicability of this method is proved, its specific features are analyzed. For the spherically symmetric problem the amplitudes of the transmitted and reflected wave packets, times of tunneling and reflection in relation to the barrier are calculated using this method. The effect of Hartman-Fletcher is analyzed.

  13. ASSISTments Dataset from Multiple Randomized Controlled Experiments

    Science.gov (United States)

    Selent, Douglas; Patikorn, Thanaporn; Heffernan, Neil

    2016-01-01

    In this paper, we present a dataset consisting of data generated from 22 previously and currently running randomized controlled experiments inside the ASSISTments online learning platform. This dataset provides data mining opportunities for researchers to analyze ASSISTments data in a convenient format across multiple experiments at the same time.…

  14. Preservation of the ulnar bursa within the carpal tunnel: does it improve the outcome of carpal tunnel surgery? A randomized, controlled trial.

    Science.gov (United States)

    Forward, D P; Singh, A K; Lawrence, T M; Sithole, J S; Davis, T R C; Oni, J A

    2006-11-01

    It was hypothesized that preserving a layer of gliding tissue, the parietal layer of the ulnar bursa, between the contents of the carpal tunnel and the soft tissues incised during carpal tunnel surgery might reduce scar pain and improve grip strength and function following open carpal tunnel decompression. Patients consented to randomization to treatment with either preservation of the parietal layer of the ulnar bursa beneath the flexor retinaculum at the time of open carpal tunnel decompression (fifty-seven patients) or division of this gliding layer as part of a standard open carpal tunnel decompression (sixty-one patients). Grip strength was measured, scar pain was rated, and the validated Patient Evaluation Measure questionnaire was used to assess symptoms and disability preoperatively and at eight to nine weeks following the surgery in seventy-seven women and thirty-four men; the remaining seven patients were lost to follow-up. There was no difference between the groups with respect to age, sex, hand dominance, or side of surgery. Grip strength, scar pain, and the Patient Evaluation Measure score were not significantly different between the two groups, although there was a trend toward a poorer subjective outcome as demonstrated by the questionnaire in the group in which the ulnar bursa within the carpal tunnel had been preserved. Preserving the ulnar bursa within the carpal tunnel did, however, result in a lower prevalence of suspected wound infection or inflammation (p = 0.04). In this group of patients, preservation of the ulnar bursa around the median nerve during open carpal tunnel release produced no significant difference in grip strength or self-rated symptoms. We recommend incision of the ulnar bursa during open carpal tunnel decompression to allow complete visualization of the median nerve and carpal tunnel contents.

  15. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial.

    Science.gov (United States)

    Michalsen, Andreas; Bock, Silke; Lüdtke, Rainer; Rampp, Thomas; Baecker, Marcus; Bachmann, Jürgen; Langhorst, Jost; Musial, Frauke; Dobos, Gustav J

    2009-06-01

    We investigated the effectiveness of cupping, a traditional method of treating musculoskeletal pain, in patients with carpal tunnel syndrome (CTS) in an open randomized trial. n = 52 outpatients (58.5 +/- 8.0 years) with neurologically confirmed CTS were randomly assigned to either a verum (n = 26) or a control group (n = 26). Verum patients were treated with a single application of wet cupping, and control patients with a single local application of heat within the region overlying the trapezius muscle. Patients were followed up on day 7 after treatment. The primary outcome, severity of CTS symptoms (VAS), was reduced from 61.5 +/- 20.5 to 24.6 +/- 22.7 mm at day 7 in the cupping group and from 67.1 +/- 20.2 to 51.7 +/- 23.9 mm in the control group [group difference -24.5mm (95%CI -36.1; -2.9, P cupping therapy may be effective in relieving the pain and other symptoms related to CTS. The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified. The results of a randomized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented. Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.

  16. Brick tunnel randomization for unequal allocation to two or more treatment groups.

    Science.gov (United States)

    Kuznetsova, Olga M; Tymofyeyev, Yevgen

    2011-04-15

    Studies with unequal allocation to two or more treatment groups often require a large block size for permuted block allocation. This could present a problem in small studies, multi-center studies, or adaptive design dose-finding studies. In this paper, an allocation procedure, which generalizes the maximal procedure by Berger, Ivanova, and Knoll to the case of K≥2 treatment groups and any allocation ratio, is offered. Brick tunnel (BT) randomization requires the allocation path drawn in the k-dimensional space to stay close to the allocation ray that corresponds to the targeted allocation ratio. Specifically, it requires the allocation path to be confined to the set of the k-dimensional unitary cubes that are pierced by the allocation ray (the 'brick tunnel'). The important property of the BT randomization is that the transition probabilities at each node within the tunnel are defined in such a way that the unconditional allocation ratio is the same for every allocation step. This property is not necessarily met by other allocation procedures that implement unequal allocation. Copyright © 2011 John Wiley & Sons, Ltd.

  17. Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study

    Science.gov (United States)

    Metin Ökmen, Burcu; Kasapoğlu Aksoy, Meliha; Güneş, Aygül; Eröksüz, Riza; Altan, Lale

    2017-08-01

    Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)( n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2)( n = 28), patients received splint treatment(every night for 6 weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0( p study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

  18. Shared medical appointments as a new model for carpal tunnel surgery consultation: A randomized clinical trial.

    Science.gov (United States)

    Wong, Alison L; Martin, Janet; Wong, Michael J; Bezuhly, Michael; Tang, David

    2016-01-01

    In chronic disease management, shared medical appointments have been shown to improve clinic access, productivity and patient education. However, adoption of this model in surgical consultation is limited, and its effect on surgical patients' satisfaction, comfort and surgical risk recall is unknown. To determine whether shared medical appointments could be applied to carpal tunnel surgery consultation while being equally effective as individual consultation for risk recall, patient comfort and satisfaction. A prospective randomized trial involving 80 patients referred for carpal tunnel release consultation, in which patients were assigned to an educational discussion individually or as part of a shared appointment, was conducted. In a blinded fashion, patients were contacted preoperatively to assess their risk recall and postoperatively to rate their overall satisfaction, comfort and satisfaction with the surgeon. Patient demographics were equal. Surgical risk recall was equivalent between shared and individual consults (2.06±1.15 versus 1.64±1.04; P=0.11). More participants in the shared appointments condition remembered the specific risks of infection (61.1% versus 33.3%; P=0.020) and bleeding (30.6% versus 10.3%; P=0.028). There was no difference in overall satisfaction (8.70 versus 8.88; P=0.75), satisfaction with the surgeon (8.05 versus 8.13; P=0.92) or overall comfort (8.80 versus 8.31; P=0.46). Shared medical appointments for carpal tunnel surgery consultation were equivalent to individual consultation in terms of surgical risk recall, patient satisfaction and comfort. These results support the use of shared appointments for large-volume, low-variation surgery.

  19. Predictors of postoperative outcomes of cubital tunnel syndrome treatments using multiple logistic regression analysis.

    Science.gov (United States)

    Suzuki, Taku; Iwamoto, Takuji; Shizu, Kanae; Suzuki, Katsuji; Yamada, Harumoto; Sato, Kazuki

    2017-05-01

    This retrospective study was designed to investigate prognostic factors for postoperative outcomes for cubital tunnel syndrome (CubTS) using multiple logistic regression analysis with a large number of patients. Eighty-three patients with CubTS who underwent surgeries were enrolled. The following potential prognostic factors for disease severity were selected according to previous reports: sex, age, type of surgery, disease duration, body mass index, cervical lesion, presence of diabetes mellitus, Workers' Compensation status, preoperative severity, and preoperative electrodiagnostic testing. Postoperative severity of disease was assessed 2 years after surgery by Messina's criteria which is an outcome measure specifically for CubTS. Bivariate analysis was performed to select candidate prognostic factors for multiple linear regression analyses. Multiple logistic regression analysis was conducted to identify the association between postoperative severity and selected prognostic factors. Both bivariate and multiple linear regression analysis revealed only preoperative severity as an independent risk factor for poor prognosis, while other factors did not show any significant association. Although conflicting results exist regarding prognosis of CubTS, this study supports evidence from previous studies and concludes early surgical intervention portends the most favorable prognosis. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  20. Single vacancy defect spectroscopy on HfO2 using random telegraph noise signals from scanning tunneling microscopy

    Science.gov (United States)

    Thamankar, R.; Raghavan, N.; Molina, J.; Puglisi, F. M.; O'Shea, S. J.; Shubhakar, K.; Larcher, L.; Pavan, P.; Padovani, A.; Pey, K. L.

    2016-02-01

    Random telegraph noise (RTN) measurements are typically carried out at the device level using standard probe station based electrical characterization setup, where the measured current represents a cumulative effect of the simultaneous response of electron capture/emission events at multiple oxygen vacancy defect (trap) sites. To better characterize the individual defects in the high-κ dielectric thin film, we propose and demonstrate here the measurement and analysis of RTN at the nanoscale using a room temperature scanning tunneling microscope setup, with an effective area of interaction of the probe tip that is as small as 10 nm in diameter. Two-level and multi-level RTN signals due to single and multiple defect locations (possibly dispersed in space and energy) are observed on 4 nm HfO2 thin films deposited on n-Si (100) substrate. The RTN signals are statistically analyzed using the Factorial Hidden Markov Model technique to decode the noise contribution of more than one defect (if any) and estimate the statistical parameters of each RTN signal (i.e., amplitude of fluctuation, capture and emission time constants). Observation of RTN at the nanoscale presents a new opportunity for studies on defect chemistry, single-defect kinetics and their stochastics in thin film dielectric materials. This method allows us to characterize the fast traps with time constants ranging in the millisecond to tens of seconds range.

  1. Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

    Science.gov (United States)

    Ordahan, Banu; Karahan, Ali Yavuz

    2017-08-01

    Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3 weeks) alone and splint (during the night and day time as much as possible for 3 weeks) + paraffin treatment (five consecutive days a week for 3 weeks). Clinical and electrophysiological assessments were performed before and 3 weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values (p 0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group (p 0.05), and the difference in these parameters between the groups was statistically significant (p < 0.05). In conclusion, using splinting alone in patients with CTS is an effective treatment for reducing symptoms in the early stages. Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

  2. Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

    Science.gov (United States)

    Ordahan, Banu; Karahan, Ali Yavuz

    2017-12-01

    Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3 weeks) alone and splint (during the night and day time as much as possible for 3 weeks) + paraffin treatment (five consecutive days a week for 3 weeks). Clinical and electrophysiological assessments were performed before and 3 weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values ( p 0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group ( p 0.05), and the difference in these parameters between the groups was statistically significant ( p Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

  3. Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial.

    Science.gov (United States)

    Fernández-de-Las Peñas, César; Ortega-Santiago, Ricardo; de la Llave-Rincón, Ana I; Martínez-Perez, Almudena; Fahandezh-Saddi Díaz, Homid; Martínez-Martín, Javier; Pareja, Juan A; Cuadrado-Pérez, Maria L

    2015-11-01

    This randomized clinical trial investigated the effectiveness of surgery compared with physical therapy consisting of manual therapies including desensitization maneuvers in carpal tunnel syndrome (CTS). The setting was a public hospital and 2 physical therapy practices in Madrid, Spain. One hundred twenty women with CTS were enrolled between February 2013 and January 2014, with 1-year follow-up completed in January 2015. Interventions consisted of 3 sessions of manual therapies including desensitization maneuvers of the central nervous system (physical therapy group, n = 60) or decompression/release of the carpal tunnel (surgical group, n = 60). The primary outcome was pain intensity (mean pain and the worst pain), and secondary outcomes included functional status and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire and the self-perceived improvement. They were assessed at baseline and 1, 3, 6, and 12 months by a blinded assessor. Analysis was by intention to treat. At 12 months, 111 (92%) women completed the follow-up (55/60 physical therapy, 56/60 surgery). Adjusted analyses showed an advantage (all, P physical therapy at 1 and 3 months in mean pain (Δ -2.0 [95% confidence interval (CI) -2.8 to -1.2]/-1.3 [95% CI -2.1 to -.6]), the worst pain (Δ -2.9 [-4.0 to -2.0]/-2.0 [-3.0 to -.9]), and function (Δ -.8 [-1.0 to -.6]/-.3 [-.5 to -.1]), respectively. Changes in pain and function were similar between the groups at 6 and 12 months. The 2 groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire at all follow-ups. In women with CTS, physical therapy may result in similar outcomes on pain and function to surgery. http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT01789645. This study found that surgery and physical manual therapies including desensitization maneuvers of the central nervous system were similarly effective at medium-term and long-term follow-ups for improving pain and

  4. Tunneling Conductivity and Piezoresistivity of Composites Containing Randomly Dispersed Conductive Nano-Platelets

    Directory of Open Access Journals (Sweden)

    Amirhossein Biabangard Oskouyi

    2014-03-01

    Full Text Available In this study, a three-dimensional continuum percolation model was developed based on a Monte Carlo simulation approach to investigate the percolation behavior of an electrically insulating matrix reinforced with conductive nano-platelet fillers. The conductivity behavior of composites rendered conductive by randomly dispersed conductive platelets was modeled by developing a three-dimensional finite element resistor network. Parameters related to the percolation threshold and a power-low describing the conductivity behavior were determined. The piezoresistivity behavior of conductive composites was studied employing a reoriented resistor network emulating a conductive composite subjected to mechanical strain. The effects of the governing parameters, i.e., electron tunneling distance, conductive particle aspect ratio and size effects on conductivity behavior were examined.

  5. Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial.

    Science.gov (United States)

    Chung, Vincent C H; Ho, Robin S T; Liu, Siya; Chong, Marc K C; Leung, Albert W N; Yip, Benjamin H K; Griffiths, Sian M; Zee, Benny C Y; Wu, Justin C Y; Sit, Regina W S; Lau, Alexander Y L; Wong, Samuel Y S

    2016-09-06

    The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] -0.20, 95% confidence interval [CI] -0.36 to -0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD -6.72, 95% CI -10.9 to -2.57), function (Functional Status Scale score MD -0.22, 95% CI -0.38 to -0.05), dexterity (time to complete blinded pick-up test MD -6.13 seconds, 95% CI -10.6 to -1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale -0.70, 95% CI -1.34 to -0.06), and not significant for sensation (first finger monofilament test -0.08 mm, 95% CI -0.22 to 0.06). For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting. Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch/Trial2.aspx

  6. Quantum optics in multiple scattering random media

    NARCIS (Netherlands)

    Lodahl, P.; Lagendijk, Aart

    2005-01-01

    The paper presents the first experimental study of the propagation of quantum noise through an elastic, multiple scattering medium. Two different types of quantum noise measurements have been carried out: total transmission and short-range frequency correlations. When comparing shot noise (quantum)

  7. Properties of thermoluminescence glow curves from tunneling recombination processes in random distributions of defects

    Energy Technology Data Exchange (ETDEWEB)

    Kitis, George [Nuclear Physics Laboratory, Aristotle University of Thessaloniki, 54124 Thessaloniki (Greece); Pagonis, Vasilis, E-mail: vpagonis@mcdaniel.edu [Physics Department, McDaniel College, Westminster, MD 21157 (United States)

    2014-09-15

    Localized electronic recombination processes in donor–acceptor pairs of luminescent materials have been recently modeled using a new kinetic model based on tunneling. Within this model, recombination is assumed to take place via the excited state of the donor, and nearest-neighbor recombinations take place within a random distribution of centers. An approximate semi-analytical version of the model has been shown to simulate successfully thermally and optically stimulated luminescence (TL and OSL), linearly modulated OSL (LM-OSL) and isothermal TL processes. This paper presents a detailed analysis of the geometrical properties of the TL glow curves obtained within three different published versions of the model. The dependence of the shape of the TL glow curves on the kinetic parameters of the model is examined by allowing simultaneous random variations of the parameters, within wide ranges of physically reasonable values covering several orders of magnitude. It is found that the TL glow curves can be characterized according to their shape factors μ{sub g}, as commonly done in TL theory of delocalized transitions. The values of the shape factor are found to depend rather weakly on the activation energy E and the frequency factor s, but they have a strong dependence on the parameter ρ′ which characterizes the concentration of acceptors in the model. It is also shown by simulation that both the variable heating rate and initial rise methods are applicable in this type of model and can yield the correct value of the activation energy E. However, the initial rise method of analysis for the semianalytical version of the model fails to yield the correct E value, since it underestimates the low temperature part of the TL glow curves. Two analytical expressions are given for the TL intensity, which can be used on an empirical basis for computerized glow curve deconvolution analysis (CGCD). - Highlights: • Detailed study of TL glow curves in a tunneling model for

  8. Coverage of Multiple Mandibular Gingival Recessions Using Tunnel Technique with Connective Tissue Graft: A Prospective Case Series.

    Science.gov (United States)

    Thalmair, Tobias; Fickl, Stefan; Wachtel, Hannes

    The aim of this clinical case series was to evaluate the clinical performance of the modified tunnel technique for treatment of multiple gingival recessions in the anterior mandible. A total of 20 patients with 63 Miller Class I and II defects were treated via a modified tunnel technique with subepithelial connective tissue graft. At baseline and 6 months postoperative, recession depth, probing pocket depth, width of keratinized tissue, and gingival tissue thickness were assessed. At 6 months, the results revealed a mean recession coverage of 93.87%. Complete recession coverage was achieved in 74.60%. The mean reduction of recession depth was 2.79 ± 0.12 mm. The modified tunnel technique showed successful mean root coverage in the delicate anterior mandible and was able to increase the amount of keratinized tissue.

  9. Bilateral carpal tunnel syndrome and multiple trigger fingers in a child with mucolipidosis Type III disease

    Directory of Open Access Journals (Sweden)

    Ahmadreza Afshar

    2011-01-01

    Full Text Available This report presents a five-year-old girl with mucolipidosis Type III disease who had bilateral carpal tunnel syndrome and eight trigger fingers. Bilateral open carpal tunnel release was performed. The trigger fingers were treated with A1 and A3 pulleys release and the ulnar slips of the flexor digitorum superficialis tendons were removed.

  10. Prediction of mechanical fatigue caused by multiple random excitations

    NARCIS (Netherlands)

    Bonte, M.H.A.; de Boer, Andries; Liebregts, R.

    2004-01-01

    A simulation method is presented for the fatigue analysis of automotive and other products that are subjected to multiple random excitations. The method is denoted as frequency domain stress-life fatigue analysis and was implemented in the automotive industry at DAF Trucks N.V. in Eindhoven, The

  11. Non-stationary random vibration analysis of structures under multiple correlated normal random excitations

    Science.gov (United States)

    Li, Yanbin; Mulani, Sameer B.; Kapania, Rakesh K.; Fei, Qingguo; Wu, Shaoqing

    2017-07-01

    An algorithm that integrates Karhunen-Loeve expansion (KLE) and the finite element method (FEM) is proposed to perform non-stationary random vibration analysis of structures under excitations, represented by multiple random processes that are correlated in both time and spatial domains. In KLE, the auto-covariance functions of random excitations are discretized using orthogonal basis functions. The KLE for multiple correlated random excitations relies on expansions in terms of correlated sets of random variables reflecting the cross-covariance of the random processes. During the response calculations, the eigenfunctions of KLE used to represent excitations are applied as forcing functions to the structure. The proposed algorithm is applied to a 2DOF system, a 2D cantilever beam and a 3D aircraft wing under both stationary and non-stationary correlated random excitations. Two methods are adopted to obtain the structural responses: a) the modal method and b) the direct method. Both the methods provide the statistics of the dynamic response with sufficient accuracy. The structural responses under the same type of correlated random excitations are bounded by the response obtained by perfectly correlated and uncorrelated random excitations. The structural response increases with a decrease in the correlation length and with an increase in the correlation magnitude. The proposed methodology can be applied for the analysis of any complex structure under any type of random excitation.

  12. Tunnel Technique With Collagen Matrix Compared With Connective Tissue Graft for Treatment of Periodontal Recession: A Randomized Clinical Trial.

    Science.gov (United States)

    Cieślik-Wegemund, Marta; Wierucka-Młynarczyk, Beata; Tanasiewicz, Marta; Gilowski, Łukasz

    2016-12-01

    The aim of this study is to compare efficacy of the tunnel technique for root coverage using collagen matrix (CM) versus connective tissue graft (CTG) for treatment of multiple recessions of Miller Classes I and II over a short period of time. Twenty-eight patients were enrolled in the study. Patients in the control group were treated with the tunnel technique using CTGs, whereas patients in the test group were treated with the tunnel technique using xenogeneic CM. Clinical recordings were obtained at baseline and after 3 and 6 months. Percentages of average recession coverage (ARC) and complete recession coverage (CRC) were evaluated 3 and 6 months after surgery. Significant decreases were recorded in both groups of recession parameters compared with baseline measurements. Mean recession depth (0.21 versus 0.39 mm) and recession area (0.31 versus 0.53 mm 2 ) after 6 months were significantly higher in the test group (P tissue width (KTW) increased at a similar rate in both groups (1.0 versus 0.8 mm for control and test groups, respectively). ARC after 6 months was 95% in the control group and 91% in the test group (P <0.05), and CRC was 71.4% (10/14) in the control group and 14.3% (2/14) in the test group (P <0.05). Xenogeneic CM combined with tunnel technique leads to satisfactory ARC and increase in KTW similar to CTG, but yields lower unsatisfactory CRC.

  13. Characterization of Magnetic Tunnel Junctions For Spin Transfer Torque Magnetic Random Access Memory

    Science.gov (United States)

    Dill, Joshua Luchay

    This thesis details two experimental methods for quantifying magnetic tunnel junction behavior, namely write error rates and field modulated spin-torque ferromagnetic resonance. The former examines how reliably an applied spin-transfer torque can excite magnetization dynamics that lead to a reversal of magnetization direction while the latter studies steady state dynamics provided by an oscillating spin-transfer torque. These characterization techniques reveal write error rate behavior for a particular composition magnetic tunnel junction that qualitatively deviates from theoretical predictions. Possible origins of this phenomenon are also investigated with the field modulated spin-torque ferromagnetic resonance technique. By understanding the dynamics of magnetic moments predicted by theory, one can experimentally confirm or disprove these theories in order to accurately model and predict tunnel junction behavior. By having a better model for what factors are important in magnetization dynamics, one can optimize these factors in terms of improving magnetic tunnel junctions for their use as computer memory.

  14. Comparison of anterior subcutaneous and submuscular transposition of ulnar nerve in treatment of cubital tunnel syndrome: A prospective randomized trial

    Directory of Open Access Journals (Sweden)

    Abolghassem Zarezadeh

    2012-01-01

    Full Text Available Background: This study was designed to compare two methods of surgery, anterior subcutaneous transposition (ASCT and anterior submuscular transposition (ASMT of the ulnar nerve in treatment of cubital tunnel syndrome. Materials and Methods: This randomized trial study was conducted from October 2008 to March 2009 in the Department of Orthopedic Surgery at University Hospital. Forty-eight patients with confirmed cubital tunnel syndrome were randomized in two groups, and each patient received one of two different surgical treatment methods, either ASCT (n = 24 or ASMT (n = 24. In the ASCT technique, the ulnar nerve was transposed and retained in the subcutaneous bed, whereas in the ASMT, the nerve was retained deep in the transected muscular complex, near the median nerve. Patient outcomes, including pain, sensation, muscle strength, and muscle atrophy were compared between groups. Results: The two groups were similar in baseline characteristics. However, those treated with ASMT had a statistically significant reduction in their pain levels compared with ASCT (21 (87.5% vs 8 (33.3%, P 0.05. Conclusions: Our results indicate that ASMT are more efficient than ASCT for managing cubital tunnel syndrome. In patients who had ASMT, there were significant reductions of pain compared with ASCT.

  15. Eye Movement Training and Suggested Gaze Strategies in Tunnel Vision - A Randomized and Controlled Pilot Study.

    Directory of Open Access Journals (Sweden)

    Iliya V Ivanov

    Full Text Available Degenerative retinal diseases, especially retinitis pigmentosa (RP, lead to severe peripheral visual field loss (tunnel vision, which impairs mobility. The lack of peripheral information leads to fewer horizontal eye movements and, thus, diminished scanning in RP patients in a natural environment walking task. This randomized controlled study aimed to improve mobility and the dynamic visual field by applying a compensatory Exploratory Saccadic Training (EST.Oculomotor responses during walking and avoiding obstacles in a controlled environment were studied before and after saccade or reading training in 25 RP patients. Eye movements were recorded using a mobile infrared eye tracker (Tobii glasses that measured a range of spatial and temporal variables. Patients were randomly assigned to two training conditions: Saccade (experimental and reading (control training. All subjects who first performed reading training underwent experimental training later (waiting list control group. To assess the effect of training on subjects, we measured performance in the training task and the following outcome variables related to daily life: Response Time (RT during exploratory saccade training, Percent Preferred Walking Speed (PPWS, the number of collisions with obstacles, eye position variability, fixation duration, and the total number of fixations including the ones in the subjects' blind area of the visual field.In the saccade training group, RTs on average decreased, while the PPWS significantly increased. The improvement persisted, as tested 6 weeks after the end of the training. On average, the eye movement range of RP patients before and after training was similar to that of healthy observers. In both, the experimental and reading training groups, we found many fixations outside the subjects' seeing visual field before and after training. The average fixation duration was significantly shorter after the training, but only in the experimental training

  16. Eye Movement Training and Suggested Gaze Strategies in Tunnel Vision - A Randomized and Controlled Pilot Study

    Science.gov (United States)

    Ivanov, Iliya V.; Mackeben, Manfred; Vollmer, Annika; Martus, Peter; Nguyen, Nhung X.; Trauzettel-Klosinski, Susanne

    2016-01-01

    Purpose Degenerative retinal diseases, especially retinitis pigmentosa (RP), lead to severe peripheral visual field loss (tunnel vision), which impairs mobility. The lack of peripheral information leads to fewer horizontal eye movements and, thus, diminished scanning in RP patients in a natural environment walking task. This randomized controlled study aimed to improve mobility and the dynamic visual field by applying a compensatory Exploratory Saccadic Training (EST). Methods Oculomotor responses during walking and avoiding obstacles in a controlled environment were studied before and after saccade or reading training in 25 RP patients. Eye movements were recorded using a mobile infrared eye tracker (Tobii glasses) that measured a range of spatial and temporal variables. Patients were randomly assigned to two training conditions: Saccade (experimental) and reading (control) training. All subjects who first performed reading training underwent experimental training later (waiting list control group). To assess the effect of training on subjects, we measured performance in the training task and the following outcome variables related to daily life: Response Time (RT) during exploratory saccade training, Percent Preferred Walking Speed (PPWS), the number of collisions with obstacles, eye position variability, fixation duration, and the total number of fixations including the ones in the subjects' blind area of the visual field. Results In the saccade training group, RTs on average decreased, while the PPWS significantly increased. The improvement persisted, as tested 6 weeks after the end of the training. On average, the eye movement range of RP patients before and after training was similar to that of healthy observers. In both, the experimental and reading training groups, we found many fixations outside the subjects' seeing visual field before and after training. The average fixation duration was significantly shorter after the training, but only in the

  17. SOME SYSTEMATIC SAMPLING STRATEGIES USING MULTIPLE RANDOM STARTS

    Directory of Open Access Journals (Sweden)

    Sampath Sundaram

    2010-09-01

    Full Text Available In this paper an attempt is made to extend linear systematic sampling using multiple random starts due to Gautschi(1957for various types of systematic sampling schemes available in literature, namely(i  Balanced Systematic Sampling (BSS of  Sethi (1965 and (ii Modified Systematic Sampling (MSS of Singh, Jindal, and Garg  (1968. Further, the proposed methods were compared with Yates corrected estimator developed with reference to Gautschi’s Linear systematic sampling (LSS with two random starts using appropriate super population models with the  help of R package for statistical computing.

  18. SOME SYSTEMATIC SAMPLING STRATEGIES USING MULTIPLE RANDOM STARTS

    OpenAIRE

    Sampath Sundaram; Ammani Sivaraman

    2010-01-01

    In this paper an attempt is made to extend linear systematic sampling using multiple random starts due to Gautschi(1957)for various types of systematic sampling schemes available in literature, namely(i)  Balanced Systematic Sampling (BSS) of  Sethi (1965) and (ii) Modified Systematic Sampling (MSS) of Singh, Jindal, and Garg  (1968). Further, the proposed methods were compared with Yates corrected estimator developed with reference to Gautschi’s Linear systematic samplin...

  19. Multiplicity of summands in the random partitions of an integer

    Indian Academy of Sciences (India)

    Theoretical Statistics and Mathematics Unit, Indian Statistical Institute, ... probability that there is a summand of multiplicity j in any randomly chosen partition or ... Introduction. 1.1 Integer partitions. Let n ≥ 1 be any integer and let n = a1 +a2 +···+am for some m ≥ 1 and some positive integers {ai }m i=1. We define the set {a1 ...

  20. Comparison of the Effects between Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome (Randomized, Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Ji-young Ku

    2010-12-01

    Full Text Available Objectives : The purpose of this study is to compare the effects of Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome. Methods : From February to September 2010, the number of patients with Carpal Tunnel Syndrome who volunteered for this clinical study was 16 and 7 out of 16 patients complained both hands. Total 23 cases of hands were randomly divided by 2 groups. We injected Sweet Bee Venom Pharmacopuncture on PC7(Daereung twice a week for 4weeks for experimental group(n=11, and Scolopendrid Pharmacopuncture with the same methods for control group(n=12. One case was dropped out due to itchiness of allergic response in the experimental group. Improvement of the symptoms was evaluated by Visual Analogue Scale, Pain Rating Scale, Tinel’s sign, Phalen’s sign and Nerve Conduction Velocity. Nerve Conduction Velocity was checked at baseline and the end of the trial and others were checked at baseline, after 2 and 4 weeks. Results : Both groups showed significant improvement in Visual Analogue Scale, Pain Rating Scale, but no significant difference between two groups. Only the control group showed significant reduction of the‘ poitive response’in the Tinel’s sign and Phalen’s sign. However, no groups improved in Nerve Conduction Velocity. Conclusions : These results showed that Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture could decrease the symptoms of Carpal Tunnel Syndrome. Further studies will be required to examine more cases for the long period and use more various concentration and amount pharmacopuncture for the effect on Carpal Tunnel Syndrome.

  1. CMOS Interface Circuits for Spin Tunneling Junction Based Magnetic Random Access Memories

    Energy Technology Data Exchange (ETDEWEB)

    Saripalli, Ganesh [Iowa State Univ., Ames, IA (United States)

    2002-01-01

    Magneto resistive memories (MRAM) are non-volatile memories which use magnetic instead of electrical structures to store data. These memories, apart from being non-volatile, offer a possibility to achieve densities better than DRAMs and speeds faster than SRAMs. MRAMs could potentially replace all computer memory RAM technologies in use today, leading to future applications like instan-on computers and longer battery life for pervasive devices. Such rapid development was made possible due to the recent discovery of large magnetoresistance in Spin tunneling junction devices. Spin tunneling junctions (STJ) are composite structures consisting of a thin insulating layer sandwiched between two magnetic layers. This thesis research is targeted towards these spin tunneling junction based Magnetic memories. In any memory, some kind of an interface circuit is needed to read the logic states. In this thesis, four such circuits are proposed and designed for Magnetic memories (MRAM). These circuits interface to the Spin tunneling junctions and act as sense amplifiers to read their magnetic states. The physical structure and functional characteristics of these circuits are discussed in this thesis. Mismatch effects on the circuits and proper design techniques are also presented. To demonstrate the functionality of these interface structures, test circuits were designed and fabricated in TSMC 0.35μ CMOS process. Also circuits to characterize the process mismatches were fabricated and tested. These results were then used in Matlab programs to aid in design process and to predict interface circuit's yields.

  2. Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial

    NARCIS (Netherlands)

    Azaripour, Adriano; Kissinger, Maren; Farina, Vittorio Siro Leone; van Noorden, Cornelis J. F.; Gerhold-Ay, Aslihan; Willershausen, Brita; Cortellini, Pierpaolo

    2016-01-01

    Aim: The aim of this randomized clinical trial was to compare the coronally advanced flap (CAF) with the modified microsurgical tunnel technique (MMTT) for treatment of Miller class I and II recessions. Material and Methods: Forty patients with 71 gingival recessions were recruited and randomly

  3. Multiple Volar Carpometacarpal Dislocations with Associated Carpal Tunnel Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    C Fletcher

    2015-09-01

    Full Text Available We report a rare injury involving volar fracture dislocations of the second to fifth carpometacarpal dislocations. Carpometacarpal dislocations are usually dorsally displaced and most commonly only involve the fourth and fifth joints. An associated carpal tunnel syndrome adds another dimension to the complexity and rarity of the injury in this index case. A high index of clinical suspicion and subsequent emergent management is of utmost importance to treat this unusual combination of injuries in order to avoid significant morbidity.

  4. Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial.

    Science.gov (United States)

    Wolny, Tomasz; Saulicz, Edward; Linek, Paweł; Shacklock, Michael; Myśliwiec, Andrzej

    2017-05-01

    The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS). The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment. Therapy was conducted twice weekly and both groups received 20 therapy sessions. A baseline assessment revealed group differences in sensory conduction of the median nerve (P therapy, analysis of variance revealed group differences in pain severity (P therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in individuals with CTS. However, the results regarding pain reduction, subjective symptoms, and functional status were better in the MT group. Copyright © 2017. Published by Elsevier Inc.

  5. Sequential multiple assignment randomization trials with enrichment design.

    Science.gov (United States)

    Liu, Ying; Wang, Yuanjia; Zeng, Donglin

    2017-06-01

    Sequential multiple assignment randomization trial (SMART) is a powerful design to study Dynamic Treatment Regimes (DTRs) and allows causal comparisons of DTRs. To handle practical challenges of SMART, we propose a SMART with Enrichment (SMARTER) design, which performs stage-wise enrichment for SMART. SMARTER can improve design efficiency, shorten the recruitment period, and partially reduce trial duration to make SMART more practical with limited time and resource. Specifically, at each subsequent stage of a SMART, we enrich the study sample with new patients who have received previous stages' treatments in a naturalistic fashion without randomization, and only randomize them among the current stage treatment options. One extreme case of the SMARTER is to synthesize separate independent single-stage randomized trials with patients who have received previous stage treatments. We show data from SMARTER allows for unbiased estimation of DTRs as SMART does under certain assumptions. Furthermore, we show analytically that the efficiency gain of the new design over SMART can be significant especially when the dropout rate is high. Lastly, extensive simulation studies are performed to demonstrate performance of SMARTER design, and sample size estimation in a scenario informed by real data from a SMART study is presented. © 2016, The International Biometric Society.

  6. On the design of a tunnel-entrance hood with multiple windows

    Science.gov (United States)

    Howe, M. S.

    2004-05-01

    An analysis is made to determine the optimal distribution of 'windows' in the wall of a long tunnel-entrance hood used to suppress the micro-pressure wave produced when the compression wave generated by an entering high-speed train reaches the far end of the tunnel. An ideally designed hood causes the pressure to rise linearly across a compression wavefront of thickness equal approximately to the ratio of the hood length to the train Mach number. At moderate train Mach numbers the hood length can be assumed to be 'acoustically compact', and the initial form of the compression wave can then be expressed in terms of an equivalent source distribution representing the train and the compact Green's function for sources in the hood. The requirement that the wavefront profile be linear imposes certain conditions on the Green's function that permits the determination of the hood window dimensions. Our calculations take no account of the influence on compression wave formation of separated air flow over the train, from the hood portal and from the peripheries of the windows. The explicit predictions of the optimum window sizes given in this paper may therefore be too small, and should be refined by using model scale tests that allow window dimensions to be varied from their predicted optimal values to incorporate the effects of flow separation.

  7. Endoscopic vs Open Decompression of the Ulnar Nerve in Cubital Tunnel Syndrome: A Prospective Randomized Double-Blind Study.

    Science.gov (United States)

    Schmidt, Sarah; Kleist Welch-Guerra, Waltraud; Matthes, Marc; Baldauf, Jörg; Schminke, Ulf; Schroeder, Henry W S

    2015-12-01

    Prospective randomized data for comparison of endoscopic and open decompression methods are lacking. To compare the long- and short-term results of endoscopic and open decompression in cubital tunnel syndrome. In a prospective randomized double-blind study, 54 patients underwent ulnar nerve decompression for 56 cubital tunnel syndromes from October 2008 to April 2011. All patients presented with typical clinical and neurophysiological findings and underwent preoperative nerve ultrasonography. They were randomized for either endoscopic (n = 29) or open (n = 27) surgery. Both patients and the physician performing the follow-up examinations were blinded. The follow-up took place 3, 6, 12, and 24 months postoperatively. The severity of symptoms was measured by McGowan and Dellon Score, and the clinical outcome by modified Bishop Score. Additionally, the neurophysiological data were evaluated. No differences were found regarding clinical or neurophysiological outcome in both early and late follow-up between both groups. Hematomas were more frequent after endoscopic decompression (P = .05). The most frequent constrictions were found at the flexor carpi ulnaris (FCU) arch and the retrocondylar retinaculum. We found no compressing structures more than 4 cm distal from the sulcus in the endoscopic group. The outcome was classified as "good" or "excellent" in 46 out of 56 patients (82.1%). Eight patients did not improve sufficiently or had a relapse and underwent a second surgery. The endoscopic technique showed no additional benefits to open surgery. We could not detect relevant compressions distal to the FCU arch. Therefore, an extensive far distal endoscopic decompression is not routinely required. The open decompression remains the procedure of choice at our institution. Dig, digitFCU, flexor carpi ulnarisNAS, numeric analog scale.

  8. Do Patients With Carpal Tunnel Syndrome Benefit From Low-Level Laser Therapy? A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Franke, Thierry P; Koes, Bart W; Geelen, Sven J; Huisstede, Bionka M

    2017-06-16

    To systematically review the literature on the effectiveness of low-level laser therapy for patients with carpal tunnel syndrome. The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016. Two reviewers independently applied the inclusion criteria to select potential studies. Two reviewers independently extracted the data and assessed the methodologic quality. A best-evidence synthesis was performed to summarize the results of the 2 systematic reviews and 17 RCTs that were included. Strong evidence was found for the effectiveness of low-level laser therapy compared with placebo treatment in the very short term (0 to ≤5wk). After 5 weeks, the positive effects of low-level laser therapy on pain, function, or recovery diminished over time (moderate and conflicting evidence were found at 7- and 12-wk follow-up, respectively). In the very short term, low-level laser therapy is more effective as a single intervention than placebo low-level laser therapy in patients with carpal tunnel syndrome, after which the positive effects of low-level laser therapy tend to subside. Evidence in the midterm and long term is sparse. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  9. Pulsed magnetic field versus ultrasound in the treatment of postnatal carpal tunnel syndrome: A randomized controlled trial in the women of an Egyptian population

    Directory of Open Access Journals (Sweden)

    Dalia M. Kamel

    2017-01-01

    Full Text Available The aim of this study was to compare the effects of pulsed electromagnetic field versus pulsed ultrasound in treating patients with postnatal carpal tunnel syndrome. The study was a randomized, double-blinded trial. Forty postnatal female patients with idiopathic carpal tunnel syndrome were divided randomly into two equal groups. One group received pulsed electromagnetic field, with nerve and tendon gliding exercises for the wrist, three times per week for four weeks. The other group received pulsed ultrasound and the same wrist exercises. Pain level, sensory and motor distal latencies and conduction velocities of the median nerve, functional status scale and hand grip strength were assessed pre- and post-treatment. There was a significant decrease (P  0.05. In conclusion, while the symptoms were alleviated in both groups, pulsed electromagnetic field was more effective than pulsed ultrasound in treating postnatal carpal tunnel syndrome.

  10. A randomized pilot study of naturopathic medicine in multiple sclerosis.

    Science.gov (United States)

    Shinto, Lynne; Calabrese, Carlo; Morris, Cynthia; Yadav, Vijayshree; Griffith, Debbie; Frank, Rachel; Oken, Barry S; Baldauf-Wagner, Sara; Bourdette, Dennis

    2008-06-01

    Complementary and alternative medicine (CAM) use is high in people with multiple sclerosis (MS), yet there are limited reports on safety and effectiveness of CAM in MS. Naturopathic medicine encompasses a broad range of CAM modalities and may improve quality of life in patients with MS. To assess quality of life in MS subjects who received interventions designed to "model" the "whole practice" of naturopathy. A pilot, randomized, controlled study with a 6-month intervention period. Participants who met criteria for clinically definite MS. The 3 intervention arms were usual care, naturopathic medicine plus usual care, and MS education plus usual care. The primary outcome measure was quality of life (36-item short form health survey [SF-36]). Secondary outcome measures included fatigue (Modified Fatigue Impact Scale); depression (Beck Depression Inventory); cognition battery (Stroop test and Paced Auditory Serial Addition Test 3), and neurologic impairment (Expanded Disability Status Scale [EDSS] and Multiple Sclerosis Functional Composite). Adverse event reporting and laboratory measures were used to assess safety. Forty-five (45) participants (15 per group) were randomized and all completed the 6-month intervention. There were no significant differences between groups on any outcome measure. There was a trend in favoring the naturopathic group in the General Health subscale of the SF-36 (p = 0.11), Timed Walk (p = 0.11), and neurologic impairment (EDSS) (p = 0.07). There was a trend favoring the Education group in the Stroop attention test (p = 0.07). There was no difference between groups in adverse events or laboratory changes. Naturopathic medicine combined with usual care for MS showed a trend in improvement in the General Health subscale of the SF-36, Timed Walk, and neurologic impairment. Evaluation of naturopathic medicine, as a multimodality regimen, warrants further investigation.

  11. Mendelian randomization analysis with multiple genetic variants using summarized data.

    Science.gov (United States)

    Burgess, Stephen; Butterworth, Adam; Thompson, Simon G

    2013-11-01

    Genome-wide association studies, which typically report regression coefficients summarizing the associations of many genetic variants with various traits, are potentially a powerful source of data for Mendelian randomization investigations. We demonstrate how such coefficients from multiple variants can be combined in a Mendelian randomization analysis to estimate the causal effect of a risk factor on an outcome. The bias and efficiency of estimates based on summarized data are compared to those based on individual-level data in simulation studies. We investigate the impact of gene-gene interactions, linkage disequilibrium, and 'weak instruments' on these estimates. Both an inverse-variance weighted average of variant-specific associations and a likelihood-based approach for summarized data give similar estimates and precision to the two-stage least squares method for individual-level data, even when there are gene-gene interactions. However, these summarized data methods overstate precision when variants are in linkage disequilibrium. If the P-value in a linear regression of the risk factor for each variant is less than 1×10⁻⁵, then weak instrument bias will be small. We use these methods to estimate the causal association of low-density lipoprotein cholesterol (LDL-C) on coronary artery disease using published data on five genetic variants. A 30% reduction in LDL-C is estimated to reduce coronary artery disease risk by 67% (95% CI: 54% to 76%). We conclude that Mendelian randomization investigations using summarized data from uncorrelated variants are similarly efficient to those using individual-level data, although the necessary assumptions cannot be so fully assessed. © 2013 WILEY PERIODICALS, INC.

  12. Long-term reliable physically unclonable function based on oxide tunnel barrier breakdown on two-transistors two-magnetic-tunnel-junctions cell-based embedded spin transfer torque magnetoresistive random access memory

    Science.gov (United States)

    Takaya, Satoshi; Tanamoto, Tetsufumi; Noguchi, Hiroki; Ikegami, Kazutaka; Abe, Keiko; Fujita, Shinobu

    2017-04-01

    Among the diverse applications of spintronics, security for internet-of-things (IoT) devices is one of the most important. A physically unclonable function (PUF) with a spin device (spin transfer torque magnetoresistive random access memory, STT-MRAM) is presented. Oxide tunnel barrier breakdown is used to realize long-term stability for PUFs. A secure PUF has been confirmed by evaluating the Hamming distance of a 32-bit STT-MRAM-PUF fabricated using 65 nm CMOS technology.

  13. Randomized trial of oral teriflunomide for relapsing multiple sclerosis.

    Science.gov (United States)

    O'Connor, Paul; Wolinsky, Jerry S; Confavreux, Christian; Comi, Giancarlo; Kappos, Ludwig; Olsson, Tomas P; Benzerdjeb, Hadj; Truffinet, Philippe; Wang, Lin; Miller, Aaron; Freedman, Mark S

    2011-10-06

    Teriflunomide is a new oral disease-modifying therapy for relapsing forms of multiple sclerosis. We concluded a randomized trial involving 1088 patients with multiple sclerosis, 18 to 55 years of age, with a score of 0 to 5.5 on the Expanded Disability Status Scale and at least one relapse in the previous year or at least two relapses in the previous 2 years. Patients were randomly assigned (in a 1:1:1 ratio) to placebo, 7 mg of teriflunomide, or 14 mg of teriflunomide once daily for 108 weeks. The primary end point was the annualized relapse rate, and the key secondary end point was confirmed progression of disability for at least 12 weeks. Teriflunomide reduced the annualized relapse rate (0.54 for placebo vs. 0.37 for teriflunomide at either 7 or 14 mg), with relative risk reductions of 31.2% and 31.5%, respectively (Pteriflunomide at 7 mg (P=0.08), and 20.2% with teriflunomide at 14 mg (P=0.03). Both teriflunomide doses were superior to placebo on a range of end points measured by magnetic resonance imaging (MRI). Diarrhea, nausea, and hair thinning were more common with teriflunomide than with placebo. The incidence of elevated alanine aminotransferase levels (≥1 times the upper limit of the normal range) was higher with teriflunomide at 7 mg and 14 mg (54.0% and 57.3%, respectively) than with placebo (35.9%); the incidence of levels that were at least 3 times the upper limit of the normal range was similar in the lower- and higher-dose teriflunomide groups and the placebo group (6.3%, 6.7%, and 6.7%, respectively). Serious infections were reported in 1.6%, 2.5%, and 2.2% of patients in the three groups, respectively. No deaths occurred. Teriflunomide significantly reduced relapse rates, disability progression (at the higher dose), and MRI evidence of disease activity, as compared with placebo. (Funded by Sanofi-Aventis; TEMSO ClinicalTrials.gov number, NCT00134563.).

  14. Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus: prospective randomized clinical trial.

    Science.gov (United States)

    Kubaloglu, Anil; Sari, Esin Sogutlu; Cinar, Yasin; Cingu, Kürşat; Koytak, Arif; Coşkun, Erol; Ozertürk, Yusuf

    2010-09-01

    To compare the outcomes of mechanical and femtosecond laser-assisted tunnel creation for intrastromal corneal ring segment (ICRS) implantation in eyes with keratoconus. Kartal Training and Research Hospital, Istanbul, Turkey. In this prospective study, consecutive eyes with keratoconus were randomly assigned to have ICRS tunnel creation with a mechanical device or a femtosecond laser. Keraring ICRS with a 5.0 mm diameter and 160-degree arc length were implanted in all cases. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and keratometry (K) readings were measured preoperatively and 1 year postoperatively, and the data in the mechanical group and the femtosecond group were compared statistically. One year postoperatively, there was significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder in both groups (Pmechanical group and 2.0 lines in the femtosecond group and the CDVA by 3.3 lines and 2.7 lines, respectively; the mean reduction in maximum keratometry was 4.50 diopters (D) and 4.70 D, respectively, and the mean reduction in SE, 3.18 D and 3.09 D, respectively. There were no statistically significant differences between the 2 groups in visual or refractive results (P>.05). Anterior corneal perforation, superficial segment placement, and segment extrusion occurred in 1 eye each in the mechanical group. Segment migration occurred in 1 eye in the femtosecond group. Despite intraoperative complications in the mechanical group, the visual and refractive outcomes were similar to those in the femtosecond group. Copyright (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  15. Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

    Directory of Open Access Journals (Sweden)

    Barbosa Rafael Inácio

    2012-12-01

    Full Text Available Abstract Background Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. Methods/Design Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test. Discussion This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. Trial registration Brazilian Clinical Trials Registry (ReBec - 75ddtf / Universal Trial Number: U1111-1121-5184

  16. Randomized trial of oral teriflunomide for relapsing multiple sclerosis

    DEFF Research Database (Denmark)

    O'Connor, Paul; Wolinsky, Jerry S; Confavreux, Christian

    2011-01-01

    Teriflunomide is a new oral disease-modifying therapy for relapsing forms of multiple sclerosis.......Teriflunomide is a new oral disease-modifying therapy for relapsing forms of multiple sclerosis....

  17. Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial

    Directory of Open Access Journals (Sweden)

    Onur Armagan

    2014-08-01

    Full Text Available OBJECTIVE: The aim of this placebo-controlled study was to evaluate the effects of pulsed and continuous ultrasound treatments combined with splint therapy on patients with mild and moderate idiopathic carpal tunnel syndrome. METHODS: The study included 46 carpal tunnel syndrome patients who were randomly divided into 3 groups. The first group (n = 15 received a 0 W/cm2 ultrasound treatment (placebo; the second group (n = 16 received a 1.0 W/cm2 continuous ultrasound treatment and the third group (n = 15 received a 1.0 W/cm2 1:4 pulsed ultrasound treatment 5 days a week for a total of 15 sessions. All patients also wore night splints during treatment period. Pre-treatment and post-treatment Visual Analogue Scale, Symptom Severity Scale and Functional Status Scale scores, median nerve motor conduction velocity and distal latency and sensory conduction velocities of the median nerve in the 2nd finger and palm were compared. Clinicaltrials.gov: NCT02054247. RESULTS: There were significant improvements in all groups in terms of the post-treatment Functional Status Scale score (p<0.05 for all groups, Symptom Severity Scale score (first group: p<0.05, second group: p<0.01, third group: p<0.001 and Visual Analogue Scale score (first and third groups: p<0.01, second group: p<0.001. Sensory conduction velocities improved in the second and third groups (p<0.01. Distal latency in the 2nd finger showed improvement only in the third group (p<0.01 and action potential latency in the palm improved only in the second group (p<0.05. CONCLUSION: The results of this study suggest that splinting therapy combined with placebo and pulsed or continuous ultrasound have similar effects on clinical improvement. Patients treated with continuous and pulsed ultrasound showed electrophysiological improvement; however, the results were not superior to those of the placebo.

  18. A random effect multiplicative heteroscedastic model for bacterial growth

    Directory of Open Access Journals (Sweden)

    Quinto Emiliano J

    2010-02-01

    Full Text Available Abstract Background Predictive microbiology develops mathematical models that can predict the growth rate of a microorganism population under a set of environmental conditions. Many primary growth models have been proposed. However, when primary models are applied to bacterial growth curves, the biological variability is reduced to a single curve defined by some kinetic parameters (lag time and growth rate, and sometimes the models give poor fits in some regions of the curve. The development of a prediction band (from a set of bacterial growth curves using non-parametric and bootstrap methods permits to overcome that problem and include the biological variability of the microorganism into the modelling process. Results Absorbance data from Listeria monocytogenes cultured at 22, 26, 38, and 42°C were selected under different environmental conditions of pH (4.5, 5.5, 6.5, and 7.4 and percentage of NaCl (2.5, 3.5, 4.5, and 5.5. Transformation of absorbance data to viable count data was carried out. A random effect multiplicative heteroscedastic model was considered to explain the dynamics of bacterial growth. The concept of a prediction band for microbial growth is proposed. The bootstrap method was used to obtain resamples from this model. An iterative procedure is proposed to overcome the computer intensive task of calculating simultaneous prediction intervals, along time, for bacterial growth. The bands were narrower below the inflection point (0-8 h at 22°C, and 0-5.5 h at 42°C, and wider to the right of it (from 9 h onwards at 22°C, and from 7 h onwards at 42°C. A wider band was observed at 42°C than at 22°C when the curves reach their upper asymptote. Similar bands have been obtained for 26 and 38°C. Conclusions The combination of nonparametric models and bootstrap techniques results in a good procedure to obtain reliable prediction bands in this context. Moreover, the new iterative algorithm proposed in this paper allows one to

  19. Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Huisstede, Bionka M; Hoogvliet, Peter; Franke, Thierry P; Randsdorp, Manon S; Koes, Bart W

    2017-09-20

    To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database. Two reviewers independently applied the inclusion criteria to select potential eligible studies. Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool. A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials [RCTs]). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified. Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm

  20. Random Scenario Generation for a Multiple Target Tracking Environment Evaluation

    DEFF Research Database (Denmark)

    Hussain, Dil Muhammad Akbar

    2006-01-01

    The paper presents a simulation study on the generation of a random scenario for the performance of track splitting algorithm on a digital signal processor.  Much of the previous work [1] was done on specific (deterministic) scenarios. One of the reasons for considering the specific scenarios, wh...

  1. Spatial quantum correlations induced by random multiple scattering of quadrature squeezed light

    DEFF Research Database (Denmark)

    Lodahl, Peter

    2007-01-01

    The authors demonstrates that spatial quantum correlations are induced by multiple scattering of quadrature squeezed light through a random medium. As a consequence, light scattered along two different directions by the random medium will not be independent, but be correlated to an extent that ca...... only be described by a quantum mechanical theory for multiple scattering. The spatial quantum correlation is revealed in the fluctuations of the total intensity transmission or reflection through the multiple scattering medium.......The authors demonstrates that spatial quantum correlations are induced by multiple scattering of quadrature squeezed light through a random medium. As a consequence, light scattered along two different directions by the random medium will not be independent, but be correlated to an extent that can...

  2. On solving discrete optimization problems with multiple random elements under general regret functions

    NARCIS (Netherlands)

    Mandal, Pranab K.; Ghosh, D.; Das, S

    2005-01-01

    In this paper we attempt to find least risk solutions for stochastic discrete optimization problems (SDOP) with multiple random elements, where the feasibility of a solution does not depend on the particular values the random elements in the problem take. While the optimal solution, for a linear

  3. A pilot randomized double-blind placebo-controlled trial on topical chamomile (Matricaria chamomilla L.) oil for severe carpal tunnel syndrome.

    Science.gov (United States)

    Hashempur, Mohammad Hashem; Lari, Zeinab Nasiri; Ghoreishi, Parissa Sadat; Daneshfard, Babak; Ghasemi, Mohammad Sadegh; Homayouni, Kaynoosh; Zargaran, Arman

    2015-11-01

    To assess the effectiveness of standardized topical Chamomile (Matricaria chamomilla L.) oil in patients with severe carpal tunnel syndrome, as a complementary treatment. A pilot randomized double-blind placebo-controlled trial was conducted. Twenty six patients with documented severe carpal tunnel syndrome were treated in two parallel groups with a night splint plus topical chamomile oil or placebo. They were instructed to use their prescribed oil for 4 weeks, twice daily. Symptomatic and functional status of the patients and their electrodiagnostic parameters were evaluated when enrolled and after the trial period, as our outcome measures. A significant improvement of symptomatic and functional status of patients in the chamomile oil group was observed (p = 0.019 and 0.016, respectively) compared with those in the placebo group. However, electrodiagnostic parameters showed no significant changes between the two groups. Chamomile oil improved symptomatic and functional status of patients with severe carpal tunnel syndrome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Clinical Comparison of the Subepithelial Connective Tissue versus Platelet-Rich Fibrin for the Multiple Gingival Recession Coverage on Anterior Teeth Using the Tunneling Technique

    Directory of Open Access Journals (Sweden)

    Victor Fabrizio Cabrera Pazmiño

    2017-01-01

    Full Text Available The aim of this study was to evaluate and compare, clinically, the efficiency of the subepithelial connective tissue graft (SCTG and platelet-rich fibrin (L-PRF using the tunnel technique to cover the multiple gingival recessions on anterior teeth, in the same patient. Within the limits of this study, we conclude that both SCTG and L-PRF proved to be reliable options for the treatment of gingival recessions, efficiently supporting the biological and aesthetic demand, stimulating the periodontal tissues’ health, and bringing reliable and highly predictable results.

  5. Clinical Comparison of the Subepithelial Connective Tissue versus Platelet-Rich Fibrin for the Multiple Gingival Recession Coverage on Anterior Teeth Using the Tunneling Technique

    Science.gov (United States)

    Rodas, Miguel Agusto Riquelme; Cáceres, Carlos David Barrios; Duarte, Guillermo Gustavo Renault; Azuaga, Melanie Vanesa Cano; de Paula, Bruna Luísa; Caliente, Eliana Aparecida; Soares, Simone; Silveira, Elcia Maria Varize

    2017-01-01

    The aim of this study was to evaluate and compare, clinically, the efficiency of the subepithelial connective tissue graft (SCTG) and platelet-rich fibrin (L-PRF) using the tunnel technique to cover the multiple gingival recessions on anterior teeth, in the same patient. Within the limits of this study, we conclude that both SCTG and L-PRF proved to be reliable options for the treatment of gingival recessions, efficiently supporting the biological and aesthetic demand, stimulating the periodontal tissues' health, and bringing reliable and highly predictable results. PMID:28695021

  6. Randomization-based adjustment of multiple treatment hazard ratios for covariates with missing data.

    Science.gov (United States)

    Lam, Diana; Koch, Gary G; Preisser, John S; Saville, Benjamin R; Hussey, Michael A

    2017-01-01

    Clinical trials are designed to compare treatment effects when applied to samples from the same population. Randomization is used so that the samples are not biased with respect to baseline covariates that may influence the efficacy of the treatment. We develop randomization-based covariance adjustment methodology to estimate the log hazard ratios and their confidence intervals of multiple treatments in a randomized clinical trial with time-to-event outcomes and missingness among the baseline covariates. The randomization-based covariance adjustment method is a computationally straight-forward method for handling missing baseline covariate values.

  7. The Effects of Oscillatory Biofield Therapy on Pain and Functional Limitations Associated with Carpal Tunnel Syndrome: Randomized, Placebo-Controlled, Double-Blind Study.

    Science.gov (United States)

    Nourbakhsh, Mohammad Reza; Bell, Thomas J; Martin, Jason Benson; Arab, Amir Massoud

    2016-11-01

    Biofield treatments have been used for pain control in patients with cancer and chronic pain. However, research on the effect of biofield treatment on specific somatic disorders is lacking. This study intends to investigate the effect of oscillating biofield therapy (OBFT) on symptoms of carpal tunnel syndrome. Randomized, placebo-controlled, double-blind study. Thirty patients with chronic carpal tunnel syndrome participated in the study. Patients were randomly assigned to active or placebo treatment groups. Those in the treatment group received six sessions of OBFT with intention to treat during a period of 2 weeks. Patients in the placebo group had the same number of treatment sessions with mock OBFT treatment. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; Symptom Severity Scale (SSS); and Functional Status Scale (FSS) were used for outcome assessment. Both clinically and statistically significant changes in intensity of pain with activity (95% confidence interval [CI], 2.5-4.2; p = 0.000), night pain (p = 0.000, 95% CI, 3.2-5.7), DASH questionnaire (95% CI, 12.0-21.9; p = 0.000), SSS (95% CI, 0.64-1.15; p = 0.003), and FSS (95% CI, 0.41-0.97; p = 0.029) were found between the treatment and placebo groups. Statistically significant reduction in number of patients with positive results on the Phalen test (87%; p = 0.000), Tinel sign (73%; p = 0.000), and hand paresthesia (80%; p = 0.000) was noted in the treatment group. During 6-month follow-up, 86% of patients in the treatment group remained pain free and had no functional limitations. OBFT can be a viable and effective treatment for improving symptoms and functional limitations associated with chronic carpal tunnel syndrome.

  8. Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Eduardo Jun Sadatsune

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVES: Effective postoperative analgesia is important for reducing the incidence of chronic pain. This study evaluated the effect of preoperative gabapentin on postoperative analgesia and the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgical treatment. DESIGN AND SETTINGS: Randomized, double-blind controlled trial, Federal University of São Paulo Pain Clinic. METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period, incidence of postoperative neuropathic pain (over a six-month period, need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4 questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery.

  9. Short tunnels.

    NARCIS (Netherlands)

    Schreuder, D.A.

    1965-01-01

    Before dealing with the question of lighting short tunnels, it is necessary define what is meant by a tunnel and when it should be called 'short'. Confined to motorized road traffic the following is the most apt definition of a tunnel: every form of roofing-over a road section, irrespective of it

  10. Research on the reliability of friction system under combined additive and multiplicative random excitations

    Science.gov (United States)

    Sun, Jiaojiao; Xu, Wei; Lin, Zifei

    2018-01-01

    In this paper, the reliability of a non-linearly damped friction oscillator under combined additive and multiplicative Gaussian white noise excitations is investigated. The stochastic averaging method, which is usually applied to the research of smooth system, has been extended to the study of the reliability of non-smooth friction system. The results indicate that the reliability of friction system can be improved by Coulomb friction and reduced by random excitations. In particular, the effect of the external random excitation on the reliability is larger than the effect of the parametric random excitation. The validity of the analytical results is verified by the numerical results.

  11. Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies.

    Science.gov (United States)

    Liu, Chun-Hua; Wu, Shi-Qiang; Ke, Xiao-Bin; Wang, Han-Long; Chen, Chang-Xian; Lai, Zhan-Long; Zhuang, Zhi-Yong; Wu, Zhi-Qiang; Lin, Qin

    2015-07-01

    Subcutaneous and submuscular anterior ulnar nerve transposition have been widely used in patients with cubital tunnel syndrome. However, the reliable evidence in favor of 1 of 2 surgical options on clinical improvement remains controversial. To maximize the value of the available literature, we performed a systematic review and meta-analysis to compare subcutaneous versus submuscular anterior ulnar nerve transposition in patients with ulnar neuropathy at the elbow. PubMed, Cochrane Library, and EMBASE databases were searched for randomized and observational studies that compared subcutaneous transposition with submuscular transposition of ulnar nerve for cubital tunnel syndrome. The primary outcome was clinically relevant improvement in function compared to the baseline. Randomized and observational studies were separately analyzed with relative risks (RRs) and 95% confidence intervals (CIs). Two randomized controlled trials (RCTs) and 7 observational studies, involving 605 patients, were included. Our meta-analysis suggested that no significant differences in the primary outcomes were observed between comparison groups, both in RCT (RR, 1.16; 95% CI 0.68-1.98; P = 0.60; I2= 81%) and observational studies (RR, 1.01; 95% CI 0.95-1.08; P = 0.69; I2 = 0%). These findings were also consistent with all subgroup analyses for observational studies. In the secondary outcomes, the incidence of adverse events was significantly lower in subcutaneous group than in submuscular group (RR, 0.54; 95% CI 0.33-0.87; P = 0.01; I2 = 0%), whereas subcutaneous transposition failed to reveal more superiority than submuscular transposition in static two-point discrimination (MD, 0.04; 95% CI -0.18-0.25; P = 0.74; I = 0%). The available evidence is not adequately powered to identify the best anterior ulnar nerve transposition technique for cubital tunnel syndrome on the basis of clinical outcomes, that is, suggests that subcutaneous and submuscular anterior transposition might be equally

  12. The Role of User Control in Adherence to and Knowledge Gained from a Website: Randomized Comparison Between a Tunneled Version and a Freedom-of-Choice Version

    Science.gov (United States)

    Cyr, Dianne; de Vries, Nanne K

    2012-01-01

    Background Internet-delivered interventions can effectively change health risk behaviors and their determinants, but adherence to these interventions once they are accessed is very low. Therefore, it is relevant and necessary to systematically manipulate website characteristics to test their effect on website use. This study focuses on user control as a website characteristic. Objective To test whether and how user control (the freedom of choice to skip pages) can increase website use and knowledge gained from the website. Methods Participants older than 18 years were drawn from the Dutch Internet population (in June 2011) and completed a hepatitis knowledge questionnaire. Subsequently, they were randomly assigned to three groups: (1) a tunneled version of the website with less user control; (2) a high user control version of the website where visitors had the freedom of choice to skip pages; and (3) a control group that was not exposed to the website. Participants completed (1) a questionnaire of validated measures regarding user perceptions immediately after exposure to the website (except for the control group), and (2) a hepatitis knowledge questionnaire after one week to test whether participants in the experimental groups only clicked through the website or actually processed and learned its content. Server registrations were used to assess website use. Analyses of covariance (ANCOVA) using all available data were conducted to determine whether user control increases website use. Structural equation models (SEM) using all available data were constructed to test how user control increases website use—a latent variable derived from number of pages visited and time on website. Results Of the 1044 persons invited to participate, 668 took part (668/1044, 64.0%). One half of participants (332/668 49.7%) were female and the mean age was 49 years (SD 16). A total of 571 participants completed the one-week follow-up measure regarding hepatitis knowledge (571/668, 85

  13. On the time varying horizontal water velocity of single, multiple, and random gravity wave trains

    NARCIS (Netherlands)

    Wells, D.R.

    1964-01-01

    In this dissertation some characteristics of the horizontal water velocity for single, multiple, and random gravity wave trains are studied. This work consists of two parts, an analogue study and hydraulic measurements. An important aspect in this work is to suggest the horizontal water velocity

  14. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis.

    NARCIS (Netherlands)

    Polman, C.H.; O'Connor, P.W.; Havrdova, E.; Hutchinson, M.; Kappos, L.; Miller, D.H.; Phillips, J.T.; Lublin, F.D.; Giovannoni, G.; Wajgt, A.; Toal, M.; Lynn, F.; Panzara, M.A.; Sandrock, A.W.

    2006-01-01

    BACKGROUND: Natalizumab is the first alpha4 integrin antagonist in a new class of selective adhesion-molecule inhibitors. We report the results of a two-year phase 3 trial of natalizumab in patients with relapsing multiple sclerosis. METHODS: Of a total of 942 patients, 627 were randomly assigned to

  15. A randomized crossover study of bee sting therapy for multiple sclerosis

    NARCIS (Netherlands)

    Wesselius, T; Heersema, DJ; Mostert, JP; Heerings, M; Admiraal-Behloul, F; Talebian, A; van Buchem, MA; De Keyser, J

    2005-01-01

    Background: Bee sting therapy is increasingly used to treat patients with multiple sclerosis (MS) in the belief that it can stabilize or ameliorate the disease. However, there are no clinical studies to justify its use. Methods: In a randomized, crossover study, we assigned 26 patients with

  16. Cubital Tunnel Syndrome: Current Concepts.

    Science.gov (United States)

    Staples, Jonathan Robert; Calfee, Ryan

    2017-10-01

    Cubital tunnel syndrome is the second most common upper extremity compressive neuropathy. In recent years, rates of surgical treatment have increased, and the popularity of in situ decompression has grown. Nonsurgical treatment, aiming to decrease both compression and traction on the ulnar nerve about the elbow, is successful in most patients with mild nerve dysfunction. Recent randomized controlled trials assessing rates of symptom resolution and ultimate success have failed to identify a preferred surgical procedure. Revision cubital tunnel surgery, most often consisting of submuscular transposition, may improve symptoms. However, ulnar nerve recovery after revision cubital tunnel surgery is less consistent than that after primary cubital tunnel surgery.

  17. Acute effect of topical menthol on chronic pain in slaughterhouse workers with carpal tunnel syndrome: triple-blind, randomized placebo-controlled trial

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus Due; Brandt, Mikkel

    2014-01-01

    Topical menthol gels are classified "topical analgesics" and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS). We screened 645 slaughterhouse workers and recruited 10...... participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze) or placebo (gel with a menthol scent) during the working day and 48 hours later the other treatment (crossover design). Participants rated arm/hand pain intensity during...... the last hour of work (scale 0-10) immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC) in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol (P = 0...

  18. A randomized controlled trial and cost-effectiveness analysis of early cannulation arteriovenous grafts versus tunneled central venous catheters in patients requiring urgent vascular access for hemodialysis.

    Science.gov (United States)

    Aitken, Emma; Thomson, Peter; Bainbridge, Leigh; Kasthuri, Ram; Mohr, Belinda; Kingsmore, David

    2017-03-01

    Early cannulation arteriovenous grafts (ecAVGs) are proposed as an alternative to tunneled central venous catheters (TCVCs) in patients requiring immediate vascular access for hemodialysis (HD). We compared bacteremia rates in patients treated with ecAVG and TCVC. The study randomized 121 adult patients requiring urgent vascular access for HD in a 1:1 fashion to receive an ecAVG with or without (+/-) an arteriovenous fistula (AVF; n = 60) or TCVC+/-AVF (n = 61). Patients were excluded if they had active systemic sepsis, no anatomically suitable vessels, or an anticipated life expectancy vascular access for HD. The strategy also proved to be cost-neutral. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  19. Design of high-throughput and low-power true random number generator utilizing perpendicularly magnetized voltage-controlled magnetic tunnel junction

    Directory of Open Access Journals (Sweden)

    Hochul Lee

    2017-05-01

    Full Text Available A true random number generator based on perpendicularly magnetized voltage-controlled magnetic tunnel junction devices (MRNG is presented. Unlike MTJs used in memory applications where a stable bit is needed to store information, in this work, the MTJ is intentionally designed with small perpendicular magnetic anisotropy (PMA. This allows one to take advantage of the thermally activated fluctuations of its free layer as a stochastic noise source. Furthermore, we take advantage of the voltage dependence of anisotropy to temporarily change the MTJ state into an unstable state when a voltage is applied. Since the MTJ has two energetically stable states, the final state is randomly chosen by thermal fluctuation. The voltage controlled magnetic anisotropy (VCMA effect is used to generate the metastable state of the MTJ by lowering its energy barrier. The proposed MRNG achieves a high throughput (32 Gbps by implementing a 64×64 MTJ array into CMOS circuits and executing operations in a parallel manner. Furthermore, the circuit consumes very low energy to generate a random bit (31.5 fJ/bit due to the high energy efficiency of the voltage-controlled MTJ switching.

  20. Design of high-throughput and low-power true random number generator utilizing perpendicularly magnetized voltage-controlled magnetic tunnel junction

    Science.gov (United States)

    Lee, Hochul; Ebrahimi, Farbod; Amiri, Pedram Khalili; Wang, Kang L.

    2017-05-01

    A true random number generator based on perpendicularly magnetized voltage-controlled magnetic tunnel junction devices (MRNG) is presented. Unlike MTJs used in memory applications where a stable bit is needed to store information, in this work, the MTJ is intentionally designed with small perpendicular magnetic anisotropy (PMA). This allows one to take advantage of the thermally activated fluctuations of its free layer as a stochastic noise source. Furthermore, we take advantage of the voltage dependence of anisotropy to temporarily change the MTJ state into an unstable state when a voltage is applied. Since the MTJ has two energetically stable states, the final state is randomly chosen by thermal fluctuation. The voltage controlled magnetic anisotropy (VCMA) effect is used to generate the metastable state of the MTJ by lowering its energy barrier. The proposed MRNG achieves a high throughput (32 Gbps) by implementing a 64 ×64 MTJ array into CMOS circuits and executing operations in a parallel manner. Furthermore, the circuit consumes very low energy to generate a random bit (31.5 fJ/bit) due to the high energy efficiency of the voltage-controlled MTJ switching.

  1. Carpal tunnel release

    DEFF Research Database (Denmark)

    Larsen, Morten Bo; Sørensen, A I; Crone, K L

    2013-01-01

    A single-blind, randomized, controlled trial was done to compare the results of carpal tunnel release using classic incision, short incision, or endoscopic technique. In total, 90 consecutive cases were included. Follow-up was 24 weeks. We found a significantly shorter sick leave in the endoscopic...

  2. Multiple random walks on complex networks: A harmonic law predicts search time

    Science.gov (United States)

    Weng, Tongfeng; Zhang, Jie; Small, Michael; Hui, Pan

    2017-05-01

    We investigate multiple random walks traversing independently and concurrently on complex networks and introduce the concept of mean first parallel passage time (MFPPT) to quantify their search efficiency. The mean first parallel passage time represents the expected time required to find a given target by one or some of the multiple walkers. We develop a general theory that allows us to calculate the MFPPT analytically. Interestingly, we find that the global MFPPT follows a harmonic law with respect to the global mean first passage times of the associated walkers. Remarkably, when the properties of multiple walkers are identical, the global MFPPT decays in a power law manner with an exponent of unity, irrespective of network structure. These findings are confirmed by numerical and theoretical results on various synthetic and real networks. The harmonic law reveals a universal principle governing multiple random walks on networks that uncovers the contribution and role of the combined walkers in a target search. Our paradigm is also applicable to a broad range of random search processes.

  3. Multiple Imputation of a Randomly Censored Covariate Improves Logistic Regression Analysis.

    Science.gov (United States)

    Atem, Folefac D; Qian, Jing; Maye, Jacqueline E; Johnson, Keith A; Betensky, Rebecca A

    2016-01-01

    Randomly censored covariates arise frequently in epidemiologic studies. The most commonly used methods, including complete case and single imputation or substitution, suffer from inefficiency and bias. They make strong parametric assumptions or they consider limit of detection censoring only. We employ multiple imputation, in conjunction with semi-parametric modeling of the censored covariate, to overcome these shortcomings and to facilitate robust estimation. We develop a multiple imputation approach for randomly censored covariates within the framework of a logistic regression model. We use the non-parametric estimate of the covariate distribution or the semiparametric Cox model estimate in the presence of additional covariates in the model. We evaluate this procedure in simulations, and compare its operating characteristics to those from the complete case analysis and a survival regression approach. We apply the procedures to an Alzheimer's study of the association between amyloid positivity and maternal age of onset of dementia. Multiple imputation achieves lower standard errors and higher power than the complete case approach under heavy and moderate censoring and is comparable under light censoring. The survival regression approach achieves the highest power among all procedures, but does not produce interpretable estimates of association. Multiple imputation offers a favorable alternative to complete case analysis and ad hoc substitution methods in the presence of randomly censored covariates within the framework of logistic regression.

  4. Multiplicative random regression model for heterogeneous variance adjustment in genetic evaluation for milk yield in Simmental.

    Science.gov (United States)

    Lidauer, M H; Emmerling, R; Mäntysaari, E A

    2008-06-01

    A multiplicative random regression (M-RRM) test-day (TD) model was used to analyse daily milk yields from all available parities of German and Austrian Simmental dairy cattle. The method to account for heterogeneous variance (HV) was based on the multiplicative mixed model approach of Meuwissen. The variance model for the heterogeneity parameters included a fixed region x year x month x parity effect and a random herd x test-month effect with a within-herd first-order autocorrelation between test-months. Acceleration of variance model solutions after each multiplicative model cycle enabled fast convergence of adjustment factors and reduced total computing time significantly. Maximum Likelihood estimation of within-strata residual variances was enhanced by inclusion of approximated information on loss in degrees of freedom due to estimation of location parameters. This improved heterogeneity estimates for very small herds. The multiplicative model was compared with a model that assumed homogeneous variance. Re-estimated genetic variances, based on Mendelian sampling deviations, were homogeneous for the M-RRM TD model but heterogeneous for the homogeneous random regression TD model. Accounting for HV had large effect on cow ranking but moderate effect on bull ranking.

  5. Random multiple key streams for encryption with added CBC mode of operation

    Directory of Open Access Journals (Sweden)

    P. Penchalaiah

    2016-09-01

    For the first time, in this paper, we present a construction method to generate multiple random keys from a core-key with highest possible immunity to crack. We are with a particular emphasis on novel technique to secure user data, we have designed a secure and cost effective new cryptosystem called Rbits (Random bits cypher. In different directions we identify that Rbits having highest immunity to crack and presenting various analysis tests in support from this viewpoint and the analyzed results are reported.

  6. Excavation multiple up drafting tunnels in coastal mountains: A simple solution to resist against the severe drought in sub tropical zones

    Science.gov (United States)

    Daei, Mohammad Ali; Daei, Manizheh; Daei, Bijan

    2017-04-01

    At many sub tropical places in the globe, including the Persian Gulf in the south of Iran, there is continuously a tremendous amount of steam in the air, but it fails to transform to cloud because of the surrounding overheated lands. Reduction in precipitation in these regions has been extraordinary in recent years. The most probable reason is the global warming phenomena. Many dried forest remains, in these regions are referring to much more precipitations not long ago. All around the Persian Gulf, Oman Sea, Arab sea, and red sea there are enough steam to produce good precipitation nearly year round. The main missed requirement in this zone is the coldness. This fact can be well understand from a narrow green strip in Dhofar which is indebted to a cold oceanic stream that approaches to local shore during four months yearly. This natural cold stream helps a better condensation of water vapor and more precipitation but only in a narrow mountainous land. Based on this natural phenomenon, we hypothesize a different design to cool the water vapor with the same result. Prevention of close contact between the water vapors and hot lands by shooting the steam directly into the atmosphere may help to produce more cloud and rain. Making multiple vertical tunnels in mountains for upright conducting of humid air into the atmosphere can be a solution. Fortunately there are a few high mountain ranges alongside of the coastline in south part of Iran. So excavation of drafting tunnels in these mountains seems reasonable. These structures act passively, but for long term do their work without consuming energy, and making pollution. These earth tubes in some aspects resemble to Kariz, another innovative structure which invented by ancient Iranians, thousands of years ago in order to extract water from dry lands in deserts. Up drafting earth channels can be supposed as a wide vertical kariz which conduct water vapor into the atmosphere from the hot land near a warm sea, something

  7. A Preliminary Clinical Comparison of the Use of Fascia Lata Allograft and Autogenous Connective Tissue Graft in Multiple Gingival Recession Coverage Based on the Tunnel Technique.

    Science.gov (United States)

    Bednarz, Wojciech; Żurek, Jacek; Gedrange, Thomas; Dominiak, Marzena

    2016-01-01

    The most effective method for treating gingival recessions (GR) is with an autogenous connective tissue graft (CTG) via flap surgery. Often, however, the amount of CTG that can be grafted is insufficient to cover all of a patient's gingival recessions at one time. The objective of this study was to provide a 6-month comparative assessment of the results of covering multiple Miller Class I and II gingival recessions with a Fascia Lata Allograft (FL) and a CTG harvested from palatal mucosa. The study comprised a total of 30 people who underwent multiple gingival recession (GR) procedures using a modified, coronally advanced tunnel technique (MCAT). The patients were divided into two groups of 15 according to the type of materials used for gingival augmentation purposes: FL for the test group and CTG for the control group. A clinical assessment was made at baseline, as well as 3 and 6 months following surgery. The following factors were assessed: recession depth, recession width, probing depth, clinical attachment level, height of keratinized tissue (HKT), distance between the cemento-enamel junction and the muco-gingival junction (CEJ-MGJ), API, SBI. The following values were calculated: average root coverage (ARC), complete root coverage (CRC). No statistically significant differences were observed between the groups in terms of clinical parameters assessed after 6 months, apart from CRC, which was 94.87 ± 0.14 mm in the control group and 94.24 ± 0.20 mm in the study group (p = 0.034). The average HKT in the control group after 6 months amounted to 2.86 ± 1.60 mm, and in the test group to 3.09 ± 0.95 mm, which translates into an increase in comparison to the baseline values of 0.73 mm (p < 0.001) and 0.48 mm (p = 0.017), respectively. FL Allografts may serve as an alternative to autogenous CTG in multiple gingival recession coverage procedures based on the tunnel technique.

  8. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Adèr Herman J

    2006-11-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a common disorder, often treated with surgery or wrist splinting. The objective of this economic evaluation alongside a randomized trial was to evaluate the cost-effectiveness of splinting and surgery for patients with CTS. Methods Patients at 13 neurological outpatient clinics with clinically and electrophysiologically confirmed idiopathic CTS were randomly allocated to splinting (n = 89 or surgery (n = 87. Clinical outcome measures included number of nights waking up due to symptoms, general improvement, severity of the main complaint, paraesthesia at night and during the day, and utility. The economic evaluation was performed from a societal perspective and involved all relevant costs. Results There were no differences in costs. The mean total costs per patient were in the surgery group EURO 2,126 compared to EURO 2,111 in the splint group. After 12 months, the success rate in the surgery group (92% was significantly higher than in the splint group (72%. The acceptability curve showed that at a relatively low ceiling ratio of EURO 2,500 per patient there is a 90% probability that surgery is cost-effective. Conclusion In the Netherlands, surgery is more cost-effective compared with splinting, and recommended as the preferred method of treatment for patients with CTS.

  9. Kalman Filtering for Discrete Stochastic Systems with Multiplicative Noises and Random Two-Step Sensor Delays

    Directory of Open Access Journals (Sweden)

    Dongyan Chen

    2015-01-01

    Full Text Available This paper is concerned with the optimal Kalman filtering problem for a class of discrete stochastic systems with multiplicative noises and random two-step sensor delays. Three Bernoulli distributed random variables with known conditional probabilities are introduced to characterize the phenomena of the random two-step sensor delays which may happen during the data transmission. By using the state augmentation approach and innovation analysis technique, an optimal Kalman filter is constructed for the augmented system in the sense of the minimum mean square error (MMSE. Subsequently, the optimal Kalman filtering is derived for corresponding augmented system in initial instants. Finally, a simulation example is provided to demonstrate the feasibility and effectiveness of the proposed filtering method.

  10. The cohort multiple randomized controlled trial design: a valid and efficient alternative to pragmatic trials?

    Science.gov (United States)

    van der Velden, Joanne M; Verkooijen, Helena M; Young-Afat, Danny A; Burbach, Johannes Pm; van Vulpen, Marco; Relton, Clare; van Gils, Carla H; May, Anne M; Groenwold, Rolf Hh

    2017-02-01

    Randomized controlled trials (RCTs)-the gold standard for evaluating the effects of medical interventions-are notoriously challenging in terms of logistics, planning and costs. The cohort multiple randomized controlled trial approach is designed to facilitate randomized trials for pragmatic evaluation of (new) interventions and is a promising variation from conventional pragmatic RCTs. In this paper, we evaluate methodological challenges of conducting an RCT within a cohort. We argue that equally valid results can be obtained from trials conducted within cohorts as from pragmatic RCTs. However, whether this design is more efficient compared with conducting a pragmatic RCT depends on the amount and nature of non-compliance in the intervention arm. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  11. A Team Study of a Multiple-Power Wireless Random Channel Access Mechanism with Capture Effect

    Directory of Open Access Journals (Sweden)

    Abdelillah Karouit

    2013-01-01

    Full Text Available We present a team analysis of a slotted random wireless channel access mechanism. Under the proposed scheme, denoted wireless random access mechanism with multiple power levels (MPL-WRA, each mobile station contends for a transmission opportunity following the principles of a slotted access mechanism incorporating a random transmitting power value selected among various available power levels. In this way, a capture effect may be produced allowing the packet to be decoded whenever the signal-to-interference-plus-noise ratio is higher than a given threshold. In order to analyze the performance and optimization of the proposed setup, we build a Markovian model integrating the wireless access mechanism supplemented by the use of multiple power levels in an attractive and simple cross-layer fashion. We follow a team problem approach allowing us to fine tune the design parameters of the overall system configuration. Throughout an extensive numerical analysis, our main results set the basis for the social optimal system configuration of the proposed mechanism taking into account the physical constraints of using multiple power levels and the actual practical implementation of a slotted access mechanism. We end the paper with concluding remarks and future research directions including guidelines for the actual implementation of our proposal.

  12. Comparing cluster-level dynamic treatment regimens using sequential, multiple assignment, randomized trials: Regression estimation and sample size considerations.

    Science.gov (United States)

    NeCamp, Timothy; Kilbourne, Amy; Almirall, Daniel

    2017-08-01

    Cluster-level dynamic treatment regimens can be used to guide sequential treatment decision-making at the cluster level in order to improve outcomes at the individual or patient-level. In a cluster-level dynamic treatment regimen, the treatment is potentially adapted and re-adapted over time based on changes in the cluster that could be impacted by prior intervention, including aggregate measures of the individuals or patients that compose it. Cluster-randomized sequential multiple assignment randomized trials can be used to answer multiple open questions preventing scientists from developing high-quality cluster-level dynamic treatment regimens. In a cluster-randomized sequential multiple assignment randomized trial, sequential randomizations occur at the cluster level and outcomes are observed at the individual level. This manuscript makes two contributions to the design and analysis of cluster-randomized sequential multiple assignment randomized trials. First, a weighted least squares regression approach is proposed for comparing the mean of a patient-level outcome between the cluster-level dynamic treatment regimens embedded in a sequential multiple assignment randomized trial. The regression approach facilitates the use of baseline covariates which is often critical in the analysis of cluster-level trials. Second, sample size calculators are derived for two common cluster-randomized sequential multiple assignment randomized trial designs for use when the primary aim is a between-dynamic treatment regimen comparison of the mean of a continuous patient-level outcome. The methods are motivated by the Adaptive Implementation of Effective Programs Trial which is, to our knowledge, the first-ever cluster-randomized sequential multiple assignment randomized trial in psychiatry.

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

    Directory of Open Access Journals (Sweden)

    Lazo-Langner Alejandro

    2012-01-01

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

  14. Design and protocol of a randomized multiple behavior change trial: Make Better Choices 2 (MBC2).

    Science.gov (United States)

    Pellegrini, Christine A; Steglitz, Jeremy; Johnston, Winter; Warnick, Jennifer; Adams, Tiara; McFadden, H G; Siddique, Juned; Hedeker, Donald; Spring, Bonnie

    2015-03-01

    Suboptimal diet and inactive lifestyle are among the most prevalent preventable causes of premature death. Interventions that target multiple behaviors are potentially efficient; however the optimal way to initiate and maintain multiple health behavior changes is unknown. The Make Better Choices 2 (MBC2) trial aims to examine whether sustained healthful diet and activity change are best achieved by targeting diet and activity behaviors simultaneously or sequentially. Study design approximately 250 inactive adults with poor quality diet will be randomized to 3 conditions examining the best way to prescribe healthy diet and activity change. The 3 intervention conditions prescribe: 1) an increase in fruit and vegetable consumption (F/V+), decrease in sedentary leisure screen time (Sed-), and increase in physical activity (PA+) simultaneously (Simultaneous); 2) F/V+ and Sed- first, and then sequentially add PA+ (Sequential); or 3) Stress Management Control that addresses stress, relaxation, and sleep. All participants will receive a smartphone application to self-monitor behaviors and regular coaching calls to help facilitate behavior change during the 9 month intervention. Healthy lifestyle change in fruit/vegetable and saturated fat intakes, sedentary leisure screen time, and physical activity will be assessed at 3, 6, and 9 months. MBC2 is a randomized m-Health intervention examining methods to maximize initiation and maintenance of multiple healthful behavior changes. Results from this trial will provide insight about an optimal technology supported approach to promote improvement in diet and physical activity. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Energy conservation for fatigue management in multiple sclerosis: a pilot randomized controlled trial.

    Science.gov (United States)

    García Jalón, E Guiomar; Lennon, Sheila; Peoples, Louise; Murphy, Sam; Lowe-Strong, Andrea

    2013-01-01

    To develop and test the feasibility of an energy conservation programme to manage fatigue in multiple sclerosis. A pilot randomized controlled trial. Community setting. People with multiple sclerosis reporting fatigue. An energy conservation programme was compared to a peer support group. Both interventions were delivered in group format with 2-hour sessions once a week for five weeks. Patients' views about the interventions were sought in discussion groups one week post intervention. The primary feasibility outcomes were recruitment and adherence. Other outcome measures were the Fatigue Impact Scale, Fatigue Severity Scale, MS-Impact Scale-29, MS Self-efficacy Scale, Beck's Depression Scale-Fast Screen and Epworth Sleepiness Scale. Outcomes were administered at baseline, post intervention, 6-week and 3-month follow-up. Almost 30% of the people approached to take part in the study did not commit to participation because of transport/time issues. Twenty-three patients took part in the study. Three patients dropped out, one reporting adverse effects. A power calculation indicated that a sample of 56 (28 per group) would be required for a main randomized controlled trial. Patients valued peer support and those in the energy conservation group described the programme as useful, but reported difficulties completing some practice activities. An energy conservation programme in the community is feasible and welcomed by people with multiple sclerosis. However, future research needs to consider longer follow-ups and practical issues to improve recruitment rate by accommodating to patients' needs.

  16. Light therapy for multiple sclerosis-associated fatigue: Study protocol for a randomized controlled trial.

    Science.gov (United States)

    Mateen, Farrah J; Manalo, Natalie C; Grundy, Sara J; Houghton, Melissa A; Hotan, Gladia C; Erickson, Hans; Videnovic, Aleksandar

    2017-09-01

    Fatigue is the most commonly reported symptom among multiple sclerosis (MS) patients, more than a quarter of whom consider fatigue to be their most disabling symptom. However, there are few effective treatment options for fatigue. We aim to investigate whether supplemental exposure to bright white light will reduce MS-associated fatigue. Eligible participants will have clinically confirmed multiple sclerosis based on the revised McDonald criteria (2010) and a score ≥36 on the Fatigue Severity Scale (FSS). Participants will be randomized 1:1 to bright white light (10,000 lux; active condition) or dim red light (therapy. We will perform an intention-to-treat analysis, comparing the active and control groups to assess the postintervention difference in fatigue levels reported on FSS. Secondary outcome measures include change in global VAFS scores during the light therapy and self-reported quality of life in the Multiple Sclerosis Quality of Life-54. We present a study design and rationale for randomizing a nonpharmacological intervention for MS-associated fatigue, using bright light therapy. The study limitations relate to the logistical issues of a self-administered intervention requiring frequent participant self-report in a relapsing condition. Ultimately, light therapy for the treatment of MS-associated fatigue may provide a low-cost, noninvasive, self-administered treatment for one of the most prevalent and burdensome symptoms experienced by people with MS.

  17. Cognitive behavioural therapy in multiple sclerosis: a randomized controlled pilot study of acceptance and commitment therapy.

    Science.gov (United States)

    Nordin, Linda; Rorsman, Ia

    2012-01-01

    The aim of this study was to design a trial that could evaluate the effect of acceptance and commitment therapy as a group-intervention for multiple sclerosis patients with psychological distress. Randomized controlled trial with assessment at pretreatment, end of treatment, and at 3-month follow-up. Multiple sclerosis outpatients with elevated symptoms of anxiety and/or depression (n = 21). Patients were randomly assigned to acceptance and commitment therapy or relaxation training. Both treatments consisted of 5 sessions over 15 weeks containing didactic sessions, group discussions, and exercises. Outcome was assessed by self-rated symptoms of anxiety, depression, and a measure of acceptance. At 3-month follow-up, the relaxation training group had a significant decline in anxiety symptoms whereas the acceptance and commitment therapy group showed a maintained improvement in rated acceptance at follow-up. The results reflect the different emphases of the therapies. Acceptance and commitment therapy is aimed at living an active, valued life and increasing acceptance, while relaxation training focuses directly on coping strategies to handle emotional symptoms. The results are preliminary, but supportive of further study of brief group interventions for reducing psychological distress in patients with multiple sclerosis.

  18. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Emil Sundstrup

    2014-01-01

    Full Text Available Topical menthol gels are classified “topical analgesics” and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS. We screened 645 slaughterhouse workers and recruited 10 participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze or placebo (gel with a menthol scent during the working day and 48 hours later the other treatment (crossover design. Participants rated arm/hand pain intensity during the last hour of work (scale 0–10 immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol (P=0.026 and P=0.044, resp.. Pain intensity of the arm/hand decreased by −1.2 (CI 95%: −1.7 to −0.6 following topical menthol compared with placebo, corresponding to a moderate effect size of 0.63. In conclusion, topical menthol acutely reduces pain intensity during the working day in slaughterhouse workers with CTS and should be considered as an effective nonsystemic alternative to regular analgesics in the workplace management of chronic and neuropathic pain.

  19. Sodium citrate versus saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adults: a randomized controlled trial.

    Science.gov (United States)

    Hermite, Laure; Quenot, Jean-Pierre; Nadji, Abdelouaid; Barbar, Saber David; Charles, Pierre-Emmanuel; Hamet, Maël; Jacquiot, Nicolas; Ghiringhelli, François; Freysz, Marc

    2012-02-01

    Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock in chronic hemodialysis patients suggest it may be efficacious in preventing infection and thrombotic complications. We compared sodium citrate with saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adult patients. Primary endpoint was catheter life span without complication. This was a randomized, controlled, open-label trial involving intensive care patients with acute renal failure requiring hemodialysis. Events were defined as catheter-related bloodstream infection and catheter malfunction. Seventy-eight patients were included. Median catheter life span without complication was 6 days (saline group) versus 12 days (citrate group) [hazard ratio (HR) 2.12 (95% CI 1.32-3.4), p = 0.0019]. There was a significantly higher rate of catheter malfunction in the saline group compared with in the citrate group (127 catheter events/1,000 catheter-days, saline group vs. 26 events/1,000 catheter-days, citrate group, p catheter life span. This study shows for the first time that citrate lock reduced catheter complications and increased catheter life span as compared to saline lock in critically ill adults requiring hemodialysis.

  20. Efficacy of topical chamomile oil for mild and moderate carpal tunnel syndrome: A randomized double-blind placebo-controlled clinical trial.

    Science.gov (United States)

    Hashempur, Mohammad Hashem; Ghasemi, Mohammad Sadegh; Daneshfard, Babak; Ghoreishi, Parissa Sadat; Lari, Zeinab Nasiri; Homayouni, Kaynoosh; Zargaran, Arman

    2017-02-01

    To evaluate the efficacy of topical chamomile oil in patients with mild and moderate carpal tunnel syndrome (CTS). Eighty six patients with electrodiagnostic criteria of mild and moderate CTS were enrolled in this randomized double-blind placebo-controlled clinical trial and received wrist splint plus topical chamomile oil or placebo for 4 weeks. They were evaluated at the baseline and end of the study regarding functional and symptomatic scores, dynamometry, and electrodiagnostic indexes. Dynamometry, functionality, and symptom severity scores of the patients were significantly improved in the chamomile oil group compared with the placebo group (P = 0.040, P = 0.0001, P = 0.017, respectively). Additionally, compound latency of the median nerve in the chamomile oil group significantly decreased (P = 0.035) compared to the placebo group. Other electerodiagnostic measurements did not change significantly. Complementary treatment with topical chamomile oil may have some benefits for patients with mild and moderate CTS, both subjectively and objectively. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial.

    Science.gov (United States)

    Hall, Barbara; Lee, Hoe C; Fitzgerald, Helen; Byrne, Brent; Barton, Annette; Lee, Andy H

    2013-01-01

    This study investigated the effects of wearing a wrist support splint for 8 wk and receiving a formal education program on patients with carpal tunnel syndrome (CTS), as well as factors associated with patients' desire to seek surgical intervention. Participants were recruited from a hospital surgical wait list and randomly assigned to an intervention group (n = 30) or a control group (n = 24). Significant improvements in measures of symptom severity and functional status over the duration of the study appeared in the intervention group but not in the control group. Logistic regression for the intervention group showed that symptom severity (odds ratio [OR] = 1.53, 95% confidence interval [CI] [1.20-1.93]), functional deficits (OR = 1.31, 95% CI [1.08-1.57]), pain score (OR = 1.25, 95% CI [1.11-1.61]), and symptom duration (OR = 1.11, 95% CI [1.01-1.24]) were positively associated with the desire to seek surgical intervention. This conservative CTS treatment program conducted by occupational therapists can improve symptoms and hand function in CTS patients. Copyright © 2013 by the American Occupational Therapy Association, Inc.

  2. Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial.

    Science.gov (United States)

    Blikman, Lyan Jm; van Meeteren, Jetty; Twisk, Jos Wr; de Laat, Fred Aj; de Groot, Vincent; Beckerman, Heleen; Stam, Henk J; Bussmann, Johannes Bj

    2017-10-01

    Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS). To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue. A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue subscale of Checklist Individual Strength - CIS20r) and participation (Impact on Participation and Autonomy scale - IPA). Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the groups = -0.81; 95% confidence interval (CI), -3.71 to 2.11) or for four out of five IPA domains. An overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference between the groups = 0.19; 95% CI, 0.03 to 0.35). The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition.

  3. Conservation laws in coupled multiplicative random arrays lead to $1/f$ noise

    CERN Document Server

    Thurner, S; Teich, M C; Thurner, Stefan; Feurstein, Markus C.; Teich, Malvin C.

    1997-01-01

    We consider the dynamic evolution of a coupled array of N multiplicative random variables. The magnitude of each is constrained by a lower bound w_0 and their sum is conserved. Analytical calculation shows that the simplest case, N=2 and w_0=0, exhibits a Lorentzian spectrum which gradually becomes fractal as w_0 increases. Simulation results for larger $N$ reveal fractal spectra for moderate to high values of w_0 and power-law amplitude fluctuations at all values. The results are applied to estimating the fractal exponents for cochlear-nerve-fiber action-potential sequences with remarkable success, using only two parameters.

  4. Multiple-mode large deflection random response of beams with nonlinear damping subjected to acoustic excitation

    Science.gov (United States)

    Prasad, C. B.; Mei, Chuh

    1987-01-01

    Multiple-mode nonlinear analysis is carried out for beams subjected to acoustic excitation. Effects of both nonlinear damping and large-deflection are included in the analysis in an attempt to explain the experimental phenomena of aircraft panels excited at high sound pressure levels; that is the broadening of the strain response peaks and the increase of modal frequency. An amplitude dependent nonlinear damping model is used in the anlaysis to study the effects and interactions of multiple modes, nonlinear stiffness and nonlinear damping on the random response of beams. Mean square maximum deflection, mean square maximum strain, and spectral density function of maximum strain for simple supported and clamped beams are obtained. It is shown analytically that nonlinear damping contributes significantly to the broadening of the response peak and to the mean square deflection and strain.

  5. A randomized, placebo-controlled trial of levetiracetam in central pain in multiple sclerosis

    DEFF Research Database (Denmark)

    Falah, M; Madsen, C; Holbech, J V

    2012-01-01

    Levetiracetam is an anticonvulsant which is assumed to act by modulating neurotransmitter release via binding to the vesicle protein SV2A. This could have an impact on signalling in the pain pathway. The aim of this study was to test the analgesic effect of levetiracetam in central pain in multiple...... sclerosis. This was a randomized, double-blind, placebo-controlled, cross-over trial with levetiracetam 3000 mg/day versus placebo (6-week treatment periods). Patients with multiple sclerosis, symptoms and signs complying with central neuropathic pain and pain symptoms for more than 6 months, as well...... as pain intensity of more than 4 on a 0 to 10-point numeric rating scale were included in the study. The primary outcome measure was pain relief at the end of each treatment period as measured on a 6-point verbal scale. Eighty-nine patients were screened for participation and 30 patients entered the study...

  6. Integrative psychotherapeutic nursing home program to reduce multiple psychiatric symptoms of cognitively impaired patients and caregiver burden: randomized controlled trial

    NARCIS (Netherlands)

    Bakker, T.J.; Duivenvoorden, H.J.; Lee, J. van der; Olde Rikkert, M.G.M.; Beekman, A.T.; Ribbe, M.W.

    2011-01-01

    OBJECTIVE: To test the effectiveness of an integrative psychotherapeutic nursing home program (integrative reactivation and rehabilitation [IRR]) to reduce multiple neuropsychiatry symptoms (MNPS) of cognitively impaired patients and caregiver burden (CB). DESIGN: Randomized controlled trial.

  7. Time dependence of tunnel statistics and the energy resolution of superconducting tunnel junctions

    Science.gov (United States)

    Verhoeve, P.; Hartog, R. den; Kozorezov, A.; Martin, D.; van Dordrecht, A.; Wigmore, J. K.; Peacock, A.

    2002-11-01

    Multiple tunneling of quasiparticle charge carriers in a superconducting tunnel junction (STJ) enhances the signal generated by a photon absorption event. It is also an additional source of noise, responsible for a substantial degradation of the energy resolution. Although tunneling is a binomial chance process, governed by a constant tunneling probability, the resulting cumulative statistics of tunnelled quasiparticles depend on time. In particular, the variance of the total number of tunneled quasiparticles reaches a minimum after a finite integration time, corresponding to a minimum in the spectral linewidth. Since the intrinsic energy resolution of the present generation of STJs is mainly limited by the scatter on the number of tunneled quasiparticles, the improvement of the tunnel noise can be experimentally tested by variation of the pulse integration time. An analytical theory is developed that describes the relation between the tunnel noise and the transfer function of the pulse integration hardware for an STJ characterized by a quasiparticle tunnel and loss time in each electrode. We present experiments that demonstrate that the noise contribution from multiple tunnelling is not constant during the time that the quasiparticles are present in the STJ, and that by proper filtering of the STJ pulses the tunnel noise can be optimized at a level which lies well below the canonical tunnel limit.

  8. Asymmetric multiple information cryptosystem based on chaotic spiral phase mask and random spectrum decomposition

    Science.gov (United States)

    Rafiq Abuturab, Muhammad

    2018-01-01

    A new asymmetric multiple information cryptosystem based on chaotic spiral phase mask (CSPM) and random spectrum decomposition is put forwarded. In the proposed system, each channel of secret color image is first modulated with a CSPM and then gyrator transformed. The gyrator spectrum is randomly divided into two complex-valued masks. The same procedure is applied to multiple secret images to get their corresponding first and second complex-valued masks. Finally, first and second masks of each channel are independently added to produce first and second complex ciphertexts, respectively. The main feature of the proposed method is the different secret images encrypted by different CSPMs using different parameters as the sensitive decryption/private keys which are completely unknown to unauthorized users. Consequently, the proposed system would be resistant to potential attacks. Moreover, the CSPMs are easier to position in the decoding process owing to their own centering mark on axis focal ring. The retrieved secret images are free from cross-talk noise effects. The decryption process can be implemented by optical experiment. Numerical simulation results demonstrate the viability and security of the proposed method.

  9. Omega-3 Fatty Acids for Depression in Multiple Sclerosis: A Randomized Pilot Study.

    Directory of Open Access Journals (Sweden)

    Lynne Shinto

    Full Text Available Multiple sclerosis is the most common chronic disabling disease in the central nervous system in young to middle aged adults. Depression is common in multiple sclerosis (MS affecting between 50–60% of patients. Pilot studies in unipolar depression report an improvement in depression when omega-3 fatty acids are given with antidepressants. The objective of this study was to investigate whether omega-3 fatty acid supplementation, as an augmentation therapy, improves treatment-resistant major depressive disorder (MDD in people with MS. We performed a randomized, double-blind, placebo-controlled pilot study of omega-3 fatty acids at six grams per day over three months. The primary outcome was a 50% or greater improvement on the Montgomery-Asberg Depression Rating Scale (MADRS. Thirty-nine participants were randomized and thirty-one completed the 3-month intervention. Improvement on MADRS between groups was not significantly different at the 3-month end point with 47.4% in the omega-3 fatty acid group and 45.5% in the placebo group showing 50% or greater improvement (p = 0.30. Omega-3 fatty acids as an augmentation therapy for treatment-resistant depression in MS was not significantly different than placebo in this pilot trial. Omega-3 fatty acid supplementation at the dose given was well-tolerated over 3 months.ClinicalTrials.gov NCT00122954.

  10. Omega-3 Fatty Acids for Depression in Multiple Sclerosis: A Randomized Pilot Study.

    Science.gov (United States)

    Shinto, Lynne; Marracci, Gail; Mohr, David C; Bumgarner, Lauren; Murchison, Charles; Senders, Angela; Bourdette, Dennis

    2016-01-01

    Multiple sclerosis is the most common chronic disabling disease in the central nervous system in young to middle aged adults. Depression is common in multiple sclerosis (MS) affecting between 50–60% of patients. Pilot studies in unipolar depression report an improvement in depression when omega-3 fatty acids are given with antidepressants. The objective of this study was to investigate whether omega-3 fatty acid supplementation, as an augmentation therapy, improves treatment-resistant major depressive disorder (MDD) in people with MS. We performed a randomized, double-blind, placebo-controlled pilot study of omega-3 fatty acids at six grams per day over three months. The primary outcome was a 50% or greater improvement on the Montgomery-Asberg Depression Rating Scale (MADRS). Thirty-nine participants were randomized and thirty-one completed the 3-month intervention. Improvement on MADRS between groups was not significantly different at the 3-month end point with 47.4% in the omega-3 fatty acid group and 45.5% in the placebo group showing 50% or greater improvement (p = 0.30). Omega-3 fatty acids as an augmentation therapy for treatment-resistant depression in MS was not significantly different than placebo in this pilot trial. Omega-3 fatty acid supplementation at the dose given was well-tolerated over 3 months. ClinicalTrials.gov NCT00122954.

  11. Random exponential attractor for cocycle and application to non-autonomous stochastic lattice systems with multiplicative white noise

    Science.gov (United States)

    Zhou, Shengfan

    2017-08-01

    We first establish some sufficient conditions for constructing a random exponential attractor for a continuous cocycle on a separable Banach space and weighted spaces of infinite sequences. Then we apply our abstract result to study the existence of random exponential attractors for non-autonomous first order dissipative lattice dynamical systems with multiplicative white noise.

  12. Cortical atrophy patterns in multiple sclerosis are non-random and clinically relevant.

    Science.gov (United States)

    Steenwijk, Martijn D; Geurts, Jeroen J G; Daams, Marita; Tijms, Betty M; Wink, Alle Meije; Balk, Lisanne J; Tewarie, Prejaas K; Uitdehaag, Bernard M J; Barkhof, Frederik; Vrenken, Hugo; Pouwels, Petra J W

    2016-01-01

    %). Several cortical atrophy patterns relevant for multiple sclerosis were found. This suggests that cortical atrophy in multiple sclerosis occurs largely in a non-random manner and develops (at least partly) according to distinct anatomical patterns. In addition, these cortical atrophy patterns showed stronger associations with clinical (especially cognitive) dysfunction than global cortical atrophy. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. POROSIMETRY BY DOUBLE-RANDOM MULTIPLE TREE STRUCTURING IN VIRTUAL CONCRETE

    Directory of Open Access Journals (Sweden)

    Piet Stroeven

    2012-03-01

    Full Text Available Two different porosimetry methods are presented in two successive papers. Inspiration for the development came from the rapidly-exploring random tree (RRT approach used in robotics. The novel methods are applied to virtual cementitious materials produced by a modern concurrent algorithm-based discrete element modeling system, HADES. This would render possible realistically simulating all aspects of particulate matter that influence structure-sensitive features of the pore network structure in maturing concrete, namely size, shape and dispersion of aggregate and cement particles. Pore space is a complex tortuous entity. Practical methods conventionally applied for assessment of pore size distribution may fail or present biased information. Among them, mercury intrusion porosimetry and 2D quantitative image analysis are popular. The mathematical morphology operator “opening” can be applied to sections and even provide 3D information on pore size distribution, provided isotropy is guaranteed. Unfortunately, aggregate grain surfaces lead to pore anisotropy. The presented methods allow exploration of pore space in the virtual material, after which pore size distribution is derived from star volume measurements.  In addition to size of pores their continuity is of crucial importance for durability estimation. Double-random multiple tree structuring (DRaMuTS, presented herein, and random node structuring (RaNoS provide such information. The latter method will be introduced in a next issue of IA&S.

  14. Is customized vestibular rehabilitation effective in patients with multiple sclerosis? A randomized controlled trial.

    Science.gov (United States)

    Ozgen, Gulnur; Karapolat, Hale; Akkoc, Yesim; Yuceyar, Nur

    2016-08-01

    Balance disorders are among the most common problems encountered by patients diagnosed with multiple sclerosis (MS). The purpose of this randomized, controlled trial was to investigate the effects of customized vestibular rehabilitation (VR) on balance, functional capacity, quality of life, and depression in patients with MS. This study was designed as a prospective, randomized, controlled trial. The study was carried out in a single tertiary referral center. Forty consecutive patients referred with a diagnosis of MS were randomized into two groups: an exercise group (N.=20) and a control group (N.=20). The experimental group underwent customized VR and the wait-listed control group received the usual medical care. All of the patients were assessed with objective balance tests (Romberg Test, Tandem Romberg Test, Foam Romberg Test, Static Posturography, Six-Meter Walk Test, Five Times Sit-to-Stand Test, Berg Balance Scale, Timed Up and Go Test, Functional Gait Assessment, and Dynamic Gait Index), subjective balance parameters (Activities-Specific Balance Confidence Scale and Dizziness Handicap Inventory), and functional capacity (Six-Minute Walking Test), quality of life (Multiple Sclerosis Quality of Life-54), and depression (Beck Depression Inventory) scales. At the end of the trial, the exercise group exhibited significant changes in most of the evaluated parameters compared to the control group [except the Tandem Romberg with eyes closed and the Foam Romberg, standing with eyes open (P0.05). The intergroup comparisons of differences indicated significant recoveries in favor of the exercise group in all of the evaluated parameters (P<0.05). This study confirms the effects of customized VR programs on balance, quality of life, and functional capacity in patients with MS. Customized VR is an effective method for treating balance disorders in patients with MS.

  15. Dual task training in persons with Multiple Sclerosis: a feasability randomized controlled trial.

    Science.gov (United States)

    Sosnoff, Jacob J; Wajda, Douglas A; Sandroff, Brian M; Roeing, Kathleen L; Sung, JongHun; Motl, Robert W

    2017-10-01

    To determine the feasibility of dual task training in persons with Multiple Sclerosis. Randomized, single-blinded controlled trial. University research laboratory. A total of 234 individuals inquired about the investigation. After screening, 20 individuals with multiple sclerosis who self-reported problems with multitasking and were ambulatory volunteered for the investigation. 14 participants completed the post-assessment following the 12-week intervention. Participants were randomly assigned to either single task training program which focused on balance and walking function ( n=6) or dual task training program that incorporated cognitive tasks in balance and walking training ( n=8). Before and after the 12-week interventions participants underwent assessments of walking; dual task walking; balance (Berg Balance Scale and balance confidence) and cognition as indexed by the Brief International Cognitive Assessment for MS. There was an 8.5% recruitment rate, a 70% retention rate, and a 100% adherence rate. There was a trend for dual task gait speed to improve in the dual task training group following the intervention (Pre: task 1: 109.8±39, task 2: 104.2±34.1; Post: task 1:127.6±40.1, task 2: 122.8±37.4; P=0.14; η(2) = 0.24). There was also a trend for the dual task training group (28.1) to have greater performance than the control group (24.7) on visuospatial memory ( P=0.10; η(2)= 0.23). There were no changes in cognitive performance during walking trials. The study procedures were found to be feasible and improvements should be made in recruitment efforts going forward. Further examination of dual task training programs in individuals with multiple sclerosis is warranted.

  16. Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study.

    Science.gov (United States)

    Negahban, Hossein; Rezaie, Solmaz; Goharpey, Shahin

    2013-12-01

    The primary aim was to investigate the comparative effects of massage therapy and exercise therapy on patients with multiple sclerosis. The secondary aim was to investigate whether combination of both massage and exercise has an additive effect. Randomized controlled pilot trial with repeated measurements and blinded assessments. Local Multiple Sclerosis Society. A total of 48 patients with multiple sclerosis were randomly assigned to four equal subgroups labelled as massage therapy, exercise therapy, combined massage-exercise therapy and control group. The treatment group received 15 sessions of supervised intervention for five weeks. The massage therapy group received a standard Swedish massage. The exercise therapy group was given a combined set of strength, stretch, endurance and balance exercises. Patients in the massage-exercise therapy received a combined set of massage and exercise treatments. Patients in the control group were asked to continue their standard medical care. Pain, fatigue, spasticity, balance, gait and quality of life were assessed before and after intervention. Massage therapy resulted in significantly larger improvement in pain reduction (mean change 2.75 points, P = 0.001), dynamic balance (mean change, 3.69 seconds, P = 0.009) and walking speed (mean change, 7.84 seconds, P = 0.007) than exercise therapy. Patients involved in the combined massage-exercise therapy showed significantly larger improvement in pain reduction than those in the exercise therapy (mean change, 1.67 points, P = 0.001). Massage therapy could be more effective than exercise therapy. Moreover, the combination of massage and exercise therapy may be a little more effective than exercise therapy alone.

  17. Multiple gingival recession coverage treated with vestibular incision subperiosteal tunnel access approach with or without platelet-rich fibrin - A case series

    Directory of Open Access Journals (Sweden)

    Surbhi Garg

    2017-01-01

    Full Text Available Background: Gingival recession involves both soft tissue and hard tissue loss. In this evolutionary era of dentistry, newer techniques have evolved for complete coverage of isolated recession defects. Since 2012, vestibular incision subperiosteal tunnel access (VISTA technique was used with various regenerative membranes to treat multiple recession defects (MRDs. Platelet-rich fibrin (PRF membrane, a pool of growth factors but have any added advantage to recession coverage techniques is controversial. Thus, in this case series, we compare the effect of VISTA with or without PRF-membrane for the treatment of Classes I and III MRDs. Subjects and Methods: Four patients between of age 30 and 40 years (two patients having bilateral Class I and another two having bilateral Class III MRDs were selected from the Department of Periodontics, ITS Dental College, Greater Noida and designated as Case I–IV simultaneously. Recession defects at antagonist sites in each patient were corrected by VISTA approach with or without PRF-membrane. Recorded clinical parameters included recession depth, recession width, pocket probing depth, and clinical attachment level (CAL at baseline and 6 months postoperatively. Results: Patients having Class I recession defects showed almost complete root coverage with VISTA technique alone and reflected no added advantage of PRF-membrane. However, patients with Class III recession defects treated with VISTA + PRF-membrane showed more reduction in recession depth and gain in CAL as compared to sites treated with VISTA only. Conclusion: VISTA alone is a convenient technique for treatment of Class I MRDs. Addition of PRF-membrane for Class III recession defects give better outcome in term of reduction of recession depth and gain in CAL 6 month postoperatively.

  18. Multiple micronutrient supplementation for improving cognitive performance in children: systematic review of randomized controlled trials.

    Science.gov (United States)

    Eilander, Ans; Gera, Tarun; Sachdev, Harshpal S; Transler, Catherine; van der Knaap, Henk Cm; Kok, Frans J; Osendarp, Saskia Jm

    2010-01-01

    Although multiple micronutrient interventions have been shown to benefit children's intellectual development, a thorough evaluation of the totality of evidence is currently lacking to direct public health policy. This study aimed to systematically review the present literature and to quantify the effect of multiple micronutrients on cognitive performance in schoolchildren. The Institute for Scientific Information Web of Knowledge and local medical databases were searched for trials published from 1970 to 2008. Randomized controlled trials that investigated the effect of > or =3 micronutrients compared with placebo on cognition in healthy children aged 0-18 y were included following protocol. Data were extracted by 2 independent researchers. The cognitive tests used in the trials were grouped into several cognitive domains (eg, fluid and crystallized intelligence), and pooled effect size estimates were calculated per domain. Heterogeneity was explored through sensitivity and meta-regression techniques. Three trials were retrieved in children aged intelligence and -0.03 SD (95% CI: -0.21, 0.15; P = 0.74) for crystallized intelligence, both of which were based on 12 trials. Four trials yielded an overall effect of 0.30 SD (95% CI: 0.01, 0.58; P = 0.044) for academic performance. For other cognitive domains, no significant effects were found. Multiple micronutrient supplementation may be associated with a marginal increase in fluid intelligence and academic performance in healthy schoolchildren but not with crystallized intelligence. More research is required, however, before public health recommendations can be given.

  19. Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study.

    Science.gov (United States)

    Mansiz Kaplan, Basak; Akyuz, Gulseren; Kokar, Serdar; Yagci, Ilker

    2018-02-17

    The aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS). A single-blind randomized controlled study. Patients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months. There were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P < .01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P < .05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P < .05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P < .01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P < .05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P < .05). Adding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS. Copyright © 2018 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  20. Generalized linear longitudinal mixed models with linear covariance structure and multiplicative random effects

    DEFF Research Database (Denmark)

    Holst, René; Jørgensen, Bent

    2015-01-01

    The paper proposes a versatile class of multiplicative generalized linear longitudinal mixed models (GLLMM) with additive dispersion components, based on explicit modelling of the covariance structure. The class incorporates a longitudinal structure into the random effects models and retains...... a marginal as well as a conditional interpretation. The estimation procedure is based on a computationally efficient quasi-score method for the regression parameters combined with a REML-like bias-corrected Pearson estimating function for the dispersion and correlation parameters. This avoids...... the multidimensional integral of the conventional GLMM likelihood and allows an extension of the robust empirical sandwich estimator for use with both association and regression parameters. The method is applied to a set of otholit data, used for age determination of fish....

  1. Studies with staggered starts: multiple baseline designs and group-randomized trials.

    Science.gov (United States)

    Rhoda, Dale A; Murray, David M; Andridge, Rebecca R; Pennell, Michael L; Hade, Erinn M

    2011-11-01

    Multiple baseline designs (MBDs) have been suggested as alternatives to group-randomized trials (GRT). We reviewed structural features of MBDs and considered their potential effectiveness in public health research. We also reviewed the effect of staggered starts on statistical power. We reviewed the MBD literature to identify key structural features, recent suggestions that MBDs be adopted in public health research, and the literature on power in GRTs with staggered starts. We also computed power for MBDs and GRTs. The features that have contributed to the success of small MBDs in some fields are not likely to translate well to public health research. MBDs can be more powerful than GRTs under some conditions, but those conditions involve assumptions that require careful evaluation in practice. MBDs will often serve better as a complement of rather than as an alternative to GRTs. GRTs may employ staggered starts for logistical or ethical reasons, but this will always increase their duration and will often increase their cost.

  2. Coupled effect of stimulated Raman scattering and random lasing of dyes in multiple scattering medium

    Science.gov (United States)

    Yashchuk, Vasil P.

    2015-07-01

    Random lasing (RL) and stimulated Raman scattering (SRS) of dye in multiple scattering media (MSM) appears simultaneously and each couple with other. This coupling has considerable influence on the SRS regularities of dye in MSM. The main feature of this impact is that RL radiation promotes the Raman lines revealing in the RL spectrum range as part of total radiation. SRS initiation occurs owing to the CARS-like mechanism provided by the two component pump: incident monochromatic radiation (laser pump) and RL radiation arising inside the MSM. It leads to important consequences: the RL spectrum must overlap with the spectral region of the possible Stokes lines of the dye; only those Stokes lines appear which are in a range of the RL spectrum; all conditions which promote RL assist SRS also. It is shown MSM promotes the best conditions for SRS and RL coupling due to optimal matching of RL localization regions and pump radiation.

  3. The Statistics of Chaotic Tunnelling

    CERN Document Server

    Creagh, S C; Creagh, Stephen C.; Whelan, Niall D.

    2000-01-01

    We discuss the statistics of tunnelling rates in the presence of chaotic classical dynamics. This applies to resonance widths in chaotic metastable wells and to tunnelling splittings in chaotic symmetric double wells. The theory is based on using the properties of a semiclassical tunnelling operator together with random matrix theory arguments about wave function overlaps. The resulting distribution depends on the stability of a specific tunnelling orbit and is therefore not universal. However it does reduce to the universal Porter-Thomas form as the orbit becomes very unstable. For some choices of system parameters there are systematic deviations which we explain in terms of scarring of certain real periodic orbits. The theory is tested in a model symmetric double well problem and possible experimental realisations are discussed.

  4. Multimodal exercise training in multiple sclerosis: A randomized controlled trial in persons with substantial mobility disability.

    Science.gov (United States)

    Sandroff, Brian M; Bollaert, Rachel E; Pilutti, Lara A; Peterson, Melissa L; Baynard, Tracy; Fernhall, Bo; McAuley, Edward; Motl, Robert W

    2017-10-01

    Mobility disability is a common, debilitating feature of multiple sclerosis (MS). Exercise training has been identified as an approach to improve MS-related mobility disability. However, exercise randomized controlled trials (RCTs) on mobility in MS have generally not selectively targeted those with the onset of irreversible mobility disability. The current multi-site RCT compared the efficacy of 6-months of supervised, multimodal exercise training with an active control condition for improving mobility, gait, physical fitness, and cognitive outcomes in persons with substantial MS-related mobility disability. 83 participants with substantial MS-related mobility disability underwent initial mobility, gait, fitness, and cognitive processing speed assessments and were randomly assigned to 6-months of supervised multimodal (progressive aerobic, resistance, and balance) exercise training (intervention condition) or stretching-and-toning activities (control condition). Participants completed the same outcome assessments halfway through and immediately following the 6-month study period. There were statistically significant improvements in six-minute walk performance (F(2158)=3.12, p=0.05, ηp2=0.04), peak power output (F(2150)=8.16, pmobility disability. This is critical for informing the development of multi-site exercise rehabilitation programs in larger samples of persons with MS-related mobility disability. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Hydrotherapy for the Treatment of Pain in People with Multiple Sclerosis: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Adelaida María Castro-Sánchez

    2012-01-01

    Full Text Available Background. Multiple sclerosis (MS is a chronic demyelinating neurological disease. Several studies have reported that complementary and alternative therapies can have positive effects against pain in these patients. Objective. The objective was to investigate the effectiveness of an Ai-Chi aquatic exercise program against pain and other symptoms in MS patients. Methods. In this randomized controlled trial, 73 MS patients were randomly assigned to an experimental or control group for a 20-week treatment program. The experimental group underwent 40 sessions of Ai-Chi exercise in swimming pool and the control group 40 sessions of abdominal breathing and contraction-relaxation exercises in therapy room. Outcome variables were pain, disability, spasm, depression, fatigue, and autonomy, which were assessed before the intervention and immediately and at 4 and 10 weeks after the last treatment session. Results. The experimental group showed a significant (P<0.028 and clinically relevant decrease in pain intensity versus baseline, with an immediate posttreatment reduction in median visual analogue scale scores of 50% that was maintained for up to 10 weeks. Significant improvements were also observed in spasm, fatigue, disability, and autonomy. Conclusion. According to these findings, an Ai-Chi aquatic exercise program improves pain, spasms, disability, fatigue, depression, and autonomy in MS patients.

  6. Automatic detection of gadolinium-enhancing multiple sclerosis lesions in brain MRI using conditional random fields.

    Science.gov (United States)

    Karimaghaloo, Zahra; Shah, Mohak; Francis, Simon J; Arnold, Douglas L; Collins, D Louis; Arbel, Tal

    2012-06-01

    Gadolinium-enhancing lesions in brain magnetic resonance imaging of multiple sclerosis (MS) patients are of great interest since they are markers of disease activity. Identification of gadolinium-enhancing lesions is particularly challenging because the vast majority of enhancing voxels are associated with normal structures, particularly blood vessels. Furthermore, these lesions are typically small and in close proximity to vessels. In this paper, we present an automatic, probabilistic framework for segmentation of gadolinium-enhancing lesions in MS using conditional random fields. Our approach, through the integration of different components, encodes different information such as correspondence between the intensities and tissue labels, patterns in the labels, or patterns in the intensities. The proposed algorithm is evaluated on 80 multimodal clinical datasets acquired from relapsing-remitting MS patients in the context of multicenter clinical trials. The experimental results exhibit a sensitivity of 98% with a low false positive lesion count. The performance of the proposed algorithm is also compared to a logistic regression classifier, a support vector machine and a Markov random field approach. The results demonstrate superior performance of the proposed algorithm at successfully detecting all of the gadolinium-enhancing lesions while maintaining a low false positive lesion count.

  7. Direct Simulation of Multiple Scattering by Discrete Random Media Illuminated by Gaussian Beams

    Science.gov (United States)

    Mackowski, Daniel W.; Mishchenko, Michael I.

    2011-01-01

    The conventional orientation-averaging procedure developed in the framework of the superposition T-matrix approach is generalized to include the case of illumination by a Gaussian beam (GB). The resulting computer code is parallelized and used to perform extensive numerically exact calculations of electromagnetic scattering by volumes of discrete random medium consisting of monodisperse spherical particles. The size parameters of the scattering volumes are 40, 50, and 60, while their packing density is fixed at 5%. We demonstrate that all scattering patterns observed in the far-field zone of a random multisphere target and their evolution with decreasing width of the incident GB can be interpreted in terms of idealized theoretical concepts such as forward-scattering interference, coherent backscattering (CB), and diffuse multiple scattering. It is shown that the increasing violation of electromagnetic reciprocity with decreasing GB width suppresses and eventually eradicates all observable manifestations of CB. This result supplements the previous demonstration of the effects of broken reciprocity in the case of magneto-optically active particles subjected to an external magnetic field.

  8. Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial.

    Science.gov (United States)

    Kangovi, Shreya; Mitra, Nandita; Grande, David; Huo, Hairong; Smith, Robyn A; Long, Judith A

    2017-10-01

    To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences. Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 28% (P = .11). There were no differences in patient activation or self-rated physical health. A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems. clinicaltrials.gov identifier: NCT01900470.

  9. Modeling longitudinal data with nonparametric multiplicative random effects jointly with survival data.

    Science.gov (United States)

    Ding, Jimin; Wang, Jane-Ling

    2008-06-01

    In clinical studies, longitudinal biomarkers are often used to monitor disease progression and failure time. Joint modeling of longitudinal and survival data has certain advantages and has emerged as an effective way to mutually enhance information. Typically, a parametric longitudinal model is assumed to facilitate the likelihood approach. However, the choice of a proper parametric model turns out to be more elusive than models for standard longitudinal studies in which no survival endpoint occurs. In this article, we propose a nonparametric multiplicative random effects model for the longitudinal process, which has many applications and leads to a flexible yet parsimonious nonparametric random effects model. A proportional hazards model is then used to link the biomarkers and event time. We use B-splines to represent the nonparametric longitudinal process, and select the number of knots and degrees based on a version of the Akaike information criterion (AIC). Unknown model parameters are estimated through maximizing the observed joint likelihood, which is iteratively maximized by the Monte Carlo Expectation Maximization (MCEM) algorithm. Due to the simplicity of the model structure, the proposed approach has good numerical stability and compares well with the competing parametric longitudinal approaches. The new approach is illustrated with primary biliary cirrhosis (PBC) data, aiming to capture nonlinear patterns of serum bilirubin time courses and their relationship with survival time of PBC patients.

  10. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Leigh E Charvet

    Full Text Available Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS. We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74 vs. active control (n = 61 training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02-0·30, despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006. This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction.Clinicaltrials.gov NCT02141386.

  11. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial.

    Science.gov (United States)

    Charvet, Leigh E; Yang, Jie; Shaw, Michael T; Sherman, Kathleen; Haider, Lamia; Xu, Jianjin; Krupp, Lauren B

    2017-01-01

    Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS). We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR) program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74) vs. active control (n = 61) training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02-0·30), despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006). This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction. Clinicaltrials.gov NCT02141386.

  12. Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study.

    Science.gov (United States)

    Salcı, Yeliz; Fil, Ayla; Armutlu, Kadriye; Yildiz, F Gökçem; Kurne, Aslı; Aksoy, Songül; Nurlu, Gülay; Karabudak, Rana

    2017-12-01

    To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS). A total of 42 MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3-5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions. The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p  0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly. Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation. Implications for rehabilitation Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease. Different exercise modalities are commonly employed to control ataxic symptoms in MS patients. Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis

  13. The effectiveness of transdermal opioid in the management multiple rib fractures: randomized clinical trial.

    Science.gov (United States)

    Solak, Okan; Oz, Gürhan; Kokulu, Serdar; Solak, Ozlem; Doğan, Gökçen; Esme, Hıdır; Ocalan, Kubilay; Baki, Elif Doğan

    2013-09-01

    The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain. To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermal therapeutic system (TTS) in the management of rib fracture pain. Prospective randomized clinical trial. In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15), 4×40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 μg/mL continuous intravenous fentanyl and was 50 μg fentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS). The pain during lying down (VASl) and mobilisation (VASm) was detected. There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05). We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group (p0.05). In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.

  14. Prevention of catheter-related bacteremia with a daily ethanol lock in patients with tunnelled catheters: a randomized, placebo-controlled trial.

    Directory of Open Access Journals (Sweden)

    Lennert Slobbe

    2010-05-01

    Full Text Available Catheter-related bloodstream infection (CRBSI results in significant attributable morbidity and mortality. In this randomized, double-blind, placebo-controlled trial, we studied the efficacy and safety of a daily ethanol lock for the prevention of CRBSI in patients with a tunnelled central venous catheter (CVC.From 2005 through 2008, each lumen of the CVC of adult hematology patients was locked for 15 minutes per day with either 70%-ethanol or placebo, where after the lock solution was flushed through. As a primary endpoint, the incidence rates of endoluminal CRBSI were compared.The intent-to-treat analysis was based on 376 patients, accounting for 448 CVCs and 27,745 catheter days. For ethanol locks, the incidence of endoluminal CRBSI per 1000 CVC-days was 0.70 (95%-CI, 0.4-1.3, compared to 1.19 (95% confidence interval, 0.7-1.9 for placebo (incidence rate-ratio, 0.59; 95% confidence interval, 0.27-1.30; P = .19. For endoluminal CRBSI according to the strictest definition (positive hub culture and identical bacterial strain in blood, a 3.6-fold, non-significant, reduction was observed for patients receiving ethanol (2 of 226 versus 7 of 222; P = .103. No life-threatening adverse events were observed. More patients receiving ethanol discontinued lock-therapy (11 of 226 versus 1 of 222; P = .006 or continued with decreased lock-frequency (10 of 226 versus 0 of 222; P = .002, due to non-severe adverse events.In this study, the reduction in the incidence of endoluminal CRBSI using preventive ethanol locks was non-significant, although the low incidence of endoluminal CRBSI precludes definite conclusions. Therefore, the lack of statistical significance may partially reflect a lack of power. Significantly more patients treated with ethanol locks discontinued their prophylactic treatment due to adverse effects, which were non-severe but reasonably ethanol related. Additional studies should be performed in populations with higher incidence of

  15. Internet-based treatment for depression in multiple sclerosis: A randomized controlled trial.

    Science.gov (United States)

    Boeschoten, Rosa E; Dekker, Joost; Uitdehaag, Bernard Mj; Beekman, Aartjan Tf; Hoogendoorn, Adriaan W; Collette, Emma H; Cuijpers, Pim; Nieuwenhuis, Magdalena M; van Oppen, Patricia

    2017-07-01

    Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitations impede face-to-face treatment. Internet-based treatment is therefore a promising tool for treating depression in MS. To investigate effectiveness of a guided Internet-based problem-solving treatment (IPST) for depressed MS patients. MS patients with moderate or severe depressive symptoms were randomly assigned to IPST or a wait list control. Primary outcome was the change in depressive symptoms defined by a change in sum score on the Beck Depression Inventory Second Edition (BDI-II). Assessments took place at baseline (T0), within a week after the intervention (T1), and at 4 months follow-up (T2). Analyses were based on the intention-to-treat principle. A total of 171 patients were randomized to IPST ( n = 85) or a wait list control ( n = 86). T1 was completed by 152 (89%) and T2 by 131 patients (77%). The IPST group and wait list control showed large significant improvements in depressive symptoms, but no differences were found between groups at T1 ( d = 0.23; 95% confidence interval (CI) = (-4.03, 1.08); p = 0.259) and T2 ( d = 0.01; 95% CI = (-2.80, 2.98); p = 0.953). We found no indication that IPST for MS patients with moderate or severe depression is effective in reducing depressive symptoms compared to a waiting list. Large improvements in the wait list control were unexpected and are discussed.

  16. A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Stein, M S; Liu, Y; Gray, O M; Baker, J E; Kolbe, S C; Ditchfield, M R; Egan, G F; Mitchell, P J; Harrison, L C; Butzkueven, H; Kilpatrick, T J

    2011-10-25

    Higher latitude, lower ultraviolet exposure, and lower serum 25-hydroxyvitamin D (25OHD) correlate with higher multiple sclerosis (MS) prevalence, relapse rate, and mortality. We therefore evaluated the effects of high-dose vitamin D2 (D2) in MS. Adults with clinically active relapsing-remitting MS (RRMS) were randomized to 6 months' double-blind placebo-controlled high-dose vitamin D2, 6,000 IU capsules, dose adjusted empirically aiming for a serum 25OHD 130-175 nM. All received daily low-dose (1,000 IU) D2 to prevent deficiency. Brain MRIs were performed at baseline, 4, 5, and 6 months. Primary endpoints were the cumulative number of new gadolinium-enhancing lesions and change in the total volume of T2 lesions. Secondary endpoints were Expanded Disability Status Scale (EDSS) score and relapses. Twenty-three people were randomized, of whom 19 were on established interferon or glatiramer acetate (Copaxone) treatment. Median 25OHD rose from 54 to 69 nM (low-dose D2) vs 59 to 120 nM (high-dose D2) (p = 0.002). No significant treatment differences were detected in the primary MRI endpoints. Exit EDSS, after adjustment for entry EDSS, was higher following high-dose D2 than following low-dose D2 (p = 0.05). There were 4 relapses with high-dose D2 vs none with low-dose D2 (p = 0.04). We did not find a therapeutic advantage in RRMS for high-dose D2 over low-dose D2 supplementation. This study provides Class I evidence that high-dose vitamin D2 (targeting 25OHD 130-175 nM), compared to low-dose supplementation (1,000 IU/d), was not effective in reducing MRI lesions in patients with RRMS.

  17. Feasibility and acceptability of a multiple risk factor intervention: The Step Up randomized pilot trial

    Directory of Open Access Journals (Sweden)

    Richards Julie

    2011-03-01

    Full Text Available Abstract Background Interventions are needed which can successfully modify more than one disease risk factor at a time, but much remains to be learned about the acceptability, feasibility, and effectiveness of multiple risk factor (MRF interventions. To address these issues and inform future intervention development, we conducted a randomized pilot trial (n = 52. This study was designed to assess the feasibility and acceptability of the Step Up program, a MRF cognitive-behavioral program designed to improve participants' mental and physical well-being by reducing depressive symptoms, promoting smoking cessation, and increasing physical activity. Methods Participants were recruited from a large health care organization and randomized to receive usual care treatment for depression, smoking, and physical activity promotion or the phone-based Step Up counseling program plus usual care. Participants were assessed at baseline, three and six months. Results The intervention was acceptable to participants and feasible to offer within a healthcare system. The pilot also offered important insights into the optimal design of a MRF program. While not powered to detect clinically significant outcomes, changes in target behaviors indicated positive trends at six month follow-up and statistically significant improvement was also observed for depression. Significantly more experimental participants reported a clinically significant improvement (50% reduction in their baseline depression score at four months (54% vs. 26%, OR = 3.35, 95% CI [1.01- 12.10], p = 0.05 and 6 months (52% vs. 13%, OR = 7.27, 95% CI [1.85 - 37.30], p = 0.004 Conclusions Overall, results suggest the Step Up program warrants additional research, although some program enhancements may be beneficial. Key lessons learned from this research are shared to promote the understanding of others working in this field. Trial registration The trial is registered with ClinicalTrials.gov (NCT00644995.

  18. Comparison of heparin to citrate as a catheter locking solution for non-tunneled central venous hemodialysis catheters in patients requiring renal replacement therapy for acute renal failure (VERROU-REA study): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bruyère, Rémi; Soudry-Faure, Agnès; Capellier, Gilles; Binquet, Christine; Nadji, Abdelouaid; Torner, Stephane; Blasco, Gilles; Yannaraki, Maria; Barbar, Saber Davide; Quenot, Jean-Pierre

    2014-11-19

    The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters. We aim to compare citrate 4% catheter lock solution versus heparin in terms of event-free survival of the first non-tunneled hemodialysis catheter inserted in ICU patients with AKI requiring RRT. Secondary objectives are the rate of fibrinolysis, incidence of catheter thrombosis and catheter-related infection per 1,000 catheter days, length of stay in ICU and in-hospital and 28-day mortality. The VERROU-REA study is a randomized, prospective, multicenter, double-blind, parallel-group, controlled superiority study carried out in the medical, surgical and nephrological ICUs of two large university hospitals in eastern France. A catheter lock solution composed of trisodium citrate at 4% will be compared to unfractionated heparin at a concentration of 5,000 IU/mL. All consecutive adult patients with AKI requiring extracorporeal RRT, and in whom a first non-tunneled catheter is to be inserted by the jugular or femoral approach, will be eligible. Catheters inserted by the subclavian approach, patients with acute liver failure, thrombopenia or contraindication to systemic anticoagulation will be excluded. Patients will be followed up daily in accordance with standard practices for RRT until death or discharge. Data is scarce regarding the use of non-tunneled catheters in the ICU setting in patients with AKI. This study will provide an evidence base for

  19. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... a passing cramp? It could be carpal tunnel syndrome. The carpal tunnel is a narrow passageway of ... three times more likely to have carpal tunnel syndrome than men. Early diagnosis and treatment are important ...

  20. Effects of multidisciplinary rehabilitation on chronic fatigue in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Rietberg, Marc B; van Wegen, Erwin E H; Eyssen, Isaline C J M; Kwakkel, Gert

    2014-01-01

    Several rehabilitation programmes aim at reducing the impact of fatigue in MS patients. Acute and chronic fatigue should require different management. To assess the effects of individually tailored, multidisciplinary outpatient rehabilitation (MDR) on chronic fatigue. Forty-eight ambulatory MS patients with chronic fatigue were randomized to MDR or to MS-nurse consultation. Fatigue was assessed by the Checklist Individual Strength (CIS-20R). Secondary outcomes included the Modified Fatigue Impact Scale, Fatigue Severity Scale, Functional Independence Measure, Disability and Impact Profile (DIP), Multiple Sclerosis Impact Scale and the Impact on Participation and Autonomy (IPA). The primary outcome measure CIS-20R overall score showed no significant differences between groups at 12 weeks (P = 0.39) and 24 weeks follow-up (P = 0.14), nor for subscales (t = 12 and t = 24, 0.19≤P≤0.88). No significant within-group effects were found for both groups with respect to the primary (0.57≤p≤0.97) and secondary (0.11≤p≤0.92) outcome measures from baseline to 12 or 24 weeks. Multidisciplinary rehabilitation was not more effective in terms of reducing self-reported fatigue in MS patients compared to MS-nurse consultation. Our results suggest that chronic fatigue in patients with MS may be highly invariant over time, irrespective of interventions. controlled-trials.com ISRCTN05017507.

  1. On the estimation of multiple random integrals and U-statistics

    CERN Document Server

    Major, Péter

    2013-01-01

    This work starts with the study of those limit theorems in probability theory for which classical methods do not work. In many cases some form of linearization can help to solve the problem, because the linearized version is simpler. But in order to apply such a method we have to show that the linearization causes a negligible error. The estimation of this error leads to some important large deviation type problems, and the main subject of this work is their investigation. We provide sharp estimates of the tail distribution of multiple integrals with respect to a normalized empirical measure and so-called degenerate U-statistics and also of the supremum of appropriate classes of such quantities. The proofs apply a number of useful techniques of modern probability that enable us to investigate the non-linear functionals of independent random variables. This lecture note yields insights into these methods, and may also be useful for those who only want some new tools to help them prove limit theorems when stand...

  2. Teriflunomide added to interferon-β in relapsing multiple sclerosis: a randomized phase II trial.

    Science.gov (United States)

    Freedman, M S; Wolinsky, J S; Wamil, B; Confavreux, C; Comi, G; Kappos, L; Olsson, T P; Miller, A; Benzerdjeb, H; Li, H; Simonson, C; O'Connor, P W

    2012-06-05

    To evaluate teriflunomide as add-on therapy to ongoing stable-dosed interferon-β (IFNβ) in patients with relapsing forms of multiple sclerosis (RMS). A total of 118 patients with RMS were randomly assigned 1:1:1 to receive oral placebo or teriflunomide, 7 or 14 mg, once daily for 24 weeks; 86 patients entered the 24-week extension. The primary objective was to evaluate safety; secondary objectives were to evaluate the effects of treatment on disease activity assessed by MRI and relapse rate. Teriflunomide was well tolerated with a low and similar incidence of treatment-emergent adverse events (TEAEs) across the 3 groups; TEAEs led to treatment discontinuation of 4.9%, 8.1%, and 7.9% of patients in the placebo, 7-mg, and 14-mg groups, respectively. The number of gadolinium-enhancing T1 (T1-Gd) lesions was reduced in both teriflunomide groups, with relative risk reductions (RRRs) of 84.6% (p = 0.0005) and 82.8% (p Teriflunomide as add-on therapy to IFNβ had acceptable safety and tolerability and reduced MRI disease activity compared with IFNβ alone. This study provides Class II evidence that teriflunomide, 7 and 14 mg, added to IFNβ, is safe. The T1-Gd lesion burden was significantly reduced with both teriflunomide doses.

  3. Hippotherapy for patients with multiple sclerosis: A multicenter randomized controlled trial (MS-HIPPO).

    Science.gov (United States)

    Vermöhlen, Vanessa; Schiller, Petra; Schickendantz, Sabine; Drache, Marion; Hussack, Sabine; Gerber-Grote, Andreas; Pöhlau, Dieter

    2017-08-01

    Evidence-based complementary treatment options for multiple sclerosis (MS) are limited. To investigate the effect of hippotherapy plus standard care versus standard care alone in MS patients. A total of 70 adults with MS were recruited in five German centers and randomly allocated to the intervention group (12 weeks of hippotherapy) or the control group. Primary outcome was the change in the Berg Balance Scale (BBS) after 12 weeks, and further outcome measures included fatigue, pain, quality of life, and spasticity. Covariance analysis of the primary endpoint resulted in a mean difference in BBS change of 2.33 (95% confidence interval (CI): 0.03-4.63, p = 0.047) between intervention ( n = 32) and control ( n = 38) groups. Benefit on BBS was largest for the subgroup with an Expanded Disability Status Scale (EDSS) ⩾ 5 (5.1, p = 0.001). Fatigue (-6.8, p = 0.02) and spasticity (-0.9, p = 0.03) improved in the intervention group. The mean difference in change between groups was 12.0 ( p Hippotherapy plus standard care, while below the threshold of a minimal clinically important difference, significantly improved balance and also fatigue, spasticity, and quality of life in MS patients.

  4. The effects of robot-assisted gait training in progressive multiple sclerosis: A randomized controlled trial.

    Science.gov (United States)

    Straudi, Sofia; Fanciullacci, Chiara; Martinuzzi, Carlotta; Pavarelli, Claudia; Rossi, Bruno; Chisari, Carmelo; Basaglia, Nino

    2016-03-01

    Gait and mobility impairments are common in progressive multiple sclerosis (MS), leading to reduced quality of life (QoL). In this randomized controlled study, we tested the effects of robot-assisted gait training (RAGT) and compared it to conventional physiotherapy, measuring walking ability, depression, fatigue, and QoL in patients with progressive MS and severe gait disability. Fifty-two participants (Expanded Disability Status Scale score 6-7) completed the study protocol. They received two sessions/week over 6 weeks of RAGT or conventional walking therapy. Outcome measures were Six-Minute Walk Test, Ten-Meter Walk Test, Timed Up and Go Test, Berg Balance Scale, Fatigue Severity Scale, Patient Health Questionnaire, and Short Form 36. They were performed pre-treatment, post-treatment, and at 3 months. Walking endurance (p physical functioning QoL increased. No significant effects on fatigue were found. RAGT is a treatment option in progressive MS patients with severe gait impairments to induce short-lasting effects on mobility and QoL. © The Author(s), 2015.

  5. Increased statistical power with combined independent randomization tests used with multiple-baseline design.

    Science.gov (United States)

    Tyrrell, Pascal N; Corey, Paul N; Feldman, Brian M; Silverman, Earl D

    2013-06-01

    Physicians often assess the effectiveness of treatments on a small number of patients. Multiple-baseline designs (MBDs), based on the Wampold-Worsham (WW) method of randomization and applied to four subjects, have relatively low power. Our objective was to propose another approach with greater power that does not suffer from the time requirements of the WW method applied to a greater number of subjects. The power of a design that involves the combination of two four-subject MBDs was estimated using computer simulation and compared with the four- and eight-subject designs. The effect of a delayed linear response to treatment on the power of the test was also investigated. Power was found to be adequate (>80%) for a standardized mean difference (SMD) greater than 0.8. The effect size associated with 80% power from combined tests was smaller than that of the single four-subject MBD (SMD=1.3) and comparable with the eight-subject MBD (SMD=0.6). A delayed linear response to the treatment resulted in important reductions in power (20-35%). By combining two four-subject MBD tests, an investigator can detect better effect sizes (SMD=0.8) and be able to complete a comparatively timelier and feasible study. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. A randomized placebo-controlled phase III trial of oral laquinimod for multiple sclerosis

    DEFF Research Database (Denmark)

    Vollmer, T L; Sorensen, P S; Selmaj, K

    2014-01-01

    using EDSS was -31 % [hazard ratio (HR) 0.69, p = 0.063], and using Multiple Sclerosis Functional Composite (MSFC) z-score was -77 % (p = 0.150), vs. placebo. IFNβ-1a reduced ARR 26 % (RR = 0.74, 95 % CI 0.60-0.92, p = 0.007), showed no effect on PBVC loss (+11 %, p = 0.14), and changes in disability......The phase III placebo-controlled BRAVO study assessed laquinimod effects in patients with relapsing-remitting MS (RRMS), and descriptively compared laquinimod with interferon beta (IFNβ)-1a (Avonex(®) reference arm). RRMS patients age 18-55 years with Expanded Disability Status Scale (EDSS) scores...... months. The primary endpoint was annualized relapse rate (ARR); secondary endpoints included percent brain volume change (PBVC) and 3-month confirmed disability worsening. In all, 1,331 patients were randomized: laquinimod (n = 434), placebo (n = 450), and IFNβ-1a (n = 447). ARR was not significantly...

  7. Multiple-wavelength double random phase encoding with CCD-plane sparse-phase multiplexing for optical information verification.

    Science.gov (United States)

    Chen, Wen

    2015-12-20

    A novel method is proposed by using multiple-wavelength double random phase encoding (MW-DRPE) with CCD-plane sparse-phase multiplexing for optical information verification. Two different strategies are applied to conduct sparse-phase multiplexing in the CCD plane. The results demonstrate that large capacity can be achieved for optical multiple-image verification. The proposed optical verification strategy is implemented based on optical encoding, and the keys generated by optical encryption can further guarantee the safety of the designed optical multiple-image verification system. The proposed method provides a novel alternative for DRPE-based optical information verification.

  8. Stabilometric assessment of context dependent balance recovery in persons with multiple sclerosis: a randomized controlled study.

    Science.gov (United States)

    Cattaneo, Davide; Jonsdottir, Johanna; Regola, Alberto; Carabalona, Roberta

    2014-06-10

    Balance control relies on accurate perception of visual, somatosensory and vestibular cues. Sensory flow is impaired in Multiple Sclerosis (MS) and little is known about the ability of the sensory systems to adapt after neurological lesions reducing sensory impairment. The aims of the present study were to verify whether: 1. Balance rehabilitation administered in a challenging sensory conditions would improve stability in upright posture. 2. The improvement in a treated sensory condition would transfer to a non treated sensory condition. Fifty three persons with MS, median (min-max) EDSS score of 5 (2.5-6.5), participated in a RCT and were randomly assigned to two groups. The Experimental group received balance rehabilitation aimed at improving motor and sensory strategies. The Control group received rehabilitation treatment which did not include training of sensory strategies. Persons with MS were blindly assessed by means of a stabilometric platform with eyes open, eyes closed and dome, on both firm surface and foam. Anterior-posterior and medio-lateral sway, velocity of sway and the length of Center of Pressure (CoP) trajectory were calculated in the six sensory conditions. Experimental group showed statistically significant improvement (P stability in upright posture in eyes closed condition on firm surface, and in eyes open, closed, and dome conditions on foam. No differences were observed between groups in the eyes open condition on firm surface nor in the sensory condition not addressed during the treatment. After rehabilitation people with MS can recover from sensory impairments thus improving upright balance. Further, the improvement seems to be context-dependent and present just in the treated sensory conditions. ClinicalTrials NCT02131285.

  9. A comparison of random forest regression and multiple linear regression for prediction in neuroscience.

    Science.gov (United States)

    Smith, Paul F; Ganesh, Siva; Liu, Ping

    2013-10-30

    Regression is a common statistical tool for prediction in neuroscience. However, linear regression is by far the most common form of regression used, with regression trees receiving comparatively little attention. In this study, the results of conventional multiple linear regression (MLR) were compared with those of random forest regression (RFR), in the prediction of the concentrations of 9 neurochemicals in the vestibular nucleus complex and cerebellum that are part of the l-arginine biochemical pathway (agmatine, putrescine, spermidine, spermine, l-arginine, l-ornithine, l-citrulline, glutamate and γ-aminobutyric acid (GABA)). The R(2) values for the MLRs were higher than the proportion of variance explained values for the RFRs: 6/9 of them were ≥ 0.70 compared to 4/9 for RFRs. Even the variables that had the lowest R(2) values for the MLRs, e.g. ornithine (0.50) and glutamate (0.61), had much lower proportion of variance explained values for the RFRs (0.27 and 0.49, respectively). The RSE values for the MLRs were lower than those for the RFRs in all but two cases. In general, MLRs seemed to be superior to the RFRs in terms of predictive value and error. In the case of this data set, MLR appeared to be superior to RFR in terms of its explanatory value and error. This result suggests that MLR may have advantages over RFR for prediction in neuroscience with this kind of data set, but that RFR can still have good predictive value in some cases. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Virtual rehabilitation for multiple sclerosis using a kinect-based system: randomized controlled trial.

    Science.gov (United States)

    Lozano-Quilis, Jose-Antonio; Gil-Gómez, Hermenegildo; Gil-Gómez, Jose-Antonio; Albiol-Pérez, Sergio; Palacios-Navarro, Guillermo; Fardoun, Habib M; Mashat, Abdulfattah S

    2014-11-12

    The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients' motivation and adherence to treatment. We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient's progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers. A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales. Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system. The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional

  11. Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial.

    Science.gov (United States)

    Yadav, Vijayshree; Marracci, Gail; Kim, Edward; Spain, Rebecca; Cameron, Michelle; Overs, Shannon; Riddehough, Andrew; Li, David K B; McDougall, John; Lovera, Jesus; Murchison, Charles; Bourdette, Dennis

    2016-09-01

    The role that dietary interventions can play in multiple sclerosis (MS) management is of huge interest amongst patients and researchers but data evaluating this is limited. Possible effects of a very-low-fat, plant-based dietary intervention on MS related progression and disease activity as measured by brain imaging and MS related symptoms have not been evaluated in a randomized-controlled trial. Despite use of disease modifying therapies (DMT), poor quality of life (QOL) in MS patients can be a significant problem with fatigue being one of the common disabling symptoms. Effective treatment options for fatigue remain limited. Emerging evidence suggests diet and vascular risk factors including obesity and hyperlipidemia may influence MS disease progression and improve QOL. To evaluate adherence, safety and effects of a very-low-fat, plant-based diet (Diet) on brain MRI, clinical [MS relapses and disability, body mass index (BMI)] and metabolic (blood lipids and insulin) outcomes, QOL [Short Form-36 (SF-36)], and fatigue [Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS)], in relapsing-remitting MS (RRMS). This was a randomized-controlled, assessor-blinded, one-year long study with 61 participants assigned to either Diet (N=32) or wait-listed (Control, N=29) group. The mean age (years) [Control-40.9±8.48; Diet-40.8±8.86] and the mean disease duration (years) [Control -5.3±3.86; Diet-5.33±3.63] were comparable between the two groups. There was a slight difference between the two study groups in the baseline mean expanded disability status scale (EDSS) score [Control-2.22±0.90; Diet-2.72±1.05]. Eight subjects withdrew (Diet, N=6; Control, N=2). Adherence to the study diet based on monthly Food Frequency Questionnaire (FFQ) was excellent with the diet group showing significant difference in the total fat caloric intake compared to the control group [total fat intake/total calories averaged ~15% (Diet) versus ~40% (Control)]. The two groups

  12. Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials.

    Directory of Open Access Journals (Sweden)

    Minjie Gao

    Full Text Available Whether patients with smoldering multiple myeloma (SMM needed to receive early interventional treatment remains controversial. Herein, we conducted a meta-analysis comparing the efficacy and safety of early treatment over deferred treatment for patients with SMM.MEDLINE and Cochrane Library were searched to May 2014 for randomized controlled trials (RCTs that assessed the effect of early treatment over deferred treatment. Primary outcome measure was mortality, and secondary outcome measures were progression, response rate, and adverse events.Overall, 5 trials including 449 patients were identified. There was a markedly reduced risk of disease progression with early treatment (Odds Ratio [OR] = 0.13, 95% confidence interval [CI] = 0.07 to 0.24. There were no significant differences in mortality and response rate (OR = 0.85, 95% CI = 0.45 to 1.60, and OR = 0.63, 95% CI = 0.32 to 1.23, respectively. More patients in the early treatment arm experienced gastrointestinal toxicities (OR = 10.02, 95%CI = 4.32 to 23.23, constipation (OR = 8.58, 95%CI = 3.20 to 23.00 and fatigue or asthenia (OR = 2.72, 95%CI = 1.30 to 5.67. No significant differences were seen with the development of acute leukemia (OR = 2.80, 95%CI = 0.42 to 18.81, hematologic cancer (OR = 2.07, 95%CI = 0.43 to 10.01, second primary tumors (OR = 3.45, 95%CI = 0.81 to 14.68, nor vertebral compression (OR = 0.18, 95%CI = 0.02 to 1.59.Early treatment delayed disease progression but increased the risk of gastrointestinal toxicities, constipation and fatigue or asthenia. The differences on vertebral compression, acute leukemia, hematological cancer and second primary tumors were not statistically significant. Based on the current evidence, early treatment didn't significantly affect mortality and response rate. However, further much larger trials were needed to provide more evidence.

  13. Integrative group-based cognitive rehabilitation efficacy in multiple sclerosis: a randomized clinical trial.

    Science.gov (United States)

    Rilo, Oiane; Peña, Javier; Ojeda, Natalia; Rodríguez-Antigüedad, Alfredo; Mendibe-Bilbao, Mar; Gómez-Gastiasoro, Ainara; DeLuca, John; Chiaravalloti, Nancy; Ibarretxe-Bilbao, Naroa

    2018-01-01

    This study aimed to determine the efficacy of the integrative group-based cognitive rehabilitation programme, REHACOP, on improving cognitive functions in multiple sclerosis (MS). Fourty-two MS patients were randomized to the treatment programme REHACOP (n = 21) or waiting list control condition (n = 21). The REHACOP group received cognitive rehabilitation in group format for three months focused on attention, processing speed, learning and memory, language, executive functioning, and social cognition. Patients completed a neuropsychological assessment at baseline and follow-up, which included tests of attention, processing speed, working memory, verbal memory, verbal fluency, and executive functioning. Repeated measures multivariate analysis of covariance (MANCOVA) was used to determine the efficacy of the cognitive rehabilitation programme. Group × Time interactions revealed significant improvements in the REHACOP group as compared with the control group for processing speed (p = 0.011, np2 = 0.16), working memory (p = 0.014, np2 = 0.15), verbal memory (p = 0.025, np2 = 0.13), and executive functioning (p = 0.024, np2 = 0.13), showing medium-large effect sizes. Patients receiving REHACOP showed improvements in several cognitive domains. This preliminary study thus provides evidence supporting the efficacy of this integrative group-based cognitive rehabilitation intervention in MS. Future research should confirm these findings, examine the impact of the treatment on everyday life functioning and explore the presence of brain changes associated with cognitive rehabilitation. Implications for rehabilitation This study provides initial evidence for integrative group-based cognitive rehabilitation efficacy in MS patients through the implementation of the REHACOP cognitive rehabilitation programme. Patients received cognitive rehabilitation for three months (3 one-hour-sessions per week) focused on training attention

  14. Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials.

    Science.gov (United States)

    Gao, Minjie; Yang, Guang; Tompkins, Van S; Gao, Lu; Wu, Xiaosong; Tao, Yi; Hu, Xiaojing; Hou, Jun; Han, Ying; Xu, Hongwei; Zhan, Fenghuang; Shi, Jumei

    2014-01-01

    Whether patients with smoldering multiple myeloma (SMM) needed to receive early interventional treatment remains controversial. Herein, we conducted a meta-analysis comparing the efficacy and safety of early treatment over deferred treatment for patients with SMM. MEDLINE and Cochrane Library were searched to May 2014 for randomized controlled trials (RCTs) that assessed the effect of early treatment over deferred treatment. Primary outcome measure was mortality, and secondary outcome measures were progression, response rate, and adverse events. Overall, 5 trials including 449 patients were identified. There was a markedly reduced risk of disease progression with early treatment (Odds Ratio [OR] = 0.13, 95% confidence interval [CI] = 0.07 to 0.24). There were no significant differences in mortality and response rate (OR = 0.85, 95% CI = 0.45 to 1.60, and OR = 0.63, 95% CI = 0.32 to 1.23, respectively). More patients in the early treatment arm experienced gastrointestinal toxicities (OR = 10.02, 95%CI = 4.32 to 23.23), constipation (OR = 8.58, 95%CI = 3.20 to 23.00) and fatigue or asthenia (OR = 2.72, 95%CI = 1.30 to 5.67). No significant differences were seen with the development of acute leukemia (OR = 2.80, 95%CI = 0.42 to 18.81), hematologic cancer (OR = 2.07, 95%CI = 0.43 to 10.01), second primary tumors (OR = 3.45, 95%CI = 0.81 to 14.68), nor vertebral compression (OR = 0.18, 95%CI = 0.02 to 1.59). Early treatment delayed disease progression but increased the risk of gastrointestinal toxicities, constipation and fatigue or asthenia. The differences on vertebral compression, acute leukemia, hematological cancer and second primary tumors were not statistically significant. Based on the current evidence, early treatment didn't significantly affect mortality and response rate. However, further much larger trials were needed to provide more evidence.

  15. Randomized phase 1b trial of MOR103, a human antibody to GM-CSF, in multiple sclerosis

    OpenAIRE

    Constantinescu, Cris S.; Asher, Aliya; Fryze, Waldemar; Kozubski, Wojciech; Wagner, Frank; Aram, Jehan; Tanasescu, Radu; Korolkiewicz, Roman P.; Dirnberger-Hertweck, Maren; Steidl, Stefan; Libretto, Susan E.; Sprenger, Till; Radue, Ernst W.

    2015-01-01

    Objectives: To determine the safety, pharmacokinetics (PK), and immunogenicity of the recombinant human monoclonal antibody MOR103 to granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients with multiple sclerosis (MS) with clinical or MRI activity. Methods: In this 20-week, randomized, double-blind, placebo-controlled phase 1b dose-escalation trial (registration number NCT01517282), adults with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) received an IV infu...

  16. Subjective Well-Being and the Family: Results from an Ordered Probit Model with Multiple Random Effects

    OpenAIRE

    Winkelmann, Rainer

    2004-01-01

    The previous literature on the determinants of individual well-being has failed to fully account for the interdependencies in well-being at the family level. This paper develops an ordered probit model with multiple random effects that allows to identify the intrafamily correlation in well-being. The parameters of the model can be estimated with panel data using Maximum Marginal Likelihood. The approach is illustrated in an application using panel data for the period 1984-1997 from the German...

  17. Treatment-enhanced paired action contributes substantially to change across multiple health behaviors: secondary analyses of five randomized trials

    OpenAIRE

    Yin, Hui-Qing; Prochaska, James O.; Rossi, Joseph S.; Redding, Colleen A.; Paiva, Andrea L.; Blissmer, Bryan; Velicer, Wayne F.; Johnson, Sara S.; Kobayashi, Hisanori

    2013-01-01

    The dominant paradigm of changing multiple health behaviors (MHBs) is based on treating, assessing, and studying each behavior separately. This study focused on individuals with co-occurring baseline health-risk behavior pairs and described whether they changed over time on both or only one of the behaviors within each pair. Data from five randomized trials of computer-tailored interventions (CTIs) that simultaneously treated MHBs were analyzed. The differences between treatment and control p...

  18. Impulsive synchronization of Markovian jumping randomly coupled neural networks with partly unknown transition probabilities via multiple integral approach.

    Science.gov (United States)

    Chandrasekar, A; Rakkiyappan, R; Cao, Jinde

    2015-10-01

    This paper studies the impulsive synchronization of Markovian jumping randomly coupled neural networks with partly unknown transition probabilities via multiple integral approach. The array of neural networks are coupled in a random fashion which is governed by Bernoulli random variable. The aim of this paper is to obtain the synchronization criteria, which is suitable for both exactly known and partly unknown transition probabilities such that the coupled neural network is synchronized with mixed time-delay. The considered impulsive effects can be synchronized at partly unknown transition probabilities. Besides, a multiple integral approach is also proposed to strengthen the Markovian jumping randomly coupled neural networks with partly unknown transition probabilities. By making use of Kronecker product and some useful integral inequalities, a novel Lyapunov-Krasovskii functional was designed for handling the coupled neural network with mixed delay and then impulsive synchronization criteria are solvable in a set of linear matrix inequalities. Finally, numerical examples are presented to illustrate the effectiveness and advantages of the theoretical results. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Effect of combining multiple micronutrients with iron supplementation on Hb response in children: systematic review of randomized controlled trials.

    Science.gov (United States)

    Gera, Tarun; Sachdev, Harsh Pal Singh; Nestel, Penelope

    2009-06-01

    To study the effect of combining multiple (two or more) micronutrients with Fe supplementation on Hb response, when compared with placebo and with Fe supplementation, in children. Electronic databases, personal files, hand search of reviews, bibliographies of books, and abstracts and proceedings of international conferences. Randomized controlled trials evaluating change in Hb levels with interventions that included Fe and multiple-micronutrient supplementation in comparison to placebo alone or Fe alone were analysed in two systematic reviews. Twenty-five trials were included in the review comparing Fe and micronutrient supplementation with placebo. The pooled estimate (random effects model) for change in Hb with Fe and micronutrient supplementation (weighted mean difference) was 0.65 g/dl (95 % CI 0.50, 0.80, P micronutrients' and malarial non-hyperendemic region were significant predictors of greater Hb response and heterogeneity. Thirteen trials were included in the review comparing Fe and micronutrient supplementation with Fe alone. The pooled estimate for change in Hb with Fe and micronutrient supplementation (weighted mean difference) was 0.14 g/dl (95 % CI 0.00, 0.28, P = 0.04). None of the variables were found to be significant predictors of Hb response. Synthesized evidence indicates that addition of multiple micronutrients to Fe supplementation may only marginally improve Hb response compared with Fe supplementation alone. However, addition of 'other micronutrients' may have a negative effect. Routine addition of unselected multiple micronutrients to Fe therefore appears unjustified for nutritional anaemia control programmes.

  20. Effectiveness of Cognitive Behavioral Therapy on the Quality of Sleep in Women with Multiple Sclerosis: A Randomized Controlled Trial Study

    Directory of Open Access Journals (Sweden)

    Samira Abbasi

    2016-10-01

    Full Text Available Background: Multiple sclerosis is accompanied by secondary clinical signs such as insomnia. Considering the side effects of drugs and also increasing acceptability of psychotherapy methods in health systems, we aimed to determine the effect of group cognitive behavioral therapy on the quality of sleep in women with multiple sclerosis in 2014. Methods: This study is a randomized controlled clinical conducted on 72 women with multiple sclerosis who referred to medical centers of Isfahan. After convenience sampling, participants were randomly allocated into two equal groups of control (n=36 and intervention (n=36. In the intervention group, cognitive behavioral therapy was performed in 8 sessions. The control group, along with receiving the common drugs, participated in 3 group sessions and talked about their feelings and experiences. Data were gathered using Pittsburgh Sleep Quality Index (PSQI and analyzed through independent t-test, Chi-square, Mann Whitney, ANOVA with repeated measure, using SPSS 18. Results: There was a significant difference between the mean score of sleep quality of the control and intervention groups immediately and one month after the intervention (P<0.001. ANOVA with repeated measure test showed that the mean score of sleep quality of patients in the intervention group had a significant difference at three stages of before, immediately and one month after the intervention. Conclusions: According to the results of this study, cognitive behavioral therapy, as an effective and cost-effective therapy, could improve sleep quality in patients with multiple sclerosis.

  1. Effectiveness of Cognitive Behavioral Therapy on the Quality of Sleep in Women with Multiple Sclerosis: A Randomized Controlled Trial Study.

    Science.gov (United States)

    Abbasi, Samira; Alimohammadi, Nasrollah; Pahlavanzadeh, Saeid

    2016-10-01

    Multiple sclerosis is accompanied by secondary clinical signs such as insomnia. Considering the side effects of drugs and also increasing acceptability of psychotherapy methods in health systems, we aimed to determine the effect of group cognitive behavioral therapy on the quality of sleep in women with multiple sclerosis in 2014. This study is a randomized controlled clinical conducted on 72 women with multiple sclerosis who referred to medical centers of Isfahan. After convenience sampling, participants were randomly allocated into two equal groups of control (n=36) and intervention (n=36). In the intervention group, cognitive behavioral therapy was performed in 8 sessions. The control group, along with receiving the common drugs, participated in 3 group sessions and talked about their feelings and experiences. Data were gathered using Pittsburgh Sleep Quality Index (PSQI) and analyzed through independent t-test, Chi-square, Mann Whitney, ANOVA with repeated measure, using SPSS 18. There was a significant difference between the mean score of sleep quality of the control and intervention groups immediately and one month after the intervention (Ptherapy, as an effective and cost-effective therapy, could improve sleep quality in patients with multiple sclerosis. Trial Registration Number: IRCT2015012720833N1.

  2. POEM and Submucosal Tunneling.

    Science.gov (United States)

    Werner, Yuki B; Rösch, Thomas

    2016-06-01

    Submucosal endoscopy has introduced new and important aspects into gastrointestinal endoscopic therapeutics by opening the way to interventions even outside of the GI tract. At present, innovative techniques for submucosal endoscopy in different esophageal diseases include peroral endoscopic myotomy (POEM) for idiopathic achalasia and related motility disorders, submucosal tunneling endoscopic resection (STER) for submucosal tumors arising from the muscularis propria, and endoscopic submucosal tunneling dissection (ESTD) for superficial esophageal neoplastic lesions. POEM for achalasia-still a rare disease-is currently evaluated in comparison to endoscopic and surgical standard therapies, while this procedure enabling a long thoracic myotomy might constitute an advantage over the laparoscopic approach in treatments of spastic esophageal diseases. Removal of smaller submucosal esophageal tumors may appear tempting, but the clinical indications are limited by the facts that the vast majority of such smaller tumors are asymptomatic and benign.For all these innovative and technically demanding techniques, learning curves have to be taken into account, not only with regard to technical competence but also to clinical assessment, ranging from proper indication and patient selection to the management of (potential) complications and logistics/back-up. Although preliminary results from high-skilled endoscopic centers have been very encouraging, long-term data as well as prospective randomized controlled trials are needed to validate the efficacy and safety of the modalities.

  3. Internet-based home training is capable to improve balance in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Frevel, D; Mäurer, M

    2015-02-01

    Balance disorders are common in multiple sclerosis. Aim of the study is to investigate the effectiveness of an Internet-based home training program (e-Training) to improve balance in patients with multiple sclerosis. A randomized, controlled study. Academic teaching hospital in cooperation with the therapeutic riding center Gut Üttingshof, Bad Mergentheim. Eighteen multiple sclerosis patients (mean EDSS 3,5) took part in the trial. Outcome of patients using e-Training (N.=9) was compared to the outcome of patients receiving hippotherapy (N.=9), which can be considered as an advanced concept for the improvement of balance and postural control in multiple sclerosis. After simple random allocation patients received hippotherapy or Internet-based home training (balance, postural control and strength training) twice a week for 12 weeks. Assessments were done before and after the intervention and included static and dynamic balance (primary outcome). Isometric muscle strength of the knee and trunk extension/flexion (dynamometer), walking capacity, fatigue and quality of life served as secondary outcome parameters. Both intervention groups showed comparable and highly significant improvement in static and dynamic balance capacity, no difference was seen between the both intervention groups. However looking at fatigue and quality of life only the group receiving hippotherapy improved significantly. Since e-Training shows even comparable effects to hippotherapy to improve balance, we believe that the established Internet-based home training program, specialized on balance and postural control training, is feasible for a balance and strength training in persons with multiple sclerosis. We demonstrated that Internet-based home training is possible in patients with multiple sclerosis.

  4. Bortezomib consolidation after autologous stem cell transplantation in multiple myeloma: a Nordic Myeloma Study Group randomized phase 3 trial

    Science.gov (United States)

    Gimsing, Peter; Hjertner, Oyvind; Lenhoff, Stig; Laane, Edward; Remes, Kari; Steingrimsdottir, Hlif; Abildgaard, Niels; Ahlberg, Lucia; Blimark, Cecilie; Dahl, Inger Marie; Forsberg, Karin; Gedde-Dahl, Tobias; Gregersen, Henrik; Gruber, Astrid; Guldbrandsen, Nina; Haukås, Einar; Carlson, Kristina; Kvam, Ann Kristin; Nahi, Hareth; Lindås, Roald; Andersen, Niels Frost; Turesson, Ingemar; Waage, Anders; Westin, Jan; Gregersen, Henrik; Frost Andersen, Niels; Gimsing, Peter; Toffner-Clausen, Nilsaage; Abildgaard, Niels; Laane, Edward; Silvennoinen, Raija; Remes, Kari; Steingrimsdottir, Hlif; Lindås, Roald; Gedde-Dahl, Tobias; Guldbrandsen, Nina; Kristin Kvam, Ann; Haukås, Einar; Marie Dahl, Inger; Hjertner, Oyvind; Waage, Anders; Blimark, Cecilie; Mellqvist, Ulf-Henrik; Westin, Jan; Ahlberg, Lucia; Lenhoff, Stig; Turesson, Ingemar; Linder, Olle; Gruber, Astrid; Nahi, Hareth; Forsberg, Karin; Carlson, Kristina

    2013-01-01

    The Nordic Myeloma Study Group conducted an open randomized trial to compare bortezomib as consolidation therapy given after high-dose therapy and autologous stem cell transplantation (ASCT) with no consolidation in bortezomib-naive patients with newly diagnosed multiple myeloma. Overall, 370 patients were centrally randomly assigned 3 months after ASCT to receive 20 doses of bortezomib given during 21 weeks or no consolidation. The hypothesis was that consolidation therapy would prolong progression-free survival (PFS). The PFS after randomization was 27 months for the bortezomib group compared with 20 months for the control group (P = .05). Fifty-one of 90 patients in the treatment group compared with 32 of 90 controls improved their response after randomization (P = .007). No difference in overall survival was seen. Fatigue was reported more commonly by the bortezomib-treated patients in self-reported quality-of-life (QOL) questionnaires, whereas no other major differences in QOL were recorded between the groups. Consolidation therapy seemed to be beneficial for patients not achieving at least a very good partial response (VGPR) but not for patients in the ≥ VGPR category at randomization. Consolidation with bortezomib after ASCT in bortezomib-naive patients improves PFS without interfering with QOL. This trial was registered at www.clinicaltrials.gov as #NCT00417911. PMID:23616624

  5. Multiple micronutrient supplementation for improving cognitive performance in children: systematic review of randomized controlled trials

    NARCIS (Netherlands)

    Eilander, A.; Gera, T.; Sachdev, H.S.; Transler, C.; Knaap, van der H.; Kok, F.J.; Osendarp, S.J.M.

    2010-01-01

    Background: Although multiple micronutrient interventions have been shown to benefit children's intellectual development, a thorough evaluation of the totality of evidence is currently lacking to direct public health policy. Objective: This study aimed to systematically review the present literature

  6. Simultaneous detection of randomly arranged multiple barcodes using time division multiplexing technique

    Science.gov (United States)

    Haider, Saad Md. Jaglul; Islam, Md. Kafiul

    2010-02-01

    A method of detecting multiple barcodes simultaneously using time division multiplexing technique has been proposed in this paper to minimize the effective time needed for handling multiple tags of barcodes and to lessen the overall workload. Available barcode detection systems can handle multiple types of barcode but a single barcode at a time. This is not so efficient and can create large queue and chaos in places like mega shopping malls or large warehouses where we need to scan huge number of barcodes daily. Our proposed system is expected to improve the real time identification of goods or products on production lines and in automated warehouses or in mega shopping malls in a much more convenient and efficient way. For identifying of multiple barcodes simultaneously, a particular arrangement and orientation of LASER scanner and reflector have been used with a special curve shaped basement where the barcodes are placed. An effective and novel algorithm is developed to extract information from multiple barcodes which introduces starting pattern and ending pattern in barcodes with bit stuffing technique for the convenience of multiple detections. CRC technique is also used for trustworthiness of detection. The overall system enhances the existing single barcode detection system by a great amount although it is easy to implement and use.

  7. Carpal tunnel biopsy

    Science.gov (United States)

    ... tunnel Images Carpal tunnel syndrome Surface anatomy - normal palm Surface anatomy - normal wrist Carpal biopsy References Calandruccio ... CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. ...

  8. Transonic Dynamics Tunnel (TDT)

    Data.gov (United States)

    Federal Laboratory Consortium — The Transonic Dynamics Tunnel (TDT) is a continuous flow wind-tunnel facility capable of speeds up to Mach 1.2 at stagnation pressures up to one atmosphere. The TDT...

  9. Hypersonic Tunnel Facility (HTF)

    Data.gov (United States)

    Federal Laboratory Consortium — The Hypersonic Tunnel Facility (HTF) is a blow-down, non-vitiated (clean air) free-jet wind tunnel capable of testing large-scale, propulsion systems at Mach 5, 6,...

  10. Carpal tunnel repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100078.htm Carpal tunnel repair - series—Normal anatomy To use the sharing ... in the wrist and the wrist bones (carpal tunnel). Review Date 4/18/2017 Updated by: C. ...

  11. Road and Railroad Tunnels

    Data.gov (United States)

    Department of Homeland Security — Tunnels in the United States According to the HSIP Tiger Team Report, a tunnel is defined as a linear underground passageway open at both ends. This dataset is based...

  12. Quantum theory of tunneling

    CERN Document Server

    Razavy, Mohsen

    2014-01-01

    In this revised and expanded edition, in addition to a comprehensible introduction to the theoretical foundations of quantum tunneling based on different methods of formulating and solving tunneling problems, different semiclassical approximations for multidimensional systems are presented. Particular attention is given to the tunneling of composite systems, with examples taken from molecular tunneling and also from nuclear reactions. The interesting and puzzling features of tunneling times are given extensive coverage, and the possibility of measurement of these times with quantum clocks are critically examined. In addition by considering the analogy between evanescent waves in waveguides and in quantum tunneling, the times related to electromagnetic wave propagation have been used to explain certain aspects of quantum tunneling times. These topics are treated in both non-relativistic as well as relativistic regimes. Finally, a large number of examples of tunneling in atomic, molecular, condensed matter and ...

  13. Sampling versus Random Binning for Multiple Descriptions of a Bandlimited Source

    DEFF Research Database (Denmark)

    Mashiach, Adam; Østergaard, Jan; Zamir, Ram

    2013-01-01

    Random binning is an efficient, yet complex, coding technique for the symmetric L-description source coding problem. We propose an alternative approach, that uses the quantized samples of a bandlimited source as "descriptions". By the Nyquist condition, the source can be reconstructed if enough s...

  14. Inhomogeneous Linear Random Differential Equations with Mutual Correlations between Multiplicative, Additive and Initial-Value Terms

    NARCIS (Netherlands)

    Roerdink, J.B.T.M.

    1981-01-01

    The cumulant expansion for linear stochastic differential equations is extended to the general case in which the coefficient matrix, the inhomogeneous part and the initial condition are all random and, moreover, statistically interdependent. The expansion now involves not only the autocorrelation

  15. Tunnel and Station Cost Methodology : Mined Tunnels

    Science.gov (United States)

    1983-01-01

    The main objective of this study was to develop a model for estimating the cost of subway station and tunnel construction. This report describes a cost estimating methodology for subway tunnels that can be used by planners, designers, owners, and gov...

  16. Fall risk and incidence reduction in high risk individuals with multiple sclerosis: a pilot randomized control trial.

    Science.gov (United States)

    Sosnoff, Jacob J; Moon, Yaejin; Wajda, Douglas A; Finlayson, Marcia L; McAuley, Edward; Peterson, Elizabeth W; Morrison, Steve; Motl, Robert W

    2015-10-01

    To determine the feasibility of three fall prevention programs delivered over 12 weeks among individuals with multiple sclerosis: (A) a home-based exercise program targeting physiological risk factors; (B) an educational program targeting behavioral risk factors; and (C) a combined exercise-and-education program targeting both factors. Randomized controlled trial. Home-based training with assessments at research laboratory. A total of 103 individuals inquired about the investigation. After screening, 37 individuals with multiple sclerosis who had fallen in the last year and ranged in age from 45-75 years volunteered for the investigation. A total of 34 participants completed postassessment following the 12-week intervention. Participants were randomly assigned into one of four conditions: (1) wait-list control (n = 9); (2) home-based exercise (n = 11); (3) education (n = 9); or (4) a combined exercise and education (n = 8) group. Before and after the 12-week interventions, participants underwent a fall risk assessment as determined by the physiological profile assessment and provided information on their fall prevention behaviors as indexed by the Falls Prevention Strategy Survey. Participants completed falls diaries during the three-months postintervention. A total of 34 participants completed postintervention testing. Procedures and processes were found to be feasible. Overall, fall risk scores were lower in the exercise groups (1.15 SD 1.31) compared with the non-exercise groups (2.04 SD 1.04) following the intervention (p 0.05). Further examination of home-based exercise/education programs for reducing falls in individuals with multiple sclerosis is warranted. A total of 108 participants would be needed in a larger randomized controlled trial.ClinicalTrials.org #NCT01956227. © The Author(s) 2014.

  17. An iterative fullwave simulation approach to multiple scattering in media with randomly distributed microbubbles

    Science.gov (United States)

    Joshi, Aditya; Lindsey, Brooks D.; Dayton, Paul A.; Pinton, Gianmarco; Muller, Marie

    2017-05-01

    Ultrasound contrast agents (UCA), such as microbubbles, enhance the scattering properties of blood, which is otherwise hypoechoic. The multiple scattering interactions of the acoustic field with UCA are poorly understood due to the complexity of the multiple scattering theories and the nonlinear microbubble response. The majority of bubble models describe the behavior of UCA as single, isolated microbubbles suspended in infinite medium. Multiple scattering models such as the independent scattering approximation can approximate phase velocity and attenuation for low scatterer volume fractions. However, all current models and simulation approaches only describe multiple scattering and nonlinear bubble dynamics separately. Here we present an approach that combines two existing models: (1) a full-wave model that describes nonlinear propagation and scattering interactions in a heterogeneous attenuating medium and (2) a Paul-Sarkar model that describes the nonlinear interactions between an acoustic field and microbubbles. These two models were solved numerically and combined with an iterative approach. The convergence of this combined model was explored in silico for 0.5 × 106 microbubbles ml-1, 1% and 2% bubble concentration by volume. The backscattering predicted by our modeling approach was verified experimentally with water tank measurements performed with a 128-element linear array transducer. An excellent agreement in terms of the fundamental and harmonic acoustic fields is shown. Additionally, our model correctly predicts the phase velocity and attenuation measured using through transmission and predicted by the independent scattering approximation.

  18. Sensitivity Analysis of Multiple Informant Models When Data Are Not Missing at Random

    Science.gov (United States)

    Blozis, Shelley A.; Ge, Xiaojia; Xu, Shu; Natsuaki, Misaki N.; Shaw, Daniel S.; Neiderhiser, Jenae M.; Scaramella, Laura V.; Leve, Leslie D.; Reiss, David

    2013-01-01

    Missing data are common in studies that rely on multiple informant data to evaluate relationships among variables for distinguishable individuals clustered within groups. Estimation of structural equation models using raw data allows for incomplete data, and so all groups can be retained for analysis even if only 1 member of a group contributes…

  19. Wrist immobilization after carpal tunnel release: a prospective study

    OpenAIRE

    Martins Roberto S.; Siqueira Mario G.; Simplício Hougelli

    2006-01-01

    This prospective study evaluates the possible advantages of wrist imobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuosly for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment...

  20. Markovian Geology Prediction Approach and its Application in Mountain Tunnels

    OpenAIRE

    Guan, Zhenchang; Deng, Tao; Du, Saizhao; Li, Bo; Jiang, Yujing

    2012-01-01

    A geology prediction approach based on Markov random process and Bayesian updating procedure is presented in this article. It can dynamically predict the ground conditions ahead of tunnel face in a probabilistic way with very low cost, when the tunnel face advances and new geological information is revealed. The application case study on Chuangshi Tunnel project shows that the prediction results fit the real grounds condition well, especially for the short range ahead of face. This approach c...

  1. Sum of ratios of products forα-μ random variables in wireless multihop relaying and multiple scattering

    KAUST Repository

    Wang, Kezhi

    2014-09-01

    The sum of ratios of products of independent 2642 2642α-μ random variables (RVs) is approximated by using the Generalized Gamma ratio approximation (GGRA) with Gamma ratio approximation (GRA) as a special case. The proposed approximation is used to calculate the outage probability of the equal gain combining (EGC) or maximum ratio combining (MRC) receivers for wireless multihop relaying or multiple scattering systems considering interferences. Numerical results show that the newly derived approximation works very well verified by the simulation, while GRA has a slightly worse performance than GGRA when outage probability is below 0.1 but with a more simplified form.

  2. Random effects modeling of multiple binomial responses using the multivariate binomial logit-normal distribution.

    Science.gov (United States)

    Coull, B A; Agresti, A

    2000-03-01

    The multivariate binomial logit-normal distribution is a mixture distribution for which, (i) conditional on a set of success probabilities and sample size indices, a vector of counts is independent binomial variates, and (ii) the vector of logits of the parameters has a multivariate normal distribution. We use this distribution to model multivariate binomial-type responses using a vector of random effects. The vector of logits of parameters has a mean that is a linear function of explanatory variables and has an unspecified or partly specified covariance matrix. The model generalizes and provides greater flexibility than the univariate model that uses a normal random effect to account for positive correlations in clustered data. The multivariate model is useful when different elements of the response vector refer to different characteristics, each of which may naturally have its own random effect. It is also useful for repeated binary measurement of a single response when there is a nonexchangeable association structure, such as one often expects with longitudinal data or when negative association exists for at least one pair of responses. We apply the model to an influenza study with repeated responses in which some pairs are negatively associated and to a developmental toxicity study with continuation-ratio logits applied to an ordinal response with clustered observations.

  3. Effects of aerobic exercise and yoga on fatigue and general health of patients with multiple sclerosis: a randomized trial

    Directory of Open Access Journals (Sweden)

    Ali Hassanpour Dehkordi

    2016-01-01

    Full Text Available Background: Multiple sclerosis (MS is a common disease of central nervous system (CNS that causes sensorimotor complications through demyelination of CNS neurons. This study was aimed to evaluate the effects of aerobic exercise and yoga on the fatigue and general health of patients with multiple sclerosis. Methods: In this clinical trial, the samples were randomly assigned to three groups of yoga (n: 30, aerobics exercises (n: 30, and control group (n: 30. The data were analyzed by SPSS software using descriptive statistics (mean and standard deviation, ANOVA and independent and pair t-test. Results: The results indicated no significant difference in fatigue and general health among the three groups prior to the study, but after the study, the results showed a significant difference in general health and fatigue in yoga and aerobic exercise groups. Conclusion: Yoga and aerobics exercise decreased the fatigue, promoted the general health, and improved the psychological performance and efficiency of MS patients.

  4. Alzheimer’s disease multiple intervention trial (ADMIT: study protocol for a randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Callahan Christopher M

    2012-06-01

    Full Text Available Abstract Background Given the current lack of disease-modifying therapies, it is important to explore new models of longitudinal care for older adults with dementia that focus on improving quality of life and delaying functional decline. In a previous clinical trial, we demonstrated that collaborative care for Alzheimer’s disease reduces patients’ neuropsychiatric symptoms as well as caregiver stress. However, these improvements in quality of life were not associated with delays in subjects’ functional decline. Trial design Parallel randomized controlled clinical trial with 1:1 allocation. Participants A total of 180 community-dwelling patients aged ≥45 years who are diagnosed with possible or probable Alzheimer’s disease; subjects must also have a caregiver willing to participate in the study and be willing to accept home visits. Subjects and their caregivers are enrolled from the primary care and geriatric medicine practices of an urban public health system serving Indianapolis, Indiana, USA. Interventions All patients receive best practices primary care including collaborative care by a dementia care manager over two years; this best practices primary care program represents the local adaptation and implementation of our prior collaborative care intervention in the urban public health system. Intervention patients also receive in-home occupational therapy delivered in twenty-four sessions over two years in addition to best practices primary care. The focus of the occupational therapy intervention is delaying functional decline and helping both subjects and caregivers adapt to functional impairments. The in-home sessions are tailored to the specific needs and goals of each patient-caregiver dyad; these needs are expected to change over the course of the study. Objective To determine whether best practices primary care plus home-based occupational therapy delays functional decline among patients with Alzheimer’s disease compared

  5. The effects of a group-based cognitive behavioral therapy on people with multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Graziano, Federica; Calandri, Emanuela; Borghi, Martina; Bonino, Silvia

    2014-03-01

    To evaluate the effectiveness of a cognitive behavioral group-based intervention aimed at reducing depression and fostering quality of life and psychological well-being of multiple sclerosis patients through the promotion of identity redefinition, sense of coherence, and self-efficacy. A randomized controlled trial. Non-medical setting, external to the Multiple Sclerosis Clinic Centre. Eighty-two patients: 64% women; mean age 40.5, SD = 9.4; 95% with relapsing-remitting multiple sclerosis; Expanded Disability Status Scale (EDSS) between 1 and 5.5 were included in the study. Patients were randomly assigned to an intervention group (five cognitive behavioral group-based sessions, n = 41) or to a control group (three informative sessions, n = 41). Depression (CES-D), Quality of life (MSQOL revised), Psychological well-being (PANAS), Identity Motives Scale, Sense of Coherence (SOC), and Self Efficacy in Multiple Sclerosis. Quality of life increased in the intervention group compared with the control at 6-months follow-up (mean change 0.72 vs. -1.76, p < 0.05). Well-being in the intervention group increased for males and slightly decreased for females at 6-months follow-up (mean change 6.58 vs. -0.82, p < 0.05). Contrasts revealed an increase in self-efficacy in the intervention group at posttreatment compared with the control (mean change 2.95 vs. -0.11, p < 0.05). Depression tended to lower, while identity and coherence increased in the intervention group compared with the control, though the differences were not significant. Preliminary evidence suggests that intervention promotes patients' quality of life and has an effect on psychological well-being and self-efficacy.

  6. Proton tunneling in solids

    Energy Technology Data Exchange (ETDEWEB)

    Kondo, J.

    1998-10-01

    The tunneling rate of the proton and its isotopes between interstitial sites in solids is studied theoretically. The phonons and/or the electrons in the solid have two effects on the tunneling phenomenon. First, they suppress the transfer integral between two neighbouring states. Second, they give rise to a finite lifetime of the proton state. Usually the second effect is large and the tunneling probability per unit time (tunneling rate) can be defined. In some cases, however, a coherent tunneling is expected and actually observed. (author)

  7. Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Tarakci, Ela; Yeldan, Ipek; Huseyinsinoglu, Burcu E; Zenginler, Yonca; Eraksoy, Mefkure

    2013-09-01

    To determine the effectiveness of group exercise training on balance, functional status, spasticity, fatigue and quality of life in patients with multiple sclerosis. A randomized single-blind controlled study. University hospital, outpatient physical therapy department. Ambulatory patients with multiple sclerosis. Exercise group completed a 12-week group exercise programme under the physical therapists' supervision. Control group was included in the waiting list. The primary outcome measures were the Berg Balance Scale, 10-metre walk test, 10-steps climbing test and secondary outcome measures were the Modified Ashworth Scale, Fatigue Severity Scale and Multiple Sclerosis International Quality of Life. Ninety-nine patients completed the study. There were statistically significant improvements for all outcome measures in the group exercise group (n = 51) (p exercise group, while a decreased of 2.33 in control group. The 10-metre walk test duration (second) was decreased 2.72 in exercise group, while increased 1.44 in control group. In comparing inter-groups changes, both primary and secondary outcome mesures showed significant improvements in favour of the exercise group after the training (p exercise training is effective in improving balance, functional status, spasticity, fatigue and quality of life in moderately affected people with multiple sclerosis, with no worsening of their clinical status.

  8. Developing a pooled job physical exposure data set from multiple independent studies: an example of a consortium study of carpal tunnel syndrome.

    Science.gov (United States)

    Bao, Stephen S; Kapellusch, Jay M; Garg, Arun; Silverstein, Barbara A; Harris-Adamson, Carisa; Burt, Susan E; Dale, Ann Marie; Evanoff, Bradley A; Gerr, Frederic E; Hegmann, Kurt T; Merlino, Linda A; Thiese, Matthew S; Rempel, David M

    2015-02-01

    Six research groups independently conducted prospective studies of carpal tunnel syndrome (CTS) incidence in 54 US workplaces in 10 US States. Physical exposure variables were collected by all research groups at the individual worker level. Data from these research groups were pooled to increase the exposure spectrum and statistical power. This paper provides a detailed description of the characteristics of the pooled physical exposure variables and the source data information from the individual research studies. Physical exposure data were inspected and prepared by each of the individual research studies according to detailed instructions provided by an exposure subcommittee of the research consortium. Descriptive analyses were performed on the pooled physical exposure data set. Correlation analyses were performed among exposure variables estimating similar exposure aspects. At baseline, there were a total of 3010 participants in the pooled physical exposure data set. Overall, the pooled data meaningfully increased the spectra of most exposure variables. The increased spectra were due to the wider range in exposure data of different jobs provided by the research studies. The correlations between variables estimating similar exposure aspects showed different patterns among data provided by the research studies. The increased spectra of the physical exposure variables among the data pooled likely improved the possibility of detecting potential associations between these physical exposure variables and CTS incidence. It is also recognised that methods need to be developed for general use by all researchers for standardisation of physical exposure variable definition, data collection, processing and reduction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Time trends in incidence and prevalence of carpal tunnel syndrome over eight years according to multiple data sources: Pays de la Loire study.

    Science.gov (United States)

    Roquelaure, Yves; Chazelle, Emilie; Gautier, Ludivine; Plaine, Julie; Descatha, Alexis; Evanoff, Bradley; Bodin, Julie; Fouquet, Natacha; Catherine, Buisson

    2017-01-01

    Objective The aim of this study was to describe time trends of incidence/prevalence of carpal tunnel syndrome (CTS), one of the most common musculoskeletal disorders, in a French region over an 8-year period. Methods Three independent data sources were analyzed for the population of the Pays de la Loire region aged 20-59 between 2004 and 2011: hospital discharge records for "surgically treated CTS" (SURG-CTS), the social insurance data on "CTS compensated for as an occupational disease" (OD-CTS), and the regional surveillance program of "work-related diseases" (WRD-CTS). Case counts were analyzed using negative binomial regression models and cubic spline curves with year as the main covariate. Results The annual incidence rates of SURG-CTS decreased from 3.35 to 2.98 per 1000 person-years over the 8-year period, with an overall declining trend [-2.00%, 95% confidence interval (95% CI) -3.07- -0.91%), P<0.001]. The annual incidence rate of OD-CTS per 1000 person-years decreased (from 1.52 to 1.01) between 2004 and 2007 and increased after 2007 (from 1.45 to 2.34), with an overall gain of 54% during the study period. The prevalence rate of WRD-CTS decreased from 5.04 (95% CI 3.90-6.13) to 3.08 (95% CI 2.11-4.06) per 1000 employed person-years, with a non-significant trend between 2004 and 2011. Conclusion The study showed declining rates of SURG-CTS and WRD-CTS in the population of working age between 2004 and 2011, contrasting with increasing rate of OD-CTS after 2007. More research and surveillance data are needed to assess whether and to what extent the declining rates of CTS are actually attributable to improvement in working conditions and/or to non-occupational factors.

  10. Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial.

    Science.gov (United States)

    Gobbato, Luca; Nart, Jose; Bressan, Eriberto; Mazzocco, Fabio; Paniz, Gianluca; Lops, Diego

    2016-11-01

    Subepithelial connective tissue grafts (SeCTG) in conjunction with a coronally advanced flap (CAF) or with tunneling technique (TT) are common periodontal procedures with similar indications for the treatment of a denuded root surface; however, it is unclear whether patient discomfort and postoperative morbidity are comparable in both approaches. The aim of this randomized controlled clinical trial was to compare the patient morbidity and root coverage outcomes of a SeCTG used in combination with a CAF or TT. For this single-center, randomized, clinical trial, patients were randomly assigned to receive SeCTG + CAF (control group) or SeCTG + TT (test group). Postoperative questionnaires at 3 days post intervention were administered to evaluate postoperative discomfort, bleeding, and inability to masticate. Evaluation of patients' perception of pain was performed using a visual analog scale (VAS). Clinical outcomes including percentage of root coverage (RC) and complete root coverage (CRC) were recorded 12 months postoperatively. Fifty patients (25 SeCTG + CAF and 25 SeCTG + TT) completed the study. Healing was uneventful for all test and control patients. The SeCTG + TT group showed a longer chair time (33.6 (3.6) and 23.6 (4.2) min for the SeCTG + TT and the SeCTG + CAF, respectively), as well as more painkiller consumption: 2736 vs. 1536 mg (p < 0.001). At the same time, the SeCTG + CAF group reported less pain or discomfort in all four sections of the questionnaire: pain experienced within the mouth as a whole, pain experienced throughout the day, pain experienced at night, and edema experienced after the surgery (p = 0.002, p = 0.001, p = 0.001, and p = 0001, respectively). Both treatments showed clinical efficacy in terms of root coverage as no differences per group were observed in the percentage of root coverage (87 vs. 85 %, p = 704) or patients with complete root coverage (60 vs. 52 %, p = 0.569). SeCTG + TT is

  11. Harmonic functions on multiplicative graphs and inverse Pitman transform on infinite random paths

    OpenAIRE

    Lecouvey, Cédric; Lesigne, Emmanuel; Peigné, Marc

    2014-01-01

    27 pages, minor corrections and a simpler definition of the Pitman inverse.; We introduce and characterize central probability distributions on Littelmann paths. Next we establish a law of large numbers and a central limit theorem for the generalized Pitmann transform. We then study harmonic functions on multiplicative graphs defined from the tensor powers of finite-dimensional Lie algebras representations. Finally, we show there exists an inverse of the generalized Pitman transform defined a...

  12. Treatment of multiple adjacent maxillary Miller Class I, II, and III gingival recessions with the modified coronally advanced tunnel, enamel matrix derivative, and subepithelial connective tissue graft: A report of 12 cases.

    Science.gov (United States)

    Sculean, Anton; Cosgarea, Raluca; Stähli, Alexana; Katsaros, Christos; Arweiler, Nicole Birgit; Miron, Richard John; Deppe, Herbert

    2016-01-01

    To clinically evaluate the healing of multiple adjacent maxillary Miller Class I, II, and III gingival recessions (MAGR) treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG). Twelve systemically healthy patients (6 females) with a total of 54 adjacent maxillary Miller Class I, II, or III MAGR were consecutively treated with MCAT in conjunction with EMD and SCTG. Out of the 54 recessions, 44 were classified as Miller Class I, five as Miller Class II, and five as Miller Class III. Patients were included in the study if they presented at least two adjacent recessions with a depth of ≥ 3 mm. Measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). Healing was uneventful in all cases without any complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG. At 12 months, statistically highly significant (P tissue width increased statistically highly significantly (P < .004) from 2.04 ± 0.95 mm at baseline to 2.37 ± 0.89 mm at 12 months. The present findings indicate that the proposed treatment concept results in predictable coverage of multiple adjacent maxillary Miller Class I, II, and III MAGR.

  13. [Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: a randomized controlled trial].

    Science.gov (United States)

    Gaspard, L; Tombal, B; Opsomer, R-J; Castille, Y; Van Pesch, V; Detrembleur, C

    2014-09-01

    This randomized controlled trial compare the efficacy of pelvic floor muscle training vs. transcutaneous posterior tibial nerve stimulation. Inclusion criteria were EDSS scorepregnancy. The primary outcome was quality of life (SF-Qualiveen questionnaire). Secondary outcomes included overactive bladder (USP questionnaire) score and frequency of urgency episodes (3-day bladder diary). Sample size was calculated after 18 patients were included. Data analysis was blinded. Each patient received 9 sessions of 30 minutes weekly. Patients were randomized in pelvic floor muscles exercises with biofeedback group (muscle endurance and relaxation) or transcutaneous posterior tibial nerve stimulation group (rectangular alternative biphasic current with low frequency). A total of 31 patients were included. No difference appeared between groups for quality of life, overactive bladder and frequency of urgency episodes (respectively P=0.197, P=0.532 et P=0.788). These parameters were significantly improved in pelvic floor muscle training group (n=16) (respectively P=0.004, P=0.002 et P=0.006) and in transcutaneous posterior tibial nerve stimulation group (n=15) (respectively P=0.001, P=0.001 et P=0.031). Pelvic floor muscle training and transcutaneous posterior tibial nerve stimulation improved in the same way symptoms related to urgency in MS patients with mild disability. 2. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Azathioprine versus Beta Interferons for Relapsing-Remitting Multiple Sclerosis: A Multicentre Randomized Non-Inferiority Trial

    Science.gov (United States)

    Massacesi, Luca; Tramacere, Irene; Amoroso, Salvatore; Battaglia, Mario A.; Benedetti, Maria Donata; Filippini, Graziella; La Mantia, Loredana; Repice, Anna; Solari, Alessandra; Tedeschi, Gioacchino; Milanese, Clara

    2014-01-01

    For almost three decades in many countries azathioprine has been used to treat relapsing-remitting multiple sclerosis. However its efficacy was usually considered marginal and following approval of β interferons for this indication it was no longer recommended as first line treatment, even if presently no conclusive direct β interferon-azathioprine comparison exists. To compare azathioprine efficacy versus the currently available β interferons in relapsing-remitting multiple sclerosis, a multicenter, randomized, controlled, single-blinded, non-inferiority trial was conducted in 30 Italian multiple sclerosis centers. Eligible patients (relapsing-remitting course; ≥2 relapses in the last 2 years) were randomly assigned to azathioprine or β interferons. The primary outcome was annualized relapse rate ratio (RR) over 2 years. Key secondary outcome was number of new brain MRI lesions. Patients (n = 150) were randomized in 2 groups (77 azathioprine, 73 β interferons). At 2 years, clinical evaluation was completed in 127 patients (62 azathioprine, 65 β interferons). Annualized relapse rate was 0.26 (95% Confidence Interval, CI, 0.19–0.37) in the azathioprine and 0.39 (95% CI 0.30–0.51) in the interferon group. Non-inferiority analysis showed that azathioprine was at least as effective as β interferons (relapse RRAZA/IFN 0.67, one-sided 95% CI 0.96; p<0.01). MRI outcomes were analyzed in 97 patients (50 azathioprine and 47 β interferons). Annualized new T2 lesion rate was 0.76 (95% CI 0.61–0.95) in the azathioprine and 0.69 (95% CI 0.54–0.88) in the interferon group. Treatment discontinuations due to adverse events were higher (20.3% vs. 7.8%, p = 0.03) in the azathioprine than in the interferon group, and concentrated within the first months of treatment, whereas in the interferon group discontinuations occurred mainly during the second year. The results of this study indicate that efficacy of azathioprine is not inferior to that of

  15. Thalidomide versus dexamethasone for the treatment of relapsed and/or refractory multiple myeloma: results from OPTIMUM, a randomized trial

    Science.gov (United States)

    Kropff, Martin; Baylon, Honorata Giongco; Hillengass, Jens; Robak, Tadeusz; Hajek, Roman; Liebisch, Peter; Goranov, Stefan; Hulin, Cyrille; Bladé, Joan; Caravita, Tommaso; Avet-Loiseau, Herve; Moehler, Thomas M.; Pattou, Claire; Lucy, Lela; Kueenburg, Elisabeth; Glasmacher, Axel; Zerbib, Robert; Facon, Thierry

    2012-01-01

    Background Thalidomide has potent antimyeloma activity, but no prospective, randomized controlled trial has evaluated thalidomide monotherapy in patients with relapsed/refractory multiple myeloma. Design and Methods We conducted an international, randomized, open-label, four-arm, phase III trial to compare three different doses of thalidomide (100, 200, or 400 mg/day) with standard dexamethasone in patients who had received one to three prior therapies. The primary end-point was time to progression. Results In the intent-to-treat population (N=499), the median time to progression was 6.1, 7.0, 7.6, and 9.1 months in patients treated with dexamethasone, and thalidomide 100, 200, and 400 mg/day, respectively; the difference between treatment groups was not statistically significant. In the per-protocol population (n=465), the median time to progression was 6.0, 7.0, 8.0, and 9.1 months, respectively. In patients who had received two or three prior therapies, thalidomide significantly prolonged the time to progression at all dose levels compared to the result achieved with dexamethasone. Response rates and median survival were similar in all treatment groups, but the median duration of response was significantly longer in all thalidomide groups than in the dexamethasone group. Adverse events reported in the thalidomide groups, such as fatigue, constipation and neuropathy, confirmed the known safety profile of thalidomide. Conclusions Although thalidomide was not superior to dexamethasone in this randomized trial, thalidomide monotherapy may be considered an effective salvage therapy option for patients with relapsed/refractory multiple myeloma, particularly those with a good prognosis and those who have received two or three prior therapies. The recommended starting dose of thalidomide monotherapy is 400 mg/day, which can be rapidly reduced for patients who do not tolerate this treatment. (Clinical trial registration number: NCT00452569) PMID:22133776

  16. Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Kalron, Alon; Rosenblum, Uri; Frid, Lior; Achiron, Anat

    2017-03-01

    Evaluate the effects of a Pilates exercise programme on walking and balance in people with multiple sclerosis and compare this exercise approach to conventional physical therapy sessions. Randomized controlled trial. Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Forty-five people with multiple sclerosis, 29 females, mean age (SD) was 43.2 (11.6) years; mean Expanded Disability Status Scale (S.D) was 4.3 (1.3). Participants received 12 weekly training sessions of either Pilates ( n=22) or standardized physical therapy ( n=23) in an outpatient basis. Spatio-temporal parameters of walking and posturography parameters during static stance. Functional tests included the Time Up and Go Test, 2 and 6-minute walk test, Functional Reach Test, Berg Balance Scale and the Four Square Step Test. In addition, the following self-report forms included the Multiple Sclerosis Walking Scale and Modified Fatigue Impact Scale. At the termination, both groups had significantly increased their walking speed ( P=0.021) and mean step length ( P=0.023). According to the 2-minute and 6-minute walking tests, both groups at the end of the intervention program had increased their walking speed. Mean (SD) increase in the Pilates and physical therapy groups were 39.1 (78.3) and 25.3 (67.2) meters, respectively. There was no effect of group X time in all instrumented and clinical balance and gait measures. Pilates is a possible treatment option for people with multiple sclerosis in order to improve their walking and balance capabilities. However, this approach does not have any significant advantage over standardized physical therapy.

  17. Methods for synthesizing findings on moderation effects across multiple randomized trials.

    Science.gov (United States)

    Brown, C Hendricks; Sloboda, Zili; Faggiano, Fabrizio; Teasdale, Brent; Keller, Ferdinand; Burkhart, Gregor; Vigna-Taglianti, Federica; Howe, George; Masyn, Katherine; Wang, Wei; Muthén, Bengt; Stephens, Peggy; Grey, Scott; Perrino, Tatiana

    2013-04-01

    This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

  18. A randomized trial of teriflunomide added to glatiramer acetate in relapsing multiple sclerosis.

    Science.gov (United States)

    Freedman, M S; Wolinsky, J S; Truffinet, P; Comi, G; Kappos, L; Miller, A E; Olsson, T P; Benamor, M; Chambers, S; O'Connor, P W

    2015-01-01

    Teriflunomide is a once-daily oral immunomodulator for the treatment of relapsing-remitting MS. To evaluate the safety and tolerability of teriflunomide as add-on therapy to a stable dose of glatiramer acetate (GA) in patients with relapsing forms of MS (RMS). Phase II, randomized, double-blind, add-on, placebo-controlled study. The primary objective was to assess safety and tolerability; secondary objectives were to evaluate effects of treatment on disease activity assessed by MRI and relapse. Patients with RMS on GA (N = 123) were randomized 1:1:1 to receive teriflunomide 14 mg (n = 40), 7 mg (n = 42), or placebo (n = 41) for 24 weeks; 96 patients entered the 24-week extension, remaining on original treatment allocation. Teriflunomide was well tolerated over 48 weeks. The frequency of adverse events (AEs) was low across all groups; 5 (12.2%), 3 (7.1%), and 2 (5.0%) patients in the 14 mg, 7 mg, and placebo groups, respectively, discontinued treatment due to AEs. Teriflunomide reduced the number of T1-Gd lesions vs placebo (14 mg: 46.6% relative reduction, p = 0.1931; 7 mg: 64.0%: relative reduction, p = 0.0306). Teriflunomide added to stable-dose GA had acceptable safety and tolerability, and reduced some MRI markers of disease activity compared with GA alone. NCT00475865 (core study); NCT00811395 (extension).

  19. Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS Trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Dörr Jan

    2012-02-01

    Full Text Available Abstract Background Multiple sclerosis is the most common chronic inflammatory disease of the central nervous system in young adults. Despite the fact that numerous lines of evidence link both the risk of disease development and the disease course to the serum level of 25-hydroxyvitamin D it still remains elusive whether multiple sclerosis patients benefit from boosting the serum level of 25-hydroxyvitamin D, mainly because interventional clinical trials that directly address the therapeutic effects of vitamin D in multiple sclerosis are sparse. We here present the protocol of an interventional clinical phase II study to test the hypothesis, that high-dose vitamin D supplementation of multiple sclerosis patients is safe and superior to low-dose supplementation with respect to beneficial therapeutic effects. Methods/Design The EVIDIMS trial is a German multi-center, stratified, randomized, controlled and double-blind clinical phase II pilot study. Eighty patients with the diagnosis of definite multiple sclerosis or clinically isolated syndrome who are on a stable immunomodulatory treatment with interferon-β1b will be randomized to additionally receive either high-dose (average daily dose 10.200 IU or low-dose (average daily dose 200 IU cholecalciferol for a total period of 18 months. The primary outcome measure is the number of new lesions detected on T2-weighted cranial MRI at 3 tesla. Secondary endpoints include additional magnetic resonance imaging and optical coherence tomography parameters for neuroinflammation and -degeneration, clinical parameters for disease activity, as well as cognition, fatigue, depression, and quality of life. Safety and tolerability of high-dose vitamin D supplementation are further outcome parameters. Discussion In light of the discrepancy between existing epidemiological and preclinical data on the one hand and available clinical data on the other the EVIDIMS trial will substantially contribute to the evaluation

  20. Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial

    Science.gov (United States)

    Puntumetakul, Rungthip; Suvarnnato, Thavatchai; Werasirirat, Phurichaya; Uthaikhup, Sureeporn; Yamauchi, Junichiro; Boucaut, Rose

    2015-01-01

    Background Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP). Methods Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM) at T6–T7 or multiple-level thoracic manipulation (MTM), or to a control group (prone lying). Cervical range of motion (CROM), visual analog scale (VAS), and the Thai version of the Neck Disability Index (NDI-TH) scores were measured at baseline, and at 24-hour and at 1-week follow-up. Results At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (Pneck disability, pain level at rest, and CROM between the STM and MTM groups. Conclusion These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability, pain levels, and CROM at 24-hour and 1-week follow-up in patients with CMNP. PMID:25624764

  1. Uncorrelated multiple conductive filament nucleation and rupture in ultra-thin high-κ dielectric based resistive random access memory

    Science.gov (United States)

    Wu, Xing; Li, Kun; Raghavan, Nagarajan; Bosman, Michel; Wang, Qing-Xiao; Cha, Dongkyu; Zhang, Xi-Xiang; Pey, Kin-Leong

    2011-08-01

    Resistive switching in transition metal oxides could form the basis for next-generation non-volatile memory (NVM). It has been reported that the current in the high-conductivity state of several technologically relevant oxide materials flows through localized filaments, but these filaments have been characterized only individually, limiting our understanding of the possibility of multiple conductive filaments nucleation and rupture and the correlation kinetics of their evolution. In this study, direct visualization of uncorrelated multiple conductive filaments in ultra-thin HfO2-based high-κ dielectric resistive random access memory (RRAM) device has been achieved by high-resolution transmission electron microscopy (HRTEM), along with electron energy loss spectroscopy (EELS), for nanoscale chemical analysis. The locations of these multiple filaments are found to be spatially uncorrelated. The evolution of these microstructural changes and chemical properties of these filaments will provide a fundamental understanding of the switching mechanism for RRAM in thin oxide films and pave way for the investigation into improving the stability and scalability of switching memory devices.

  2. Uncorrelated multiple conductive filament nucleation and rupture in ultra-thin high-κ dielectric based resistive random access memory

    KAUST Repository

    Wu, Xing

    2011-08-29

    Resistive switching in transition metal oxides could form the basis for next-generation non-volatile memory (NVM). It has been reported that the current in the high-conductivity state of several technologically relevant oxide materials flows through localized filaments, but these filaments have been characterized only individually, limiting our understanding of the possibility of multiple conductive filaments nucleation and rupture and the correlation kinetics of their evolution. In this study, direct visualization of uncorrelated multiple conductive filaments in ultra-thin HfO2-based high-κ dielectricresistive random access memory (RRAM) device has been achieved by high-resolution transmission electron microscopy (HRTEM), along with electron energy loss spectroscopy(EELS), for nanoscale chemical analysis. The locations of these multiple filaments are found to be spatially uncorrelated. The evolution of these microstructural changes and chemical properties of these filaments will provide a fundamental understanding of the switching mechanism for RRAM in thin oxide films and pave way for the investigation into improving the stability and scalability of switching memory devices.

  3. Protocol for the saMS trial (supportive adjustment for multiple sclerosis: a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

    Directory of Open Access Journals (Sweden)

    McCrone Paul

    2009-08-01

    Full Text Available Abstract Background Multiple Sclerosis (MS is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a Cognitive Behavioural intervention compared to Supportive Listening to assist adjustment in the early stages of MS. Methods/Design This is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks, mid-therapy (week 5 of therapy, post-therapy (15 weeks and at six months (26 weeks and twelve months (52 weeks follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants' experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. Discussion This trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the

  4. Metabolic response to epigallocatechin-3-gallate in relapsing-remitting multiple sclerosis: a randomized clinical trial.

    Science.gov (United States)

    Mähler, Anja; Steiniger, Jochen; Bock, Markus; Klug, Lars; Parreidt, Nadine; Lorenz, Mario; Zimmermann, Benno F; Krannich, Alexander; Paul, Friedemann; Boschmann, Michael

    2015-03-01

    Muscle weakness and fatigue are common symptoms in multiple sclerosis (MS). Green tea catechins such as (-)epigallocatechin-3-gallate (EGCG) are known to improve energy metabolism at rest and during exercise. We tested the hypothesis that EGCG improves energy metabolism and substrate utilization in patients with MS. Eighteen patients (8 men) with relapsing-remitting MS (expanded disability status scale score women). After placebo, exercise EE was mainly fueled by FAOx in both men and women. After EGCG, there was a shift to a higher and more stable CHOx during exercise in men but not in women. Our data indicate that EGCG given to patients with MS over 12 wk improves muscle metabolism during moderate exercise to a greater extent in men than in women, possibly because of sex-specific effects on autonomic and endocrine control. © 2015 American Society for Nutrition.

  5. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

    Directory of Open Access Journals (Sweden)

    Cinnamon S. Bloss

    2016-01-01

    Full Text Available Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large

  6. Critical side channel effects in random bit generation with multiple semiconductor lasers in a polarization-based quantum key distribution system.

    Science.gov (United States)

    Ko, Heasin; Choi, Byung-Seok; Choe, Joong-Seon; Kim, Kap-Joong; Kim, Jong-Hoi; Youn, Chun Ju

    2017-08-21

    Most polarization-based BB84 quantum key distribution (QKD) systems utilize multiple lasers to generate one of four polarization quantum states randomly. However, random bit generation with multiple lasers can potentially open critical side channels that significantly endangers the security of QKD systems. In this paper, we show unnoticed side channels of temporal disparity and intensity fluctuation, which possibly exist in the operation of multiple semiconductor laser diodes. Experimental results show that the side channels can enormously degrade security performance of QKD systems. An important system issue for the improvement of quantum bit error rate (QBER) related with laser driving condition is further addressed with experimental results.

  7. The Superluminal Tunneling Story

    OpenAIRE

    Aichmann, Horst; Nimtz, Günter

    2013-01-01

    Since 1992 experimental evidence of superluminal (faster than light, FTL) signals are causing much excitement in the physical community and in the media. Superluminal signal velocity and zero time tunneling was first observed in an analog tunneling experiment with microwaves. Recently, the conjectured zero time of electron was claimed to be observed in ionizing helium. The FTL signal velocity was reproduced with infrared light and with various tunneling barriers in several laboratories worldw...

  8. A multicenter randomized crossover multiple-dose comparison study of arotinolol and propranolol in essential tremor.

    Science.gov (United States)

    Lee, Kwang-Soo; Kim, Joong-Seok; Kim, Jae-Woo; Lee, Won-Yong; Jeon, Beum-Seok; Kim, Dongjae

    2003-08-01

    A new medication is needed to treat essential tremor. Preliminary evidence suggests that arotinolol may be effective in the treatment of this disorder. To study the effect of arotinolol and propranolol in a crossover, multiple dose comparative trial of patients with essential tremor. One hundred and seventy-five outpatients, with essential tremor were included in the study; 161 patients completed the study. Patients were identically evaluated at eight consecutive visits. The study consisted of two treatments, which were arranged according to a crossover design that evaluated the dose of each (arotinolol 10 mg per day and propranolol 40 mg per day, arotinolol 20 mg per day and propranolol 80 mg per day, arotinolol 30 mg per day and propranolol 160 mg per day). Each course of treatment lasted 6 weeks. Major outcome evaluations consisted of a self-reported disability scale, and motor performance score obtained before drug intake and 14 days after each treatment. The treatment effects were evaluated by analysis of variance using the Hills-Armitage test. Arotinolol was found to be as effective as propranolol at reducing tremor. Drug effects as evaluated using motor-task performance scores revealed that arotinolol had a more significant effect than propranolol. Arotinolol may be more useful than propranolol for the treatment of essential tremor.

  9. Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial.

    Science.gov (United States)

    Kasari, Connie; Kaiser, Ann; Goods, Kelly; Nietfeld, Jennifer; Mathy, Pamela; Landa, Rebecca; Murphy, Susan; Almirall, Daniel

    2014-06-01

    This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism. A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample. Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes. Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545. Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  10. Communication Interventions for Minimally Verbal Children With Autism: Sequential Multiple Assignment Randomized Trial

    Science.gov (United States)

    Kasari, Connie; Kaiser, Ann; Goods, Kelly; Nietfeld, Jennifer; Mathy, Pamela; Landa, Rebecca; Murphy, Susan; Almirall, Daniel

    2014-01-01

    Objective This study tested the effect of beginning treatment with a speech-generating device in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism. Method Sixty-one minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a speech-generating device (SGD) for 6 months with a 3-month follow-up. The intervention consisted of two stages. In Stage 1 all children received two sessions per week for 3 months. Stage 2 intervention was adapted (increased sessions or adding the SGD) based on the child’s early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were total number of novel words and total comments from a natural language sample. Results Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better post-treatment outcomes. Conclusion Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children’s response to treatment. Clinical trial registration information—Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545. PMID:24839882

  11. A Novel Randomized Search Technique for Multiple Mobile Robot Paths Planning In Repetitive Dynamic Environment

    Directory of Open Access Journals (Sweden)

    Vahid Behravesh

    2012-08-01

    Full Text Available Presented article is studying the issue of path navigating for numerous robots. Our presented approach is based on both priority and the robust method for path finding in repetitive dynamic. Presented model can be generally implementable and useable: We do not assume any restriction regarding the quantity of levels of freedom for robots, and robots of diverse kinds can be applied at the same time. We proposed a random method and hill-climbing technique in the area based on precedence plans, which is used to determine a solution to a given trajectory planning problem and to make less the extent of total track. Our method plans trajectories for particular robots in the setting-time scope. Therefore, in order to specifying the interval of constant objects similar to other robots and the extent of the tracks which is traversed. For measuring the hazard for robots to conflict with each other it applied a method based on probability of the movements of robots. This algorithm applied to real robots with successful results. The proposed method performed and judged on both real robots and in simulation. We performed sequence of100tests with 8 robots for comparing with coordination method and current performances are effective. However, maximizing the performance is still possible. These performances estimations performed on Windows operating system and 3GHz Intel Pentium IV with and compiles with GCC 3.4. We used our PCGA robot for all experiments.  For a large environment of 19×15m2where we accomplished 40tests, our model is competent to plan high-quality paths in a severely short time (less than a second. Moreover, this article utilized lookup tables to keep expenses the formerly navigated robots made, increasing the number of robots don’t expand computation time.

  12. Microsystem Aeromechanics Wind Tunnel

    Data.gov (United States)

    Federal Laboratory Consortium — The Microsystem Aeromechanics Wind Tunnel advances the study of fundamental flow physics relevant to micro air vehicle (MAV) flight and assesses vehicle performance...

  13. Well controlled multiple resistive switching states in the Al local doped HfO2 resistive random access memory device

    Science.gov (United States)

    Chen, Y. S.; Chen, B.; Gao, B.; Liu, L. F.; Liu, X. Y.; Kang, J. F.

    2013-04-01

    The resistive switching behaviors in the sandwiched Ti/HfO2/Pt devices with different doping condition were systematically investigated. We show that, comparing with the undoped and the Al layer doped HfO2 devices, significant improvement of switching characteristics is achieved in the Al local doped HfO2 device, including uniformity, reliability, and operation current. As a result, well controlled multiple switching states are obtained in the local doping device by modulating the set current compliance or the maximal reset voltage, respectively. Our results suggest that the switching characteristics of HfO2 device are very closely related to the inducement and controlling of conductive filaments' growth in the dielectric layer, which can be considered in the optimization of resistive random access memory device design.

  14. A Parallel Biased Random-Key Genetic Algorithm with Multiple Populations Applied to Irregular Strip Packing Problems

    Directory of Open Access Journals (Sweden)

    Bonfim Amaro Júnior

    2017-01-01

    Full Text Available The irregular strip packing problem (ISPP is a class of cutting and packing problem (C&P in which a set of items with arbitrary formats must be placed in a container with a variable length. The aim of this work is to minimize the area needed to accommodate the given demand. ISPP is present in various types of industries from manufacturers to exporters (e.g., shipbuilding, clothes, and glass. In this paper, we propose a parallel Biased Random-Key Genetic Algorithm (µ-BRKGA with multiple populations for the ISPP by applying a collision-free region (CFR concept as the positioning method, in order to obtain an efficient and fast layout solution. The layout problem for the proposed algorithm is represented by the placement order into the container and the corresponding orientation. In order to evaluate the proposed (µ-BRKGA algorithm, computational tests using benchmark problems were applied, analyzed, and compared with different approaches.

  15. Computed tomography synthesis from magnetic resonance images in the pelvis using multiple random forests and auto-context features

    DEFF Research Database (Denmark)

    Andreasen, Daniel; Morgenthaler Edmund, Jens; Zografos, Vasileios

    2016-01-01

    In radiotherapy treatment planning that is only based on magnetic resonance imaging (MRI), the electron density information usually obtained from computed tomography (CT) must be derived from the MRI by synthesizing a so-called pseudo CT (pCT). This is a non-trivial task since MRI intensities...... are neither uniquely nor quantitatively related to electron density. Typical approaches involve either a classification or regression model requiring specialized MRI sequences to solve intensity ambiguities, or an atlas-based model necessitating multiple registrations between atlases and subject scans....... In this work, we explore a machine learning approach for creating a pCT of the pelvic region from conventional MRI sequences without using atlases. We use a random forest provided with information about local texture, edges and spatial features derived from the MRI. This helps to solve intensity ambiguities...

  16. A group-delivered self-management program reduces spasticity in people with multiple sclerosis: A randomized, controlled pilot trial.

    Science.gov (United States)

    Hugos, Cinda L; Bourdette, Dennis; Chen, Yiyi; Chen, Zunqiu; Cameron, Michelle

    2017-01-01

    Spasticity affects more than 80% of people with multiple sclerosis (MS), affecting activity, participation, and quality of life. Based on an international guideline, an MS spasticity group education and stretching program, MS Spasticity: Take Control (STC), has been developed. The objective of this paper is to determine whether STC with home stretching is associated with greater changes in spasticity than usual care (UC), consisting of an illustrated stretching booklet and home stretching but without group instruction or support, in people with MS. Ambulatory MS patients with self-reported spasticity interfering with daily activities were randomized to STC or UC. Individuals completed questionnaires regarding MS, spasticity, walking, fatigue and mood, and physical measures of spasticity and walking. Thirty-eight of 40 participants completed both assessments. Mean total score and scores on two subscales of the MS Spasticity Scale-88 improved more with STC than with UC (p spasticity more than UC and provided encouraging improvements in other measures.

  17. Advancing Test Capabilities at NASA Wind Tunnels

    Science.gov (United States)

    Bell, James

    2015-01-01

    NASA maintains twelve major wind tunnels at three field centers capable of providing flows at 0.1 M 10 and unit Reynolds numbers up to 45106m. The maintenance and enhancement of these facilities is handled through a unified management structure under NASAs Aeronautics and Evaluation and Test Capability (AETC) project. The AETC facilities are; the 11x11 transonic and 9x7 supersonic wind tunnels at NASA Ames; the 10x10 and 8x6 supersonic wind tunnels, 9x15 low speed tunnel, Icing Research Tunnel, and Propulsion Simulator Laboratory, all at NASA Glenn; and the National Transonic Facility, Transonic Dynamics Tunnel, LAL aerothermodynamics laboratory, 8 High Temperature Tunnel, and 14x22 low speed tunnel, all at NASA Langley. This presentation describes the primary AETC facilities and their current capabilities, as well as improvements which are planned over the next five years. These improvements fall into three categories. The first are operations and maintenance improvements designed to increase the efficiency and reliability of the wind tunnels. These include new (possibly composite) fan blades at several facilities, new temperature control systems, and new and much more capable facility data systems. The second category of improvements are facility capability advancements. These include significant improvements to optical access in wind tunnel test sections at Ames, improvements to test section acoustics at Glenn and Langley, the development of a Supercooled Large Droplet capability for icing research, and the development of an icing capability for large engine testing. The final category of improvements consists of test technology enhancements which provide value across multiple facilities. These include projects to increase balance accuracy, provide NIST-traceable calibration characterization for wind tunnels, and to advance optical instruments for Computational Fluid Dynamics (CFD) validation. Taken as a whole, these individual projects provide significant

  18. Employees' Knowledge of Carpal Tunnel Syndrome.

    Science.gov (United States)

    Gandy-Goldston, Terrie M.

    A study examined employees' knowledge of the causes of carpal tunnel syndrome (CTS), its prevention, and their legal rights after being diagnosed with CTS. A 24-item questionnaire was administered to a random sample of 30 Chicago-area employees who had been afflicted with CTS. Of those surveyed, 99% considered their CTS injury related to their…

  19. Effects of correlations and fees in random multiplicative environments: Implications for portfolio management

    Science.gov (United States)

    Alper, Ofer; Somekh-Baruch, Anelia; Pirvandy, Oz; Schaps, Malka; Yaari, Gur

    2017-08-01

    Geometric Brownian motion (GBM) is frequently used to model price dynamics of financial assets, and a weighted average of multiple GBMs is commonly used to model a financial portfolio. Diversified portfolios can lead to an increased exponential growth compared to a single asset by effectively reducing the effective noise. The sum of GBM processes is no longer a log-normal process and has a complex statistical properties. The nonergodicity of the weighted average process results in constant degradation of the exponential growth from the ensemble average toward the time average. One way to stay closer to the ensemble average is to maintain a balanced portfolio: keep the relative weights of the different assets constant over time. To keep these proportions constant, whenever assets values change, it is necessary to rebalance their relative weights, exposing this strategy to fees (transaction costs). Two strategies that were suggested in the past for cases that involve fees are rebalance the portfolio periodically and rebalance it in a partial way. In this paper, we study these two strategies in the presence of correlations and fees. We show that using periodic and partial rebalance strategies, it is possible to maintain a steady exponential growth while minimizing the losses due to fees. We also demonstrate how these redistribution strategies perform in a phenomenal way on real-world market data, despite the fact that not all assumptions of the model hold in these real-world systems. Our results have important implications for stochastic dynamics in general and to portfolio management in particular, as we show that there is a superior alternative to the common buy-and-hold strategy, even in the presence of correlations and fees.

  20. Online Resource to Promote Vocational Interests Among Job Seekers With Multiple Sclerosis: A Randomized Controlled Trial in Australia.

    Science.gov (United States)

    Dorstyn, Diana; Roberts, Rachel; Murphy, Gregory; Kneebone, Ian; Craig, Ashley; Migliorini, Christine

    2017-09-18

    To provide a preliminary evaluation of the effectiveness of an online resource for job seekers with multiple sclerosis (MS). Randomized controlled design. Community-dwelling cohort. Adults (N = 97) with relapsing-remitting or progressive MS were randomly assigned to one of two groups. Forty-seven accessed an email delivered, 7 module resource, Work and MS, over a 4 week period. Waitlist control participants (n=50) were offered the opportunity to access Work and MS 4 weeks postenrollment. Primary outcomes focused on vocational interests (My Vocational Situation Scale) and self-efficacy in job-seeking activities (Job-Procurement Self Efficacy Scale). Secondary outcomes focused on perceived workplace difficulties (Multiple Sclerosis Work Difficulties Questionnaire [MSWDQ]), optimism (Life Orientation Test - Revised), and mood (Patient Health Questionnaire-9). Intention-to-treat analyses revealed pre-post gains: participants who accessed Work and MS reported improved confidence in their career goals (My Vocational Situation Scale g=.55; 95% confidence interval [CI], .14-.96; P=.008) and positively reappraised potential workplace difficulties (MSWDQ g range, .42-.47; P range, .023-.042). The effect on job self-efficacy was not significant, but changed in the expected direction (g=.17; 95% CI, -.23 to .57; P=.409). Completer data revealed larger, significant effect estimates (g range, .52-.64; P range, .009-.035). Findings provide preliminary support for the utility of a job information resource, Work and MS, to augment existing employment services. The results also suggest the need to test employment-ready interventions in a larger study population. This might include the addition of online peer support to increase intervention compliance. Copyright © 2017 American Congress of Rehabilitation Medicine. All rights reserved.

  1. A Locust Phase Change Model with Multiple Switching States and Random Perturbation

    Science.gov (United States)

    Xiang, Changcheng; Tang, Sanyi; Cheke, Robert A.; Qin, Wenjie

    2016-12-01

    Insects such as locusts and some moths can transform from a solitarious phase when they remain in loose populations and a gregarious phase, when they may swarm. Therefore, the key to effective management of outbreaks of species such as the desert locust Schistocercagregaria is early detection of when they are in the threshold state between the two phases, followed by timely control of their hopper stages before they fledge because the control of flying adult swarms is costly and often ineffective. Definitions of gregarization thresholds should assist preventive control measures and avoid treatment of areas that might not lead to gregarization. In order to better understand the effects of the threshold density which represents the gregarization threshold on the outbreak of a locust population, we developed a model of a discrete switching system. The proposed model allows us to address: (1) How frequently switching occurs from solitarious to gregarious phases and vice versa; (2) When do stable switching transients occur, the existence of which indicate that solutions with larger amplitudes can switch to a stable attractor with a value less than the switching threshold density?; and (3) How does random perturbation influence the switching pattern? Our results show that both subsystems have refuge equilibrium points, outbreak equilibrium points and bistable equilibria. Further, the outbreak equilibrium points and bistable equilibria can coexist for a wide range of parameters and can switch from one to another. This type of switching is sensitive to the intrinsic growth rate and the initial values of the locust population, and may result in locust population outbreaks and phase switching once a small perturbation occurs. Moreover, the simulation results indicate that the switching transient patterns become identical after some generations, suggesting that the evolving process of the perturbation system is not related to the initial value after some fixed number of

  2. MRI in multiple sclerosis: an intra-individual, randomized and multicentric comparison of gadobutrol with gadoterate meglumine at 3 T

    Energy Technology Data Exchange (ETDEWEB)

    Saake, Marc; Weibart, Marina; Doerfler, Arnd [University of Erlangen-Nuremberg, Department of Neuroradiology, Erlangen (Germany); Langner, Soenke; Hosten, Norbert [University Medicine Greifswald, Institute for Diagnostic Radiology and Neuroradiology, Greifswald (Germany); Schwenke, Carsten [SCO:SSiS, Statistical Consulting, Berlin (Germany); Jansen, Olav [University of Kiel, Department of Radiology and Neuroradiology, Kiel (Germany)

    2016-03-15

    To compare contrast effects of gadobutrol with gadoterate meglumine for brain MRI in multiple sclerosis (MS) in a multicentre, randomized, prospective, intraindividual study at 3 T. Institutional review board approval was obtained. Patients with known or suspected active MS lesions were included. Two identical MRIs were performed using randomized contrast agent order. Four post-contrast T1 sequences were acquired (start time points 0, 3, 6 and 9 min). If no enhancing lesion was present in first MRI, second MRI was cancelled. Quantitative (number and signal intensity of enhancing lesions) and qualitative parameters (time points of first and all lesions enhancing; subjective preference regarding contrast enhancement and lesion delineation; global preference) were evaluated blinded. Seventy-four patients (male, 26; mean age, 35 years) were enrolled in three centres. In 45 patients enhancing lesions were found. Number of enhancing lesions increased over time for both contrast agents without significant difference (median 2 for both). Lesions signal intensity was significantly higher for gadobutrol (p < 0.05 at time points 3, 6 and 9 min). Subjective preference rating showed non-significant tendency in favour of gadobutrol. Both gadobutrol and gadoterate meglumine can be used for imaging of acute inflammatory MS lesions. However, gadobutrol generates higher lesion SI. (orig.)

  3. Multiple trait model combining random regressions for daily feed intake with single measured performance traits of growing pigs

    Directory of Open Access Journals (Sweden)

    Künzi Niklaus

    2002-01-01

    Full Text Available Abstract A random regression model for daily feed intake and a conventional multiple trait animal model for the four traits average daily gain on test (ADG, feed conversion ratio (FCR, carcass lean content and meat quality index were combined to analyse data from 1 449 castrated male Large White pigs performance tested in two French central testing stations in 1997. Group housed pigs fed ad libitum with electronic feed dispensers were tested from 35 to 100 kg live body weight. A quadratic polynomial in days on test was used as a regression function for weekly means of daily feed intake and to escribe its residual variance. The same fixed (batch and random (additive genetic, pen and individual permanent environmental effects were used for regression coefficients of feed intake and single measured traits. Variance components were estimated by means of a Bayesian analysis using Gibbs sampling. Four Gibbs chains were run for 550 000 rounds each, from which 50 000 rounds were discarded from the burn-in period. Estimates of posterior means of covariance matrices were calculated from the remaining two million samples. Low heritabilities of linear and quadratic regression coefficients and their unfavourable genetic correlations with other performance traits reveal that altering the shape of the feed intake curve by direct or indirect selection is difficult.

  4. Influence of yoga and aerobics exercise on fatigue, pain and psychosocial status in patients with multiple sclerosis: a randomized trial.

    Science.gov (United States)

    Hasanpour Dehkordi, Ali

    2016-11-01

    Multiple sclerosis (MS) is an autoimmune disease involving brain and spinal cord. Weakness, cognitive impairment, pain, depression and fatigue, as common symptoms of MS, may significantly affect on general health of MS patients. This study aimed to investigate the influence of yoga and aerobic exercise on fatigue, pain, and psychosocial status among these patients. In a randomized clinical trial study on 90 patients whom were randomly assigned to three equal groups of yoga exercises, aerobics exercises, and control group. The exercise program was performed as three sessions per week for 12 weeks. The exercise program included 40 minutes, including 5-10 minutes for warm-up, 25-30 minutes of exercise (walking), and 5 minutes for cooling down. Yoga exercises were scheduled three sessions a week for 12 weeks as well. There was no significant difference in fatigue, pain severity and psychological status among three groups prior to the study, but after the study, in yoga and exercise groups, fatigue physical function, physical and emotional role which patients play throughout daily life, social function, energy, mental status and overall hygiene increased, and the pain and fatigue were relieved in the patients. Yoga and aerobics exercise could decrease some of the MS symptoms, therapeutic costs, hospital stay, and days lost from work as well as increasing the patients' efficiency.

  5. Patient-Reported Outcomes following Single- and Multiple-Radius Total Knee Replacement: A Randomized, Controlled Trial.

    Science.gov (United States)

    Mushtaq, Nadeem; Liddle, Alexander D; Isaac, David; Dillow, Katherine; Gill, Paul

    2017-05-05

    Although single-radius (SR) designs of total knee replacement (TKR) have theoretical benefits, the clinical advantage conferred by such designs is unknown. The aim of this randomized, controlled study was to compare the short-term clinical outcomes of the two design rationales. A total of 105 knees were randomized to receive either a single radius (Scorpio, Stryker; SR Group) or multiple radius (AGC, Zimmer Biomet; MR group) TKR. Patient-reported outcomes (Oxford Knee Score [OKS] and Knee Society Score [KSS]) were collected at 6 weeks, 6 months, and 1 year following surgery. No knees were revised. There was no difference in primary outcomes: OKS was 39.5 (95% confidence interval [CI]: 36.9-42.1) in the SR group and 38.1 (95% CI: 36.0-40.3) in the MR group (p = 0.40). KSS was 168.4 (95% CI: 159.8-177.0) in the SR group; 159.5 (95% CI 150.5-168.5) in the MR group (p = 0.16). There was a small but statistically significant difference in the degree of change of the objective subscale of the KSS, favoring the SR design (p = 0.04), but this is of uncertain clinical relevance. The reported benefits of SR designs do not provide demonstrable functional advantages in the short term. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Radio Wave Propagation in Tunnels

    National Research Council Canada - National Science Library

    Lee, Jeho

    2000-01-01

    This report examines the radio propagation model for narrow and long tunnels. Modal analysis is used to model the path gain in 2-D and 3-D rectangular tunnels and the coupling loss of L, T and cross tunnels...

  7. Carpal Tunnel Syndrome (For Kids)

    Science.gov (United States)

    ... OK for Kids? Your Teeth Heart Murmurs Carpal Tunnel Syndrome KidsHealth > For Kids > Carpal Tunnel Syndrome Print ... syndrome in the first place. Where Is This Tunnel? Take a look at the palm of your ...

  8. A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning, Disability and Health (ICF as a reference tool

    Directory of Open Access Journals (Sweden)

    Leite José

    2006-12-01

    Full Text Available Abstract Background A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS, however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomes assessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts contained in the International Classification of Functioning, Disability and Health (ICF. Methods The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical treatment for CTS. The outcomes assessed in these trials were identified, classified and linked to the different domains of the ICF. Results Twenty-eight studies were retrieved which met the inclusion criteria. The most frequently assessed outcomes were self-reported symptom resolution, grip or pinch strength and return to work. The majority of outcome measures employed assessed impairment of body function and body structure and a small number of studies used measures of activity and participation. Conclusion The ICF provides a useful framework for identifying the concepts contained in outcome measures employed to date in trials of surgical intervention for CTS and may help in the selection of the most appropriate domains to be assessed, especially where studies are designed to capture the impact of the intervention at individual and societal level. Comparison of results from different studies and meta-analysis would be facilitated through the use of a core set of standardised outcome measures which cross all domains of the ICF. Further work on developing consensus on such a core set is needed.

  9. Statistics of α-μ Random Variables and Their Applications inWireless Multihop Relaying and Multiple Scattering Channels

    KAUST Repository

    Wang, Kezhi

    2015-06-01

    Exact results for the probability density function (PDF) and cumulative distribution function (CDF) of the sum of ratios of products (SRP) and the sum of products (SP) of independent α-μ random variables (RVs) are derived. They are in the form of 1-D integral based on the existing works on the products and ratios of α-μ RVs. In the derivation, generalized Gamma (GG) ratio approximation (GGRA) is proposed to approximate SRP. Gamma ratio approximation (GRA) is proposed to approximate SRP and the ratio of sums of products (RSP). GG approximation (GGA) and Gamma approximation (GA) are used to approximate SP. The proposed results of the SRP can be used to calculate the outage probability (OP) for wireless multihop relaying systems or multiple scattering channels with interference. The proposed results of the SP can be used to calculate the OP for these systems without interference. In addition, the proposed approximate result of the RSP can be used to calculate the OP of the signal-To-interference ratio (SIR) in a multiple scattering system with interference. © 1967-2012 IEEE.

  10. Intravenous Hydroxypropyl β-Cyclodextrin Formulation of Letermovir: A Phase I, Randomized, Single-Ascending, and Multiple-Dose Trial.

    Science.gov (United States)

    Erb-Zohar, K; Kropeit, D; Scheuenpflug, J; Stobernack, H-P; Hulskotte, Egj; van Schanke, A; Zimmermann, H; Rübsamen-Schaeff, H

    2017-07-04

    Letermovir is a novel antiviral in clinical development for prophylaxis against human cytomegalovirus in immunocompromised transplant recipients. This two-part, single-center, randomized, double-blind, placebo-controlled trial evaluated the safety and pharmacokinetics of a hydroxypropyl β-cyclodextrin (HPβCD)-based intravenous formulation of letermovir in healthy women. Subjects received single, escalating doses (120, 240, 480, 720, and 960 mg; 6 letermovir, 2 placebo per cohort) or multiple, once-daily doses (240 mg; 8 letermovir, 4 placebo) of HPβCD-formulated letermovir and the associated pharmacokinetic profiles and adverse events were investigated. Single-dose and multiple-dose regimens were generally well tolerated. Single-dose escalation resulted in a slightly more-than-dose-proportional increase in the area under the letermovir plasma concentration-time curve (AUC), whereas increase in the maximal observed letermovir plasma concentration (Cmax ) was dose proportional. After once-daily dosing, accumulation ratios in AUC and Cmax were 1.22 and 1.03, respectively. The terminal half-life was 28.3 h, supporting once-daily dosing (EudraCT Number: 2012-001603-20). © 2017 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

  11. The effect of maternal multiple micronutrient supplementation on cognition and mood during pregnancy and postpartum in Indonesia: a randomized trial.

    Directory of Open Access Journals (Sweden)

    Elizabeth L Prado

    Full Text Available Maternal caregiving capacity, which is affected in part by cognition and mood, is crucial for the health of mothers and infants. Few interventions aim to improve maternal and infant health through improving such capacity. Multiple micronutrient (MMN supplementation may improve maternal cognition and mood, since micronutrients are essential for brain function. We assessed mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT, a double-blind cluster-randomized trial in Indonesia comparing MMN supplementation to iron and folic acid (IFA during pregnancy and until three months postpartum. We adapted a set of well-studied tests of cognition, motor dexterity, and mood to the local context and administered them to a random sample of 640 SUMMIT participants after an average of 25 weeks (SD = 9 of supplementation. Analysis was by intention to treat. Controlling for maternal age, education, and socio-economic status, MMN resulted in a benefit of 0.12 SD on overall cognition, compared to IFA (95%CI 0.03-0.22, p = .010, and a benefit of 0.18 SD on reading efficiency (95%CI 0.02-0.35, p = .031. Both effects were found particularly in anemic (hemoglobin<110 g/L; overall cognition: B = 0.20, 0.00-0.41, p = .055; reading: B = 0.40, 0.02-0.77, p = .039 and undernourished (mid-upper arm circumference<23.5 cm; overall cognition: B = 0.33, 0.07-0.59, p = .020; reading: B = 0.65, 0.19-1.12, p = .007 mothers. The benefit of MMN on overall cognition was equivalent to the benefit of one year of education for all mothers, to two years of education for anemic mothers, and to three years of education for undernourished mothers. No effects were found on maternal motor dexterity or mood. This is the first study demonstrating an improvement in maternal cognition with MMN supplementation. This improvement may increase the quality of care mothers provide for their infants, potentially partly mediating effects of maternal MMN

  12. The effects of video-game training on broad cognitive transfer in multiple sclerosis: A pilot randomized controlled trial.

    Science.gov (United States)

    Janssen, Alisha; Boster, Aaron; Lee, HyunKyu; Patterson, Beth; Prakash, Ruchika Shaurya

    2015-01-01

    Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system that results in diffuse nerve damage and associated physical and cognitive impairments. Of the few comprehensive rehabilitation options that exist for populations with lower baseline cognitive functioning, those that have been successful at eliciting broad cognitive improvements have focused on a multimodal training approach, emphasizing complex cognitive processing that utilizes multiple domains simultaneously. The current study sought to determine the feasibility of an 8-week, hybrid-variable priority training (HVT) program, with a secondary aim to assess the success of this training paradigm at eliciting broad cognitive transfer effects. Capitalizing on the multimodal training modalities offered by the Space Fortress platform, we compared the HVT strategy-based intervention with a waitlist control group, to primarily assess skill acquisition and secondarily determine presence of cognitive transfer. Twenty-eight participants met inclusionary criteria for the study and were randomized to either training or waitlist control groups. To assess broad transfer effects, a battery of neuropsychological tests was administered pre- and post-intervention. The results indicated an overall improvement in skill acquisition and evidence for the feasibility of the intervention, but a lack of broad transfer to tasks of cognitive functioning. Participants in the training group, however, did show improvements on a measure of spatial short-term memory. The current investigation provided support for the feasibility of a multimodal training approach, using the HVT strategy, within the MS population, but lacked broad transfer to multiple domains of cognitive functioning. Future improvements to obtain greater cognitive transfer efficacy would include a larger sample size, a longer course of training to evoke greater game score improvement, the inclusion of only cognitively impaired individuals, and

  13. Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial.

    Science.gov (United States)

    Moraska, Albert F; Schmiege, Sarah J; Mann, John D; Butryn, Nathan; Krutsch, Jason P

    2017-09-01

    This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with myofascial pain syndrome expressed as tension-type headache. Individuals (n = 62) with episodic or chronic tension-type headache were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on trigger point release (ischemic compression) of MTrPs in the bilateral upper trapezius and suboccipital muscles. PPT was measured at MTrPs with a pressure algometer pre and post the first and final (12th) treatments. PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups (P pain threshold of MTrPs have a great capacity to increase; even after multiple massage treatments additional gain in PPT was observed. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand the contribution of myofascial trigger points to myofascial pain; (2) Describe an effective treatment for decreasing tenderness of a myofascial trigger point; and (3) Discuss the relative values of single vs. multiple massage sessions on increasing pressure-pain thresholds at myofascial trigger points. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  14. Tunnel operations study.

    Science.gov (United States)

    2013-12-01

    In June 2000, the State of Alaska Department of Transportation and Public Facilities completed construction of the Whittier Access Project by converting the existing 2.5- : mile Whittier Tunnel into the worlds only dual-use highway/rail tunnel wit...

  15. Tunnel fire dynamics

    CERN Document Server

    Ingason, Haukur; Lönnermark, Anders

    2015-01-01

    This book covers a wide range of issues in fire safety engineering in tunnels, describes the phenomena related to tunnel fire dynamics, presents state-of-the-art research, and gives detailed solutions to these major issues. Examples for calculations are provided. The aim is to significantly improve the understanding of fire safety engineering in tunnels. Chapters on fuel and ventilation control, combustion products, gas temperatures, heat fluxes, smoke stratification, visibility, tenability, design fire curves, heat release, fire suppression and detection, CFD modeling, and scaling techniques all equip readers to create their own fire safety plans for tunnels. This book should be purchased by any engineer or public official with responsibility for tunnels. It would also be of interest to many fire protection engineers as an application of evolving technical principles of fire safety.

  16. Treatment of repetitive use carpal tunnel syndrome

    Science.gov (United States)

    Smith, Chadwick F.; Vangsness, C. Thomas; Anderson, Thomas; Good, Wayne

    1995-05-01

    In 1990, a randomized, double-blind study was initiated to evaluate the use of an eight-point conservative treatment program in carpal tunnel syndrome. A total of 160 patients were delineated with symptoms of carpal tunnel syndrome. These patients were then divided into two groups. Both groups were subjected to an ergonomically correct eight-point work modification program. A counterfeit low level laser therapy unit was utilized in Group A, while an actual low level laser therapy unit was utilized in Group B. The difference between Groups A and B was statistically significant in terms of return to work, conduction study improvement, and certain range of motion and strength studies.

  17. Zinc or multiple micronutrient supplementation to reduce diarrhea and respiratory disease in South African children: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Kany-Kany Angelique Luabeya

    2007-06-01

    Full Text Available Prophylactic zinc supplementation has been shown to reduce diarrhea and respiratory illness in children in many developing countries, but its efficacy in children in Africa is uncertain.To determine if zinc, or zinc plus multiple micronutrients, reduces diarrhea and respiratory disease prevalence.Randomized, double-blind, controlled trial.Rural community in South Africa.THREE COHORTS: 32 HIV-infected children; 154 HIV-uninfected children born to HIV-infected mothers; and 187 HIV-uninfected children born to HIV-uninfected mothers.Children received either 1250 IU of vitamin A; vitamin A and 10 mg of zinc; or vitamin A, zinc, vitamins B1, B2, B6, B12, C, D, E, and K and copper, iodine, iron, and niacin starting at 6 months and continuing to 24 months of age. Homes were visited weekly.Primary outcome was percentage of days of diarrhea per child by study arm within each of the three cohorts. Secondary outcomes were prevalence of upper respiratory symptoms and percentage of children who ever had pneumonia by maternal report, or confirmed by the field worker.Among HIV-uninfected children born to HIV-infected mothers, median percentage of days with diarrhea was 2.3% for 49 children allocated to vitamin A; 2.5% in 47 children allocated to receive vitamin A and zinc; and 2.2% for 46 children allocated to multiple micronutrients (P = 0.852. Among HIV-uninfected children born to HIV-uninfected mothers, median percentage of days of diarrhea was 2.4% in 56 children in the vitamin A group; 1.8% in 57 children in the vitamin A and zinc group; and 2.7% in 52 children in the multiple micronutrient group (P = 0.857. Only 32 HIV-infected children were enrolled, and there were no differences between treatment arms in the prevalence of diarrhea. The prevalence of upper respiratory symptoms or incidence of pneumonia did not differ by treatment arms in any of the cohorts.When compared with vitamin A alone, supplementation with zinc, or with zinc and multiple

  18. Home-based balance training using the Wii balance board: a randomized, crossover pilot study in multiple sclerosis.

    Science.gov (United States)

    Prosperini, Luca; Fortuna, Deborah; Giannì, Costanza; Leonardi, Laura; Marchetti, Maria Rita; Pozzilli, Carlo

    2013-01-01

    To evaluate the effectiveness of a home-based rehabilitation of balance using the Nintendo Wii Balance Board System (WBBS) in patients affected by multiple sclerosis (MS). In this 24-week, randomized, 2-period crossover pilot study, 36 patients having an objective balance disorder were randomly assigned in a 1:1 ratio to 2 counterbalanced arms. Group A started a 12-week period of home-based WBBS training followed by a 12-week period without any intervention; group B received the treatment in reverse order. As endpoints, we considered the mean difference (compared with baseline) in force platform measures (i.e., the displacement of body center of pressure in 30 seconds), 4-step square test (FSST), 25-foot timed walking test (25-FWT), and 29-item MS Impact Scale (MSIS-29), as evaluated after 12 weeks and at the end of the 24-week study period. The 2 groups did not differ in baseline characteristics. Repeated-measures analyses of variance showed significant time × treatment effects, indicating that WBBS was effective in ameliorating force platform measures (F = 4.608, P = .016), FSST (F = 3.745, P = .034), 25-FWT (F = 3.339, P = .048), and MSIS-29 (F = 4.282, P = .023). Five adverse events attributable to the WBSS training (knee or low back pain) were recorded, but only 1 patient had to retire from the study. A home-based WBBS training might potentially provide an effective, engaging, balance rehabilitation solution for people with MS. However, the risk of WBBS training-related injuries should be carefully balanced with benefits. Further studies, including cost-effectiveness analyses, are warranted to establish whether WBBS may be useful in the home setting.

  19. Effects of aerobic and strength exercise on motor fatigue in men and women with multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Surakka, Jukka; Romberg, Anders; Ruutiainen, Juhani; Aunola, Sirkka; Virtanen, Arja; Karppi, Sirkka-Liisa; Mäentaka, Kari

    2004-11-01

    To investigate the effects of aerobic and strength exercise on motor fatigue of knee flexor and extensor muscles in subjects with multiple sclerosis (MS). A randomized controlled trial. At Masku Neurological Rehabilitation Centre, Masku, and the Social Insurance Institution, Research Department, Turku, Finland. Ninety-five MS patients with mild to moderate disability were randomized into exercise group (n =47) and a control group (n =48). Participants in the exercise group attended in a supervised exercise period of three weeks, which was followed by a home exercise programme lasting for 23 weeks. Patients in the control group continued with their normal living. Motor fatigue of knee flexor and extensor muscles was measured during a static 30-s maximal sustained muscle contraction. The decline in force (Nm) during the 30 s was recorded, and a fatigue index (FI) was calculated. Subjective fatigue was measured by using the Fatigue Severity Scale (FSS). The Ambulatory Fatigue Index (AFI) was calculated on the basis of a 500-m walking test. Assessment took place at baseline, at the third week (not for the control group) and at the 26th week. All outcome variables were analysed, men and women together, and some interesting contrasts were analysed by gender. Associations were observed with changes in extension FI and Expanded Disability Status Scale (EDSS) score and mean extension torque (Nm), but not with changes in FI and aerobic or strength exercise activity, mean AFI, mean FSS or in mean knee flexion torque. AFI was decreased in all subject groups (p =0.007). Motor fatigue was reduced in knee flexion (p=0.0014) and extension (ns) among female but not in male exercisers after six months of exercise. The exercise activity of women was 25% higher than that of the men. Six months of exercise reduced motor fatigue in women, but not in men.

  20. The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial.

    Science.gov (United States)

    Malcolm, R; Myrick, H; Roberts, J; Wang, W; Anton, R F; Ballenger, J C

    2002-05-01

    Benzodiazepines are the mainstay of treatment for mild-to-moderate alcohol withdrawal in outpatient settings, but they can interact with alcohol, cause motor incoordination, or be abused. This study compared the therapeutic responses of the benzodiazepine lorazepam and the anticonvulsant carbamazepine for the outpatient treatment of acute alcohol withdrawal in terms of patients' previous detoxification histories, and compared the effects of these 2 medications on drinking behaviors in the immediate postdetoxification period. This was a randomized double-blind trial comparing patient responses to carbamazepine and lorazepam across 2 levels of detoxification histories (0-1 or >or=2 previous medicated detoxifications). A university medical center substance abuse clinic in Charleston, SC. One hundred thirty-six patients in moderate alcohol withdrawal were randomized. Major exclusions were significant hepatic or hematologic abnormalities and use of medications that could alter withdrawal symptoms. Patients received 600-800 mg of carbamazepine or 6-8 mg of lorazepam in divided doses on day 1 tapering to 200 mg of carbamazepine or 2 mg of lorazepam. The Clinical Institute Withdrawal Assessment for Alcohol-Revised was used to assess alcohol withdrawal symptoms on days 1 through 5 and postmedication at days 7 and 12. Daily drinking was measured by patient report using a daily drinking log and a breath alcohol level with each visit. Side effects were recorded daily. Carbamazepine and lorazepam were equally effective at decreasing the symptoms of alcohol withdrawal. In the post-treatment period, 89 patients drank on at least 1 day; on average, carbamazepine patients drank less than 1 drink per drinking day and lorazepam patients drank almost 3 drinks per drinking day (P =.003). Among those with multiple past detoxifications, the carbamazepine group drank less than 1 drink per day on average and the lorazepam group drank about 5 drinks per day on average (P =.033). Lorazepam

  1. A randomized controlled trial of telemonitoring in older adults with multiple chronic conditions: the Tele-ERA study

    Directory of Open Access Journals (Sweden)

    Takahashi Paul Y

    2010-09-01

    Full Text Available Abstract Background Older adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization. Home telemonitoring may help slow this decline. This protocol of a randomized controlled trial was designed to help determine the impact of home telemonitoring on hospitalization. The specific aim of the study reads as follows: to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older. Methods/Design Two-hundred patients with the highest 10% Mayo Clinic Elder Risk Assessment scores will be randomly assigned to one of two interventions. Home telemonitoring involves the use of a computer device, the Intel Health Guide, which records biometric and symptom data from patients in their homes. This information is monitored by midlevel providers associated with a primary care medical practice. Under the usual care scenario, patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line. Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey, the Kokmen Short Test of Mental Status, and the PHQ-9 health questionnaire. Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits. Secondary analysis will include quality of life, compliance with the device, and attitudes about telemonitoring. Sample size is based on an 80% power to detect a 36% difference between the two groups. The primary analysis will involve Cox proportional time-to-event analysis. Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis. Discussion Patients randomized to home telemonitoring will have daily assessments of their health status using the device

  2. Integrative psychotherapeutic nursing home program to reduce multiple psychiatric symptoms of cognitively impaired patients and caregiver burden: randomized controlled trial.

    Science.gov (United States)

    Bakker, Ton J E M; Duivenvoorden, Hugo J; van der Lee, Jacqueline; Olde Rikkert, Marcel G M; Beekman, Aartjan T F; Ribbe, Miel W

    2011-06-01

    To test the effectiveness of an integrative psychotherapeutic nursing home program (integrative reactivation and rehabilitation [IRR]) to reduce multiple neuropsychiatry symptoms (MNPS) of cognitively impaired patients and caregiver burden (CB). Randomized controlled trial. Psychiatric-skilled nursing home (IRR) and usual care (UC), consisting of different types of nursing home care at home or in an institution. N = 168 (81 IRR and 87 UC). Patients had to meet classification of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for dementia, amnestic disorders, or other cognitive disorders. Further inclusion criteria: Neuropsychiatric Inventory (NPI) ≥3; Mini-Mental State Examination ≥18 and ≤27; and Barthel Index (BI) ≥5 and ≤19. IRR consisted of a person-oriented integrative psychotherapeutic nursing home program to reduce MNPS of the patient and CB. UC consisted of different types of nursing home care at home or in an institution, mostly emotion oriented. Primary outcome variable was MNPS (number and sum-severity of NPI). Furthermore, burden and competence of caregiver were also measured. T1 (inclusion), T2 (end of treatment), T3 (after 6 months of follow-up). Cohen's d (Cd) was calculated for mean differences (intention to treat). For confounding, repeated measurement modeling (random regression modeling [RRM]) was applied. In the short term from the perspective of the caregiver, IRR showed up to 34% surplus effects on MNPS of the patients; NPI symptoms: 1.31 lower (Cd, -0.53); and NPI sum- severity: 11.16 lower (Cd, -0.53). In follow-up, the effects were sustained. However, from the perspective of the nursing team, these effects were insignificant, although the trend was in the same direction and correlated significantly with the caregiver results over time (at T3: r = 0.48). In addition, IRR showed surplus effects (up to 36%) on burden and competence of caregiver: NPI emotional distress: 3.78 (Cd, -0.44); CB: 17.69 (Cd, -0

  3. Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Puntumetakul R

    2015-01-01

    Full Text Available Rungthip Puntumetakul,1,2 Thavatchai Suvarnnato,1,3 Phurichaya Werasirirat,1 Sureeporn Uthaikhup,2 Junichiro Yamauchi,4,5 Rose Boucaut6 1School of Physical Therapy, Faculty of Associated Medical Sciences, 2Research Center in Back, Neck, Other Joint Pain and Human Performance, 3Physical Therapy Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 4Graduate School of Human Health Sciences, Tokyo Metropolitan University, 5Future Institute for Sport Sciences, Tokyo, Japan; 6School of Health Sciences (Physiotherapy, University of South Australia, Adelaide, SA, Australia Background: Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP.Methods: Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM at T6–T7 or multiple-level thoracic manipulation (MTM, or to a control group (prone lying. Cervical range of motion (CROM, visual analog scale (VAS, and the Thai version of the Neck Disability Index (NDI-TH scores were measured at baseline, and at 24-hour and at 1-week follow-up.Results: At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (P<0.05 improved in the STM and MTM groups compared with the control group. CROM in flexion and left lateral flexion were increased significantly (P<0.05 in the STM group when compared with the control group at 1-week follow-up. The CROM in right rotation was increased significantly after MTM compared to the control group (P<0.05 at 24-hour follow-up. There were no statistically significant differences in neck disability, pain level at rest, and CROM between the STM and MTM groups.Conclusion: These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability

  4. A prospective, randomized comparison between single- and multiple-injection techniques for ultrasound-guided subgluteal sciatic nerve block.

    Science.gov (United States)

    Yamamoto, Hiroto; Sakura, Shinichi; Wada, Minori; Shido, Akemi

    2014-12-01

    It is believed that local anesthetic injected to obtain circumferential spread around nerves produces a more rapid onset and successful blockade after some ultrasound-guided peripheral nerve blocks. However, evidence demonstrating this point is limited only to the popliteal sciatic nerve block, which is relatively easy to perform by via a high-frequency linear transducer. In the present study, we tested the hypothesis that multiple injections of local anesthetic to make circumferential spread would improve the rate of sensory and motor blocks compared with a single-injection technique for ultrasound-guided subgluteal sciatic nerve block, which is considered a relatively difficult block conducted with a low-frequency, curved-array transducer. Ninety patients undergoing knee surgery were divided randomly into 2 groups to receive the ultrasound-guided subgluteal approach to sciatic nerve block with 20 mL of 1.5% mepivacaine with epinephrine. For group M (the multiple-injection technique), the local anesthetic was injected to create circumferential spread around the sciatic nerve without limitation on the number of needle passes. For group S (the single-injection technique), the number of needle passes was limited to 1, and the local anesthetic was injected to create spread along the dorsal surface of the sciatic nerve, during which no adjustment of the needle tip was made. Sensory and motor blockade were assessed in double-blind fashion for 30 minutes after completion of the block. The primary outcome was sensory blockade of all sciatic components tested, including tibial, superficial peroneal, and sural nerves at 30 minutes after injection. Data from 86 patients (43 in each group) were analyzed. Block execution took more time for group M than group S. The proportion of patients with complete sensory blockade of all sciatic components at 30 minutes after injection was significantly larger for group M than group S (41.9% vs 16.3%, P = 0.018). Complete motor blockade of

  5. A prospective, randomized, controlled trial of autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: a position paper.

    Science.gov (United States)

    Saccardi, R; Freedman, M S; Sormani, M P; Atkins, H; Farge, D; Griffith, L M; Kraft, G; Mancardi, G L; Nash, R; Pasquini, M; Martin, R; Muraro, P A

    2012-06-01

    Haematopoietic stem cell transplantation (HSCT) has been tried in the last 15 years as a therapeutic option in patients with poor-prognosis autoimmune disease who do not respond to conventional treatments. Worldwide, more than 600 patients with multiple sclerosis (MS) have been treated with HSCT, most of them having been recruited in small, single-centre, phase 1-2 uncontrolled trials. Clinical and magnetic resonance imaging outcomes from case series reports or Registry-based analyses suggest that a major response is achieved in most patients; quality and duration of response are better in patients transplanted during the relapsing-remitting phase than in those in the secondary progressive stage. An interdisciplinary group of neurologists and haematologists has been formed, following two international meetings supported by the European and American Blood and Marrow Transplantation Societies, for the purpose of discussing a controlled clinical trial, to be designed within the new scenarios of evolving MS treatments. Objectives of the trial, patient selection, transplant technology and outcome assessment were extensively discussed. The outcome of this process is summarized in the present paper, with the goal of establishing the background and advancing the development of a prospective, randomized, controlled multicentre trial to assess the clinical efficacy of HSCT for the treatment of highly active MS.

  6. Large differences in adiponectin levels have no clear effect on multiple sclerosis risk: A Mendelian randomization study.

    Science.gov (United States)

    Devorak, Julia; Mokry, Lauren E; Morris, John A; Forgetta, Vincenzo; Davey Smith, George; Sawcer, Stephen; Richards, J Brent

    2017-10-01

    Mendelian randomization (MR) studies have demonstrated strong support for an association between genetically increased body mass index and risk of multiple sclerosis (MS). The adipokine adiponectin may be a potential mechanism linking body mass to risk of MS. To evaluate whether genetically increased adiponectin levels influence risk of MS. Using genome-wide significant single nucleotide polymorphisms (SNPs) for adiponectin, we undertook an MR study to estimate the effect of adiponectin on MS. This method prevents bias due to reverse causation and minimizes bias due to confounding. Sensitivity analyses were performed to evaluate the assumptions of MR. MR analyses did not support a role for genetically elevated adiponectin in risk of MS (odds ratio (OR) = 0.93 per unit increase in natural-log-transformed adiponectin, equivalent to a two-standard deviation increase in adiponectin on the absolute scale; 95% confidence interval (CI) = 0.66-1.33; p = 0.61). Further MR analysis suggested that genetic variation at the adiponectin gene, which influences adiponectin level, does not impact MS risk. Sensitivity analyses, including MR-Egger regression, suggested no bias due to pleiotropy. Lifelong genetically increased adiponectin levels in humans have no clear effect on risk of MS. Other biological factors driving the association between body mass and MS should be investigated.

  7. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso.

    Science.gov (United States)

    Huybregts, Lieven; Roberfroid, Dominique; Lanou, Hermann; Menten, Joris; Meda, Nicolas; Van Camp, John; Kolsteren, Patrick

    2009-12-01

    Prenatal multiple micronutrient (MMN) or balanced energy and protein supplementation has a limited effect on birth size of the offspring. The objective was to determine whether a prenatal MMN-fortified food supplement (FFS) improves anthropometric measures at birth compared with supplementation with an MMN pill alone. We conducted a nonblinded, individually randomized controlled trial in 1296 pregnant women in 2 villages in rural Burkina Faso. Supplements were provided on a daily basis, and compliance was closely verified by using a community-based network of home visitors. Anthropometric measures at birth were available for analysis for 87% of the 1175 live singleton deliveries enrolled. After adjustment for gestational age at birth, the FFS group had a significantly higher birth length (+4.6 mm; P = 0.001). FFS supplementation resulted in a modestly higher birth weight (+31 g; P = 0.197). Subgroup analyses showed clinically important treatment effects on birth length (+12.0 mm; P = 0.005) and on birth weight (+111 g; P = 0.133) for underweight [body mass index (in kg/m(2)) birth to longer newborns (+7.3 mm; P = 0.002) than did those who received MMN supplementation. The provision of FFS to pregnant women resulted in higher birth length than did MMN supplementation. For women with a suboptimal prepregnancy nutritional status, MMN supplementation should be complemented with a balanced energy and protein supplement to produce a clinical effect on birth size. The trial was registered at clinicaltrials.gov as NCT00909974.

  8. Multiple-image authentication with a cascaded multilevel architecture based on amplitude field random sampling and phase information multiplexing.

    Science.gov (United States)

    Fan, Desheng; Meng, Xiangfeng; Wang, Yurong; Yang, Xiulun; Pan, Xuemei; Peng, Xiang; He, Wenqi; Dong, Guoyan; Chen, Hongyi

    2015-04-10

    A multiple-image authentication method with a cascaded multilevel architecture in the Fresnel domain is proposed, in which a synthetic encoded complex amplitude is first fabricated, and its real amplitude component is generated by iterative amplitude encoding, random sampling, and space multiplexing for the low-level certification images, while the phase component of the synthetic encoded complex amplitude is constructed by iterative phase information encoding and multiplexing for the high-level certification images. Then the synthetic encoded complex amplitude is iteratively encoded into two phase-type ciphertexts located in two different transform planes. During high-level authentication, when the two phase-type ciphertexts and the high-level decryption key are presented to the system and then the Fresnel transform is carried out, a meaningful image with good quality and a high correlation coefficient with the original certification image can be recovered in the output plane. Similar to the procedure of high-level authentication, in the case of low-level authentication with the aid of a low-level decryption key, no significant or meaningful information is retrieved, but it can result in a remarkable peak output in the nonlinear correlation coefficient of the output image and the corresponding original certification image. Therefore, the method realizes different levels of accessibility to the original certification image for different authority levels with the same cascaded multilevel architecture.

  9. A group-delivered self-management program reduces spasticity in people with multiple sclerosis: A randomized, controlled pilot trial

    Science.gov (United States)

    Bourdette, Dennis; Chen, Yiyi; Chen, Zunqiu; Cameron, Michelle

    2017-01-01

    Background Spasticity affects more than 80% of people with multiple sclerosis (MS), affecting activity, participation, and quality of life. Based on an international guideline, an MS spasticity group education and stretching program, MS Spasticity: Take Control (STC), has been developed. Objective The objective of this paper is to determine whether STC with home stretching is associated with greater changes in spasticity than usual care (UC), consisting of an illustrated stretching booklet and home stretching but without group instruction or support, in people with MS. Methods Ambulatory MS patients with self-reported spasticity interfering with daily activities were randomized to STC or UC. Individuals completed questionnaires regarding MS, spasticity, walking, fatigue and mood, and physical measures of spasticity and walking. Results Thirty-eight of 40 participants completed both assessments. Mean total score and scores on two subscales of the MS Spasticity Scale-88 improved more with STC than with UC (p spasticity more than UC and provided encouraging improvements in other measures. PMID:28607753

  10. A randomized phase 3 study on the effect of thalidomide combined with adriamycin, dexamethasone, and high-dose melphalan, followed by thalidomide maintenance in patients with multiple myeloma.

    NARCIS (Netherlands)

    Lokhorst, H.M.; Holt, B. van der; Zweegman, S.; Vellenga, E.; Croockewit, S.; Oers, M.H. van; Borne, P. von dem; Wijermans, P.; Schaafsma, R.; Weerdt, O. de; Wittebol, S.; Delforge, M.; Berenschot, H.; Bos, G.M.; Jie, K.S.; Sinnige, H.; Marwijk-Kooy, M. van; Joosten, P.; Minnema, M.C.; Ammerlaan, R. van; Sonneveld, P.

    2010-01-01

    The phase 3 trial HOVON-50 was designed to evaluate the effect of thalidomide during induction treatment and as maintenance in patients with multiple myeloma who were transplant candidates. A total of 556 patients was randomly assigned to arm A: 3 cycles of vincristine, adriamycin, and

  11. A randomized phase 3 study on the effect of thalidomide combined with adriamycin, dexamethasone, and high-dose melphalan, followed by thalidomide maintenance in patients with multiple myeloma

    NARCIS (Netherlands)

    Lokhorst, Henk M.; van der Holt, Bronno; Zweegman, Sonja; Vellenga, Edo; Croockewit, Sandra; van Oers, Marinus H.; von dem Borne, Peter; Wijermans, Pierre; Schaafsma, Ron; de Weerdt, Okke; Wittebol, Shulamiet; Delforge, Michel; Berenschot, Henriëtte; Bos, Gerard M.; Jie, Kon-Siong G.; Sinnige, Harm; van Marwijk-Kooy, Marinus; Joosten, Peter; Minnema, Monique C.; van Ammerlaan, Rianne; Sonneveld, Pieter

    2010-01-01

    The phase 3 trial HOVON-50 was designed to evaluate the effect of thalidomide during induction treatment and as maintenance in patients with multiple myeloma who were transplant candidates. A total of 556 patients was randomly assigned to arm A: 3 cycles of vincristine, adriamycin, and

  12. Correction to: Impact of an electronic monitoring device and behavioural feedback on adherence to multiple sclerosis therapies in youth: results of a randomized trial.

    Science.gov (United States)

    Yeh, E Ann; Grover, Stephanie A; Powell, Victoria E; Alper, Gulay; Banwell, Brenda L; Edwards, Kim; Gorman, Mark; Graves, Jennifer; Lotze, Timothy E; Mah, Jean K; Mednick, Lauren; Ness, Jayne; Obadia, Maya; Slater, Ruth; Waldman, Amy; Waubant, Emmanuelle; Schwartz, Carolyn E

    2017-12-23

    The clinicaltrials.gov identifying number for the article titled "Impact of an electronic monitoring device and behavioral feedback on adherence to multiple sclerosis therapies in youth: results of a randomized trial" is NCT02234713 (https://clinicaltrials.gov/ct2/show/NCT02234713).

  13. A randomized phase 3 study on the effect of thalidomide combined with adriamycin, dexamethasone, and high-dose melphalan, followed by thalidomide maintenance in patients with multiple myeloma

    NARCIS (Netherlands)

    H.M. Lokhorst (Henk); B. van der Holt (Bronno); S. Zweegman (Sonja); E. Vellenga (Edo); S. Croockewit (Sandra); M.H.J. van Oers (Marinus); P.A. von dem Borne (P. A.); P.W. Wijermans (Pierre); R. Schaafsma (Ron); O. de Weerdt (Okke); S. Wittebol (Shulamit); M. Delforge (Michel); H. Berenschot (Henriëtte); G.M. Bos (Gerard); K.S-G. Jie; H. Sinnige (Harm); M. van Marwijk Kooy (Marinus); P. Joosten (Peter); M.C. Minnema (Monique); R.A.H.M. Ammerlaan (Rianne); P. Sonneveld (Pieter)

    2010-01-01

    textabstractThe phase 3 trial HOVON-50 was designed to evaluate the effect of thalidomide during induction treatment and as maintenance in patients with multiple myeloma who were transplant candidates. A total of 556 patients was randomly assigned to arm A: 3 cycles of vincristine, adriamycin, and

  14. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... make CTS better and help relieve symptoms. Massage, yoga, ultrasound, chiropractic manipulation, and acupuncture are just a ... tunnel syndrome > A-Z Health Topics Related information Menopause Pregnancy The javascript used in this widget is ...

  15. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... is not confined to people in a single industry or job, but is especially common in those ... tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide ...

  16. INCAS TRISONIC WIND TUNNEL

    Directory of Open Access Journals (Sweden)

    Florin MUNTEANU

    2009-09-01

    Full Text Available The 1.2 m x 1.2 m Trisonic Blowdown Wind Tunnel is the largest of the experimental facilities at the National Institute for Aerospace Research - I.N.C.A.S. "Elie Carafoli", Bucharest, Romania. The tunnel has been designed by the Canadian company DSMA (now AIOLOS and since its commissioning in 1978 has performed high speed aerodynamic tests for more than 120 projects of aircraft, missiles and other objects among which the twin jet fighter IAR-93, the jet trainer IAR-99, the MIG-21 Lancer, the Polish jet fighter YRYDA and others. In the last years the wind tunnel has been used mostly for experimental research in European projects such as UFAST. The high flow quality parameters and the wide range of testing capabilities ensure the competitivity of the tunnel at an international level.

  17. Quantum tunneling with friction

    Science.gov (United States)

    Tokieda, M.; Hagino, K.

    2017-05-01

    Using the phenomenological quantum friction models introduced by P. Caldirola [Nuovo Cimento 18, 393 (1941), 10.1007/BF02960144] and E. Kanai [Prog. Theor. Phys. 3, 440 (1948), 10.1143/ptp/3.4.440], M. D. Kostin [J. Chem. Phys. 57, 3589 (1972), 10.1063/1.1678812], and K. Albrecht [Phys. Lett. B 56, 127 (1975), 10.1016/0370-2693(75)90283-X], we study quantum tunneling of a one-dimensional potential in the presence of energy dissipation. To this end, we calculate the tunneling probability using a time-dependent wave-packet method. The friction reduces the tunneling probability. We show that the three models provide similar penetrabilities to each other, among which the Caldirola-Kanai model requires the least numerical effort. We also discuss the effect of energy dissipation on quantum tunneling in terms of barrier distributions.

  18. Wind Tunnel Testing Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — NASA Ames Research Center is pleased to offer the services of our premier wind tunnel facilities that have a broad range of proven testing capabilities to customers...

  19. Wind Tunnel Facility

    Data.gov (United States)

    Federal Laboratory Consortium — This ARDEC facility consists of subsonic, transonic, and supersonic wind tunnels to acquire aerodynamic data. Full-scale and sub-scale models of munitions are fitted...

  20. Steel formworks for tunnelling

    OpenAIRE

    Andrić, Ante; Tešović, Snježana

    2008-01-01

    The plant used for concreting the secondary tunnel lining is described. The plant is made of three segments: sheathing, self-propelled conveyor, and concrete supply system. In addition to technical properties and other features of this plant, the authors describe the work technology, and problems encountered during concept development, design and adjustment for three-rail and four-rail formwork. The structure of formwork portal, face formwork and tunnel lay-by is described and presented, incl...

  1. The Beginner's Guide to Wind Tunnels with TunnelSim and TunnelSys

    Science.gov (United States)

    Benson, Thomas J.; Galica, Carol A.; Vila, Anthony J.

    2010-01-01

    The Beginner's Guide to Wind Tunnels is a Web-based, on-line textbook that explains and demonstrates the history, physics, and mathematics involved with wind tunnels and wind tunnel testing. The Web site contains several interactive computer programs to demonstrate scientific principles. TunnelSim is an interactive, educational computer program that demonstrates basic wind tunnel design and operation. TunnelSim is a Java (Sun Microsystems Inc.) applet that solves the continuity and Bernoulli equations to determine the velocity and pressure throughout a tunnel design. TunnelSys is a group of Java applications that mimic wind tunnel testing techniques. Using TunnelSys, a team of students designs, tests, and post-processes the data for a virtual, low speed, and aircraft wing.

  2. A random matrix approach to detect defects in a strongly scattering polycrystal: How the memory effect can help overcome multiple scattering

    Science.gov (United States)

    Shahjahan, S.; Aubry, A.; Rupin, F.; Chassignole, B.; Derode, A.

    2014-06-01

    We report on ultrasonic imaging in a random heterogeneous medium. The goal is to detect flaws embedded deeply into a polycrystalline material. A 64-element array of piezoelectric transmitters/receivers at a central frequency of 5 MHz is used to capture the Green's matrix in a backscattering configuration. Because of multiple scattering, conventional imaging completely fails to detect the deepest flaws. We utilize a random matrix approach, taking advantage of the deterministic coherence of the backscattered wave-field which is characteristic of single scattering and related to the memory effect. This allows us to separate single and multiple scattering contributions. As a consequence, we show that flaws are detected beyond the conventional limit, as if multiple scattering had been overcome.

  3. Effect of multiple micronutrient supplementation on survival of HIV-infected children in Uganda: a randomized, controlled trial.

    Science.gov (United States)

    Ndeezi, Grace; Tylleskär, Thorkild; Ndugwa, Christopher M; Tumwine, James K

    2010-06-03

    Micronutrient deficiencies compromise the survival of HIV-infected children in low-income countries. We assessed the effect of multiple micronutrient supplementation on the mortality of HIV-infected children in Uganda. In a randomized, controlled trial, 847 children aged one to five years and attending HIV clinics in Uganda were stratified by antiretroviral therapy (ART, n = 85 versus no ART, n = 762). The children were randomized to six months of either: twice the recommended dietary allowance of 14 micronutrients as the intervention arm (vitamins A, B1, B2, niacin, B6, B12, C, D and E, folate, zinc, copper, iodine and selenium); or the standard recommended dietary allowance of six multivitamins (vitamins A, D2, B1, B2, C and niacin) as a comparative "standard-of-care" arm. Mortality was analyzed at 12 months of follow up using Kaplan Meier curves and the log rank test. Mortality at 12 months was 25 out of 426 (5.9%) children in the intervention arm and 28 out of 421 (6.7%) in the comparative arms: risk ratio 0.9 (95% CI 0.5 - 1.5). Two out of 85 (2.4%) children in the ART stratum died compared with 51 out of 762 (6.7%) in the non-ART stratum. Of those who died in the non-ART stratum, 25 of 383 (6.5%) were in the intervention arm and 26 of 379 (6.9%) in the comparative arm; risk ratio 1.0 (95% CI 0.6 - 1.6). There was no significant difference in survival at 12 months (p = 0.64, log rank test). In addition, there was no significant difference in mean weight-for-height at 12 months; 0.70 +/- 1.43 (95% CI 0.52 - 0.88) for the intervention versus 0.59 +/- 1.15 (95% CI 0.45 - 0.75) in the comparative arm. The mean CD4 cell count; 1024 +/- 592 (95% CI 942 - 1107) versus 1060 +/- 553 (95% CI 985 - 1136) was also similar between the two groups. Twice the recommended dietary allowance of 14 micronutrients compared with a standard recommended dietary allowance of six multivitamins for six months was well tolerated, but it did not significantly alter mortality, growth or CD

  4. Randomized controlled trial of an e-learning designed behavioral intervention for increasing physical activity behavior in multiple sclerosis.

    Science.gov (United States)

    Motl, Robert W; Hubbard, Elizabeth A; Bollaert, Rachel E; Adamson, Brynn C; Kinnett-Hopkins, Dominique; Balto, Julia M; Sommer, Sarah K; Pilutti, Lara A; McAuley, Edward

    2017-01-01

    Internet-delivered, behavioral interventions represent a cost-effective, broadly disseminable approach for teaching persons with multiple sclerosis (MS) the theory-based skills, techniques, and strategies for changing physical activity. This pilot, randomized controlled trial examined the efficacy of a newly developed Internet website based on e-learning approaches that delivered a theory-based behavior intervention for increasing physical activity and improving symptoms, walking impairment, and neurological disability. Participants with MS (N = 47) were randomly assigned into behavioral intervention (n = 23) or waitlist control (n = 24) conditions delivered over a six-month period. Outcomes were administered before and after the six-month period using blinded assessors, and data were analyzed using analysis of covariance in SPSS. There was a significant, positive intervention effect on self-reported physical activity (P = 0.05, [Formula: see text] = 0.10), and non-significant improvement in objectively measured physical activity (P = 0.24, [Formula: see text] = 0.04). There were significant, positive effects of the intervention on overall (P = 0.018, [Formula: see text] = 0.13) and physical impact of fatigue (P = 0.003, [Formula: see text] = 0.20), self-reported walking impairment (P = 0.047, [Formula: see text] = 0.10), and disability status (P = 0.033, [Formula: see text] = 0.11). There were non-significant improvements in fatigue severity (P = 0.10, [Formula: see text] = 0.06), depression (P = 0.10, [Formula: see text] = 0.07) and anxiety (P = 0.06, [Formula: see text] = 0.09) symptoms, and self-reported disability (P = 0.10, [Formula: see text] = 0.07). We provide evidence for the efficacy of an Internet-based behavioral intervention with content delivered through interactive video courses grounded in e-learning principles for increasing physical activity and possibly

  5. Effects of Prenatal Multiple Micronutrient Supplementation on Fetal Growth Factors: A Cluster-Randomized, Controlled Trial in Rural Bangladesh

    Science.gov (United States)

    Gernand, Alison D.; Schulze, Kerry J.; Nanayakkara-Bind, Ashika; Arguello, Margia; Shamim, Abu Ahmed; Ali, Hasmot; Wu, Lee; West, Keith P.; Christian, Parul

    2015-01-01

    Prenatal multiple micronutrient (MM) supplementation improves birth weight through increased fetal growth and gestational age, but whether maternal or fetal growth factors are involved is unclear. Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh. In a double-blind, cluster-randomized, controlled trial of MM vs. iron and folic acid (IFA) supplementation, we measured placental growth hormone (PGH) at 10 weeks and PGH and human placental lactogen (hPL) at 32 weeks gestation in maternal plasma (n = 396) and insulin, insulin-like growth factor-1 (IGF-1), and IGF binding protein-1 (IGFBP-1) in cord plasma (n = 325). Birth size and gestational age were also assessed. Early pregnancy mean (SD) BMI was 19.5 (2.4) kg/m2 and birth weight was 2.68 (0.41) kg. There was no effect of MM on concentrations of maternal hPL or PGH, or cord insulin, IGF-1, or IGFBP-1. However, among pregnancies of female offspring, hPL concentration was higher by 1.1 mg/L in the third trimester (95% CI: 0.2, 2.0 mg/L; p = 0.09 for interaction); and among women with height supplementation had no overall impact on intrauterine growth factors. MM supplementation altered some growth factors differentially by maternal early pregnancy nutritional status and sex of the offspring, but this should be examined in other studies. Trial Registration ClinicalTrials.gov NCT00860470 PMID:26431336

  6. Consistency of eletriptan in treating migraine: Results of a randomized, within-patient multiple-dose study.

    Science.gov (United States)

    Almas, Mary; Tepper, Stewart J; Landy, Stephen; Schweizer, Edward; Ramos, Elodie

    2014-02-01

    The current study evaluated the consistency of eletriptan response. Using a within-patient crossover design, patients with migraine completed a three-attack, open-label, lead-in period, before being treated, double-blind for four attacks, with either eletriptan 40 mg (ELE-40; N = 539) or eletriptan 80 mg (ELE-80; N = 432); placebo was randomly substituted for the treatment of one attack. On an A PRIORI analysis of within-patient consistency, double-blind treatment was associated with similar 2 hour headache response rates using a ≥2/3 response criterion for ELE-40 (77%) and ELE-80 (73%), and using a 3/3 response criterion for ELE-40 (46%) and ELE-80 (47%). Within-patient consistency in achieving pain-free status at 2 hours using a ≥2/3 criterion was slightly higher on ELE-40 (42%) compared with ELE-80 (38%), and was similar using the 3/3 criterion (18% on ELE-40, 17% on ELE-80). On a repeated measures logistic regression analysis across all treated attacks, the probability of achieving a headache response at 2 hours ranged from 71% to 74% on ELE-40 vs. 17% to 28% on placebo ( P ELE-80 vs. 21% to 27% on placebo ( P ELE-40 and ELE-80. Few adverse events occurred with incidence ≥10% on ELE-40 (asthenia, 5.0%) or ELE-80 (asthenia, 10%; nausea, 5.8%). Discontinuations because of adverse events were 0.2% on ELE-40, and 1.6% on ELE-80 CONCLUSION: In this multiple attack study, eletriptan was well-tolerated and demonstrated consistent and significant efficacy in the treatment of migraine.

  7. Randomized phase 1b trial of MOR103, a human antibody to GM-CSF, in multiple sclerosis.

    Science.gov (United States)

    Constantinescu, Cris S; Asher, Aliya; Fryze, Waldemar; Kozubski, Wojciech; Wagner, Frank; Aram, Jehan; Tanasescu, Radu; Korolkiewicz, Roman P; Dirnberger-Hertweck, Maren; Steidl, Stefan; Libretto, Susan E; Sprenger, Till; Radue, Ernst W

    2015-08-01

    To determine the safety, pharmacokinetics (PK), and immunogenicity of the recombinant human monoclonal antibody MOR103 to granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients with multiple sclerosis (MS) with clinical or MRI activity. In this 20-week, randomized, double-blind, placebo-controlled phase 1b dose-escalation trial (registration number NCT01517282), adults with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) received an IV infusion of placebo (n = 6) or MOR103 0.5 (n = 8), 1.0 (n = 8), or 2.0 (n = 9) mg/kg every 2 weeks for 10 weeks. Patients had to have ≤10 gadolinium (Gd)-enhancing brain lesions on T1-weighted MRI at baseline. The primary objective was safety. Most treatment-emergent adverse events (TEAEs) were mild to moderate in severity. The most frequent was nasopharyngitis. Between-group differences in TEAE numbers were small. There were no TEAE-related trial discontinuations, infusion-related reactions, or deaths. Nine patients experienced MS exacerbations: 3, 5, 1, and 0 patient(s) in the placebo, 0.5, 1.0, and 2.0 mg/kg groups, respectively. A few T1 Gd-enhancing lesions and/or new or enlarging T2 lesions indicative of inflammation were observed in all treatment groups. No clinically significant changes were observed in other clinical assessments or laboratory safety assessments. No anti-MOR103 antibodies were detected. PK evaluations indicated dose linearity with low/no drug accumulation over time. MOR103 was generally well-tolerated in patients with RRMS or SPMS. No evidence of immunogenicity was found. This phase 1b study provides Class I evidence that MOR103 has acceptable tolerability in patients with MS.

  8. Experimental protocol of a randomized controlled clinical trial investigating exercise, subclinical atherosclerosis, and walking mobility in persons with multiple sclerosis.

    Science.gov (United States)

    Griffith, Garett; Klaren, Rachel E; Motl, Robert W; Baynard, Tracy; Fernhall, Bo

    2015-03-01

    This randomized controlled trial (RCT) will investigate the effects of a home-based aerobic exercise training regimen (i.e., cycle ergometry) on subclinical atherosclerosis and walking mobility in persons with multiple sclerosis (MS) and minimal disability. This RCT will recruit 54 men and women who have an Expanded Disability Status Scale characteristic of the 1st stage of MS (i.e., 0-4.0) to participate in a 3 month exercise or stretching intervention, with assessments of subclinical atherosclerosis and walking mobility conducted at baseline, week 6 (midpoint), and week 12 (conclusion) of the program. The exercise intervention will consist of 3 days/week of cycling, with a gradual increase of duration followed by an increase in intensity across the 3 month period. The attention-control condition will incorporate stretching activities and will require the same contact time commitment as the exercise condition. Both study groups will participate in weekly video chat sessions with study personnel in order to monitor and track program adherence. Primary outcomes will consist of assessments of vascular structure and function, as well as several walking tasks. Additional outcomes will include questionnaires, cardiorespiratory fitness assessment, and a 1-week free-living physical activity assessment. This investigation will increase understanding of the role of aerobic exercise as part of a treatment plan for managing subclinical atherosclerosis and improving walking mobility persons in the 1st stage of MS. Overall, this study design has the potential to lead to effective aerobic exercise intervention strategies for this population and improve program adherence. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Zoledronic acid as compared with observation in multiple myeloma patients at biochemical relapse: results of the randomized AZABACHE Spanish trial.

    Science.gov (United States)

    García-Sanz, Ramón; Oriol, Albert; Moreno, María J; de la Rubia, Javier; Payer, Angel R; Hernández, Miguel T; Palomera, Luis; Teruel, Ana I; Blanchard, María J; Gironella, Mercedes; Ribas, Paz; Bargay, Joan; Abellá, Eugenia; Granell, Miquel; Ocio, Enrique M; Ribera, Josep M; San Miguel, Jesús F; Mateos, María V

    2015-09-01

    This study analyzed the anti-myeloma effect of zoledronic acid monotherapy by investigating patients at the time of asymptomatic biochemical relapse. One hundred patients were randomized to receive either zoledronic acid (4 mg iv/4 weeks, 12 doses) (n=51) or not (n=49). Experimental and control groups were well balanced for disease and prognostic features. Zoledronic acid did not show an antitumor effect according to changes in M-component. However, there were fewer symptomatic progressions in the experimental group than in the control group (34 versus 41, respectively; P=0.05) resulting in a median time to symptoms of 16 versus 10 months (P=0.161). The median time to next therapy was also slightly longer for the treated group than the untreated, control group (13.4 versus 10.1 months), although the difference was not statistically significant (P=0.360). The pattern of relapses was different for treated versus control patients: progressive bone disease (8 versus 20), anemia (24 versus 18), renal dysfunction (1 versus 2), and plasmacytomas (1 versus 1, respectively). This concurred with fewer skeletal-related events in the treated group than in the control group (2 versus 14), with a projected 4-year event proportion of 6% versus 40% (P<0.001). In summary, zoledronic acid monotherapy does not show an antitumor effect on biochemical relapses in multiple myeloma, but does reduce the risk of progression with symptomatic bone disease and skeletal complications. This trial was registered in the ClinicalTrials.gov database with code NCT01087008. Copyright© Ferrata Storti Foundation.

  10. Computed tomography synthesis from magnetic resonance images in the pelvis using multiple random forests and auto-context features

    Science.gov (United States)

    Andreasen, Daniel; Edmund, Jens M.; Zografos, Vasileios; Menze, Bjoern H.; Van Leemput, Koen

    2016-03-01

    In radiotherapy treatment planning that is only based on magnetic resonance imaging (MRI), the electron density information usually obtained from computed tomography (CT) must be derived from the MRI by synthesizing a so-called pseudo CT (pCT). This is a non-trivial task since MRI intensities are neither uniquely nor quantitatively related to electron density. Typical approaches involve either a classification or regression model requiring specialized MRI sequences to solve intensity ambiguities, or an atlas-based model necessitating multiple registrations between atlases and subject scans. In this work, we explore a machine learning approach for creating a pCT of the pelvic region from conventional MRI sequences without using atlases. We use a random forest provided with information about local texture, edges and spatial features derived from the MRI. This helps to solve intensity ambiguities. Furthermore, we use the concept of auto-context by sequentially training a number of classification forests to create and improve context features, which are finally used to train a regression forest for pCT prediction. We evaluate the pCT quality in terms of the voxel-wise error and the radiologic accuracy as measured by water-equivalent path lengths. We compare the performance of our method against two baseline pCT strategies, which either set all MRI voxels in the subject equal to the CT value of water, or in addition transfer the bone volume from the real CT. We show an improved performance compared to both baseline pCTs suggesting that our method may be useful for MRI-only radiotherapy.

  11. Use of videotape to assess mobility in a controlled randomized crossover trial of physiotherapy in chronic multiple sclerosis.

    Science.gov (United States)

    Wiles, C M; Newcombe, R G; Fuller, K J; Jones, A; Price, M

    2003-05-01

    To determine to what degree assessment of mobility based on comparison of videotape recordings before and after courses of physiotherapy in patients with chronic multiple sclerosis (MS) is reliable, correlates with 'live' assessments and indicates benefit. Prospective data collection within a randomized crossover controlled trial of physiotherapy at home, as an outpatient, or 'no therapy' in 40 patients. Hospital outpatients: outpatient and home physiotherapy. Mobility change based on a comparison of short video recordings before and after each treatment period was scored independently by two physiotherapists blinded to therapy type and other measures of outcome. Scores were compared with changes in the Rivermead Mobility Index (RMI) and other indices assessed by a physiotherapist in the patient's home. The two video observers agreed substantially on patient outcome. Changes in walking based on video correlated with RMI for home treatment (r = 0.41, p = 0.008) but not for hospital or no treatment periods (r = 0.14 and 0.15): video changes correlated with the 'live' assessor's global change score inconsistently ('no therapy' r = 0.48, p = 0.002, hospital r = 0.30, p = 0.06 and home r = 0.17, p = 0.30 treatment periods). Based on video data alone, improved mobility was evident following home therapy for only one observer but not for the other or the averaged scores of both. There was substantial agreement between two observers deciding on change in mobility based on independent blinded evaluation of short video sequences. However the correlations of these with 'live' assessments were variable. Physiotherapy had a less clear benefit on mobility based on video analysis alone compared with 'live' assessments. The study highlights the need for more objective measures of habitual mobility over longer periods.

  12. Sensor integration study for a shallow tunnel detection system.

    Energy Technology Data Exchange (ETDEWEB)

    Yee, Mark L.; Abbott, Robert E.; Bonal, Nedra; Elbring, Gregory Jay; Senglaub, Michael E.

    2010-02-01

    During the past several years, there has been a growing recognition of the threats posed by the use of shallow tunnels against both international border security and the integrity of critical facilities. This has led to the development and testing of a variety of geophysical and surveillance techniques for the detection of these clandestine tunnels. The challenges of detection of these tunnels arising from the complexity of the near surface environment, the subtlety of the tunnel signatures themselves, and the frequent siting of these tunnels in urban environments with a high level of cultural noise, have time and again shown that any single technique is not robust enough to solve the tunnel detection problem in all cases. The question then arises as to how to best combine the multiple techniques currently available to create an integrated system that results in the best chance of detecting these tunnels in a variety of clutter environments and geologies. This study utilizes Taguchi analysis with simulated sensor detection performance to address this question. The analysis results show that ambient noise has the most effect on detection performance over the effects of tunnel characteristics and geological factors.

  13. Conservative treatment of carpal tunnel syndrome: comparison between laser therapy and Fascial Manipulation(®).

    Science.gov (United States)

    Pratelli, Elisa; Pintucci, Marco; Cultrera, Pina; Baldini, Enrico; Stecco, Antonio; Petrocelli, Antonio; Pasquetti, Pietro

    2015-01-01

    The etiopathogenesis of Carpal Tunnel Syndrome (CTS) is multifactorial and most cases are classified as idiopathic (Thurston 2013). A randomized controlled trial was performed to compare the effectiveness of Fascial Manipulation(®) (FM) and Low-Level Laser Therapy (LLLT) for CTS. This prospective trial included 42 patients (70 hands with symptoms) with clinical and electroneuromyographic diagnosis of CTS. The patients were randomly assigned to receive multiple sessions of FM or multiple session of LLLT. The Visual Analogic Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) were performed at baseline, end of treatment and after three months. The group that received FM showed a significant reduction in subjective pain perception and an increased function assessed by BCTQ at the end of the treatment and follow-up. The group that received LLLT showed an improvement in the BCTQ at the end of the treatment but the improvement level was not sustained at the three month follow-up. FM is a valid alternative treatment for CTS. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Coherent light scattering of heterogeneous randomly rough films and effective medium in the theory of electromagnetic wave multiple scattering

    Energy Technology Data Exchange (ETDEWEB)

    Berginc, G [THALES, 2 avenue Gay-Lussac 78995 ELANCOURT (France)

    2013-11-30

    We have developed a general formalism based on Green's functions to calculate the coherent electromagnetic field scattered by a random medium with rough boundaries. The approximate expression derived makes it possible to determine the effective permittivity, which is generalised for a layer of an inhomogeneous random medium with different types of particles and bounded with randomly rough interfaces. This effective permittivity describes the coherent propagation of an electromagnetic wave in a random medium with randomly rough boundaries. We have obtained an expression, which contains the Maxwell – Garnett formula at the low-frequency limit, and the Keller formula; the latter has been proved to be in good agreement with experiments for particles whose dimensions are larger than a wavelength. (coherent light scattering)

  15. Tunneling in axion monodromy

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Jon; Cottrell, William; Shiu, Gary; Soler, Pablo [Department of Physics, University of Wisconsin,Madison, WI 53706 (United States)

    2016-10-06

    The Coleman formula for vacuum decay and bubble nucleation has been used to estimate the tunneling rate in models of axion monodromy in recent literature. However, several of Coleman’s original assumptions do not hold for such models. Here we derive a new estimate with this in mind using a similar Euclidean procedure. We find that there are significant regions of parameter space for which the tunneling rate in axion monodromy is not well approximated by the Coleman formula. However, there is also a regime relevant to large field inflation in which both estimates parametrically agree. We also briefly comment on the applications of our results to the relaxion scenario.

  16. LEP tunnel monorail

    CERN Multimedia

    1985-01-01

    A monorail from CERN's Large Electron Positron collider (LEP, for short). It ran around the 27km tunnel, transporting equipment and personnel. With its 27-kilometre circumference, LEP was the largest electron-positron accelerator ever built and ran from 1989 to 2000. During 11 years of research, LEP's experiments provided a detailed study of the electroweak interaction. Measurements performed at LEP also proved that there are three – and only three – generations of particles of matter. LEP was closed down on 2 November 2000 to make way for the construction of the Large Hadron Collider in the same tunnel.

  17. Breaking through the tranfer tunnel

    CERN Multimedia

    Laurent Guiraud

    2001-01-01

    This image shows the tunnel boring machine breaking through the transfer tunnel into the LHC tunnel. Proton beams will be transferred from the SPS pre-accelerator to the LHC at 450 GeV through two specially constructed transfer tunnels. From left to right: LHC Project Director, Lyn Evans; CERN Director-General (at the time), Luciano Maiani, and Director for Accelerators, Kurt Hubner.

  18. Zero-Time Tunneling - Revisited

    Science.gov (United States)

    Nimtz, Günter; Aichmann, Horst

    2017-08-01

    Since 1931, the nonclassical process of tunneling was conjectured to have a zero-time delay in the barrier. These theories have been rejected and denied. However, photonic and recent electronic tunneling experiments have proven the zero-time prediction. Tunneling is due to virtual wave packets in electromagnetic, elastic, and Schrödinger wave fields up to the macroscopic level. In this article we cite theoretical and experimental studies on zero-time tunneling, which have proven this striking behavior.

  19. Tunnelling with wormhole creation

    Energy Technology Data Exchange (ETDEWEB)

    Ansoldi, S. [National Institute of Nuclear Physics (INFN) (Italy); Tanaka, T., E-mail: tanaka@yukawa.kyoto-u.ac.jp [Kyoto University, Department of Physics (Japan)

    2015-03-15

    The description of quantum tunnelling in the presence of gravity shows subtleties in some cases. We discuss wormhole production in the context of the spherically symmetric thin-shell approximation. By presenting a fully consistent treatment based on canonical quantization, we solve a controversy present in the literature.

  20. Tunnelling Effects in Chemistry

    Indian Academy of Sciences (India)

    IAS Admin

    Tunnelling Effects in Chemistry. Molecules in the Strange Quantum World. Sharmistha Karmakar, Deepthi Jose and Ayan Datta. (left) Sharmistha Karmakar is doing her PhD in the group of. Ayan Datta, IACS,. Kolkata. Her research interests are modelling molecules with strong optical absorbtion and emission properties.

  1. Signatures of chaotic tunnelling

    OpenAIRE

    Mouchet, Amaury; Delande, Dominique

    2002-01-01

    Recent experiments with cold atoms provide a significant step toward a better understanding of tunnelling when irregular dynamics is present at the classical level. In this paper, we lay out numerical studies which shed light on the previous experiments, help to clarify the underlying physics and have the ambition to be guidelines for future experiments.

  2. INCAS SUBSONIC WIND TUNNEL

    Directory of Open Access Journals (Sweden)

    Corneliu STOICA

    2009-09-01

    Full Text Available The INCAS Subsonic Wind Tunnel is a closed circuit, continuous, atmospheric pressure facility with a maximum speed of 110 m/s. The test section is octagonal ,of 2.5 m wide, 2.0 m high and 4 m long. The tunnel is powered by a 1200 kW, air cooled variable speed DC motor which drives a 12 blade, 3.5 m diameter fan and is equipped with a six component pyramidal type external mechanical balance with a 700 Kgf maximum lift capacity.The angle of attack range is between -45º and +45º while the yaw angle range is between -140º and +216º .The data acquisition system has been modified recently to allow the recording of all test data on a PC - type computer using LABVIEW and a PXI – type chassis containing specialized data acquisition modules.The tunnel is equipped with a variable frequency electrical supply system for powered models and a 10 bar compressed air supply for pneumatic flow control applications.In the recent years the subsonic wind tunnel has been intensively used for tests within several European projects (AVERT, CESAR and others.

  3. Tunnelling Effects in Chemistry

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 19; Issue 2. Tunnelling Effects in Chemistry: Molecules in the Strange Quantum World. Sharmistha Karmakar Deepthi Jose Ayan Datta. General Article Volume 19 Issue 2 February 2014 pp 160-174 ...

  4. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghazikhanian, Varand [Brigham and Women' s Hospital, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Beltran, Javier [Maimonides Medical Center, Brooklyn, NY (United States); Nikac, Violeta [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Bencardino, Jenny T. [NYU Hospital for Joint Diseases, New York, NY (United States); Feldman, Marina

    2012-11-15

    Tunnel cyst formation is a rare complication after anterior cruciate ligament reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. There are multiple proposed theories regarding the etiology of tunnel cysts. Theories include necrosis, foreign-body reaction, lack of complete graft osteo-integration, and intravasation of articular fluid. It is important to know if the tunnel cysts are communicating or not communicating with the joint, as surgical management may be different. Imaging characteristics on magnetic resonance images (MRI) include tibial tunnel widening, multilocular or unilocular cyst formation in the graft or tibial tunnel, with possible extension into the pretibial space, intercondylar notch, and/or popliteal fossa. The MR imaging differential diagnosis of tibial tunnel cysts includes infection, foreign-body granuloma, or tibial screw extrusion. Importantly, to the best of our knowledge, graft failure or instability has not been reported in association with tibial tunnel cysts. (orig.)

  5. Multi-channel Dual Clocks three-dimensional probability Random Multiple Access protocol for Wireless Public Bus Networks based on RTS/CTS mechanism

    Directory of Open Access Journals (Sweden)

    Zhou Sheng Jie

    2016-01-01

    Full Text Available A MAC protocol for public bus networks, called Bus MAC protocol, designed to provide high quality Internet service for bus passengers. The paper proposed a multi-channel dual clocks three-demission probability random multiple access protocol based on RTS/CTS mechanism, decreasing collisions caused by multiple access from multiple passengers. Use the RTS/CTS mechanism increases the reliability and stability of the system, reducing the collision possibility of the information packets to a certain extent, improves the channel utilization; use the multi-channel mechanism, not only enables the channel load balancing, but also solves the problem of the hidden terminal and exposed terminal. Use the dual clocks mechanism, reducing the system idle time. At last, the different selection of the three-dimensional probabilities can make the system throughput adapt to the network load which could realize the maximum of the system throughput.

  6. Glatiramer Acetate in Treatment of Multiple Sclerosis: A Toolbox of Random Co-Polymers for Targeting Inflammatory Mechanisms of both the Innate and Adaptive Immune System?

    Directory of Open Access Journals (Sweden)

    Thomas Vorup-Jensen

    2012-11-01

    Full Text Available Multiple sclerosis is a disease of the central nervous system, resulting in the demyelination of neurons, causing mild to severe symptoms. Several anti-inflammatory treatments now play a significant role in ameliorating the disease. Glatiramer acetate (GA is a formulation of random polypeptide copolymers for the treatment of relapsing-remitting MS by limiting the frequency of attacks. While evidence suggests the influence of GA on inflammatory responses, the targeted molecular mechanisms remain poorly understood. Here, we review the multiple pharmacological modes-of-actions of glatiramer acetate in treatment of multiple sclerosis. We discuss in particular a newly discovered interaction between the leukocyte-expressed integrin αMβ2 (also called Mac-1, complement receptor 3, or CD11b/CD18 and perspectives on the GA co-polymers as an influence on the function of the innate immune system.

  7. Analysis of a Split-Plot Experimental Design Applied to a Low-Speed Wind Tunnel Investigation

    Science.gov (United States)

    Erickson, Gary E.

    2013-01-01

    A procedure to analyze a split-plot experimental design featuring two input factors, two levels of randomization, and two error structures in a low-speed wind tunnel investigation of a small-scale model of a fighter airplane configuration is described in this report. Standard commercially-available statistical software was used to analyze the test results obtained in a randomization-restricted environment often encountered in wind tunnel testing. The input factors were differential horizontal stabilizer incidence and the angle of attack. The response variables were the aerodynamic coefficients of lift, drag, and pitching moment. Using split-plot terminology, the whole plot, or difficult-to-change, factor was the differential horizontal stabilizer incidence, and the subplot, or easy-to-change, factor was the angle of attack. The whole plot and subplot factors were both tested at three levels. Degrees of freedom for the whole plot error were provided by replication in the form of three blocks, or replicates, which were intended to simulate three consecutive days of wind tunnel facility operation. The analysis was conducted in three stages, which yielded the estimated mean squares, multiple regression function coefficients, and corresponding tests of significance for all individual terms at the whole plot and subplot levels for the three aerodynamic response variables. The estimated regression functions included main effects and two-factor interaction for the lift coefficient, main effects, two-factor interaction, and quadratic effects for the drag coefficient, and only main effects for the pitching moment coefficient.

  8. Tunneling and Transport in Nanowires

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, Allen M. [Univ. of Minnesota, Minneapolis, MN (United States)

    2016-08-16

    The goal of this program was to study new physical phenomena that might be relevant to the performance of conductive devices and circuits of the smallest realizable feature sizes possible using physical rather than biological techniques. Although the initial scientific work supported involved the use of scanning tunneling microscopy and spectroscopy to ascertain the statistics of the energy level distribution of randomly sized and randomly shaped quantum dots, or nano-crystals, the main focus was on the investigation of selected properties, including superconductivity, of conducting and superconducting nanowires prepared using electron-beam-lithography. We discovered a magnetic-field-restoration of superconductivity in out-of-equilibrium nanowires driven resistive by current. This phenomenon was explained by the existence of a state in which dissipation coexisted with nonvanishing superconducting order. We also produced ultra-small superconducting loops to study a predicted anomalous fluxoid quantization, but instead, found a magnetic-field-dependent, high-resistance state, rather than superconductivity. Finally, we developed a simple and controllable nanowire in an induced charged layer near the surface of a masked single-crystal insulator, SrTiO3. The layer was induced using an electric double layer transistor employing an ionic liquid (IL). The transport properties of the induced nanowire resembled those of collective electronic transport through an array of quantum dots.

  9. Optimized electrode configuration for current-in-plane characterization of magnetic tunnel junction stacks

    DEFF Research Database (Denmark)

    Cagliani, Alberto; Kjær, Daniel; Østerberg, Frederik Westergaard

    2017-01-01

    The current-in-plane tunneling technique (CIPT) has been a crucial tool in the development of magnetic tunnel junction stacks suitable for magnetic random access memories (MRAM) for more than a decade. The MRAM development has now reached the maturity to make the transition from the R&D phase...

  10. The vitamin D to ameliorate multiple sclerosis (VIDAMS) trial: study design for a multicenter, randomized, double-blind controlled trial of vitamin D in multiple sclerosis.

    Science.gov (United States)

    Bhargava, Pavan; Cassard, Sandra; Steele, Sonya U; Azevedo, Christina; Pelletier, Daniel; Sugar, Elizabeth A; Waubant, Emmanuelle; Mowry, Ellen M

    2014-11-01

    Lower levels of vitamin D are associated with increased MS risk and with greater clinical and brain MRI activity in established relapsing MS. The VIDAMS trial (NCT01490502) is evaluating whether high-dose vitamin D supplementation reduces the risk of MS activity. Eligibility criteria include diagnosis of RRMS, age 18 to 50 years, and Expanded Disability Status Scale ≤4.0. Disease duration and activity requirements depend on whether 2005 or 2010 criteria are used for diagnosis. Enrollment is restricted based on prior MS therapy exposure and recent vitamin D use. After completing a one-month run-in of glatiramer acetate, 172 patients will be randomized 1:1 to oral vitamin D(3) 5000 IU versus 600 IU daily. Clinical visits occur every 12 weeks for 96 weeks. Sixteen sites throughout the United States are participating in the trial. Complete enrollment is expected by late 2014, with follow-up through 2016. No interim analyses are planned. The primary outcome for the trial is the proportion of patients experiencing a relapse in each group. Other clinical, patient-reported, and MRI outcomes will be evaluated. The VIDAMS trial will provide critical information about the safety and efficacy of vitamin D therapy in RRMS, with implications for MS patients worldwide. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Randomizing Multiple Contingency Components to Decrease Disruptive Behaviors and Increase Student Engagement in an Urban Second-Grade Classroom

    Science.gov (United States)

    McKissick, Chele; Hawkins, Renee O.; Lentz, Francis E.; Hailley, Jennifer; McGuire, Shannon

    2010-01-01

    Disruptive behaviors displayed in the classroom interfere with learning by taking time away from academic instruction. This study investigated the effects of randomizing components within an interdependent group contingency for group disruptive behavior and engagement levels of 26 students in a second-grade classroom in an urban Midwestern school.…

  12. Efficient rare-event simulation for multiple jump events in regularly varying random walks and compound Poisson processes

    NARCIS (Netherlands)

    B. Chen (Bohan); J. Blanchet; C.H. Rhee (Chang-Han); A.P. Zwart (Bert)

    2017-01-01

    textabstractWe propose a class of strongly efficient rare event simulation estimators for random walks and compound Poisson processes with a regularly varying increment/jump-size distribution in a general large deviations regime. Our estimator is based on an importance sampling strategy that hinges

  13. Programmable ferroelectric tunnel memristor

    Directory of Open Access Journals (Sweden)

    Andy eQuindeau

    2014-02-01

    Full Text Available We report an analogously programmable memristor based on genuine electronic resistive switching combining ferroelectric switching and electron tunneling. The tunnel current through an 8 unit cell thick epitaxial Pb(Zr[0.2]Ti[0.8]O[3] film sandwiched between La[0.7]Sr[0.3]MnO[3] and cobalt electrodes obeys the Kolmogorov-Avrami-Ishibashi model for bidimensional growth with a characteristic switching time in the order of 10^-7 seconds. The analytical description of switching kinetics allows us to develop a characteristic transfer function that has only one parameter viz. the characteristic switching time and fully predicts the resistive states of this type of memristor.

  14. Educational Wind Tunnel

    Directory of Open Access Journals (Sweden)

    Juozas Bielskus

    2012-12-01

    Full Text Available The paper analyzes an educational wind tunnel produced by the Department of Building Energetics (DBE of Vilnius Gediminas Technical University. The equipment could be used for performing laboratory works and simple research. The article presents the projection of inflow and outlet velocity in the working chamber of DBE wind tunnel and carries out actual noise level measurement. The received data are compared with information on the level of noise generated by the fan considering instructions provided by the manufacturer. In order to assess the reliability of the computer program, simulation applying PHOENICS software has been conducted. The aim of modeling is to simulate a pilot model and to compare the obtained results with those of an analogous test presented in scientific articles.Article in Lithuanian

  15. Nanowire resonant tunneling diodes

    Science.gov (United States)

    Björk, M. T.; Ohlsson, B. J.; Thelander, C.; Persson, A. I.; Deppert, K.; Wallenberg, L. R.; Samuelson, L.

    2002-12-01

    Semiconductor heterostructures and their implementation into electronic and photonic devices have had tremendous impact on science and technology. In the development of quantum nanoelectronics, one-dimensional (1D) heterostructure devices are receiving a lot of interest. We report here functional 1D resonant tunneling diodes obtained via bottom-up assembly of designed segments of different semiconductor materials in III/V nanowires. The emitter, collector, and the central quantum dot are made from InAs and the barrier material from InP. Ideal resonant tunneling behavior, with peak-to-valley ratios of up to 50:1 and current densities of 1 nA/μm2 was observed at low temperatures.

  16. The beam dump tunnels

    CERN Multimedia

    Patrice Loïez

    2002-01-01

    In these images workers are digging the tunnels that will be used to dump the counter-circulating beams. Travelling just a fraction under the speed of light, the beams at the LHC will each carry the energy of an aircraft carrier travelling at 12 knots. In order to dispose of these beams safely, a beam dump is used to extract the beam and diffuse it before it collides with a radiation shielded graphite target.

  17. Operation optimization of longitudinal smoke control system in urban underground traffic tunnel with multiple ramps%某多匝道城市地下道路纵向排烟系统运行优化

    Institute of Scientific and Technical Information of China (English)

    李俊梅; 王继东; 冯霄; 李炎锋; 常军; 李雁; 刘晓阳

    2016-01-01

    To study the effects of ramps on the efficiency of longitudinal smoke control systemin ur-ban traffic tunnel, a tunnel ventilation network model is established. The smoke control effects indif-ferent fire scenarios are studied by the numerical method, and the most optimal ventilation strategy in each scenario isobtained. The results show that the critical wind velocity can be reached without all designed fans running, and the fans at the downward of the ventilation shaft need to run reversely to obtain high exhaust efficiency. The longitudinal smoke control system in the main tunnel and the smoke control systems in the ramp should run in combination for high efficiency in smoke control.%为研究多出入匝道的存在对隧道纵向排烟系统效率的影响,采用通风网络对某多匝道城市地下道路分段纵向排烟系统的烟气控制效果进行了模拟分析,得到了不同火灾场景中风机运行的最佳策略。结果表明,对于该城市地下道路而言,火灾发生时各段排烟风机不必全部运行即可达到所要求的临界风速值,火源段下游竖井附近风机需逆转运行才能防止竖井上游烟气向下游扩散,从而提高其排烟效率;若主线隧道发生火灾,匝道风机最好停止运行,以帮助主线隧道达到较好得控烟效果。

  18. Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial

    NARCIS (Netherlands)

    van den Akker, Lizanne E.; Beckerman, Heleen; Collette, Emma H.; Twisk, Jos W. R.; Bleijenberg, Gijs; Dekker, Joost; Knoop, Hans; de Groot, Vincent

    2017-01-01

    Background: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. Objective: To evaluate the effectiveness of CBT to improve MS-related

  19. Up-front fludarabine impairs stem cell harvest in multiple myeloma: report from an interim analysis of the NMSG 13/03 randomized placebo controlled phase II trial

    DEFF Research Database (Denmark)

    Johnsen, Hans Erik; Knudsen, Lene Meldgaard; Mylin, Anne Kærsgaard

    2009-01-01

    toxicity and safety analysis, the trial was stopped following inclusion of 34 of a planned 80 patients due to a reduced number of patients (4/17) actually harvested in the experimental arm compared to the control arm (11/17; p lower than 0.05). In conclusion, the scheduled fludarabine dosage in 2 cycles......The impact of chemotherapy resistant B cells in multiple myeloma (MM) needs to be evaluated by in vivo targeted therapy. Here we report the conclusions from a phase II randomized, placebo controlled trial adding fludarabine to the induction with cyclophosphamide-dexamethasone. Based on an interim...

  20. Up-front fludarabine impairs stem cell harvest in multiple myeloma: report of the NMSG 13/03 randomized placebo controlled phase II trial

    DEFF Research Database (Denmark)

    Johnsen, Hans E.; Meldgaard Knudsen, Lene; Mylin, Anne K.

    2009-01-01

    toxicity and safety analysis, the trial was stopped following inclusion of 34 of a planned 80 patients due to a reduced number of patients (4/17) actually harvested in the experimental arm compared to the control arm (11/17; p...The impact of chemotherapy resistant B cells in multiple myeloma (MM) needs to be evaluated by in vivo targeted therapy. Here we report the conlusions from a phase II randomized, placebo controlled trial adding fludarabine to the induction with cyclophosphamide-dexamethasone. Based on an interim...

  1. Comparing cluster-level dynamic treatment regimens using sequential, multiple assignment, randomized trials: Regression estimation and sample size considerations

    OpenAIRE

    NeCamp, Timothy; Kilbourne, Amy; Almirall, Daniel

    2016-01-01

    Cluster-level dynamic treatment regimens can be used to guide sequential, intervention or treatment decision-making at the cluster level in order to improve outcomes at the individual or patient-level. In a cluster-level DTR, the intervention or treatment is potentially adapted and re-adapted over time based on changes in the cluster that could be impacted by prior intervention, including based on aggregate measures of the individuals or patients that comprise it. Cluster-randomized sequentia...

  2. Passive fire protection measures for concrete tunnels

    NARCIS (Netherlands)

    Both, C.; Haar, P.W. van de; Tan, G.L.; Wolsink, G.M.

    1999-01-01

    executed or in the process of designing; worth mentioning are the Western Scheld tunnel (approximately 2x6.5 km), the tunnels in the Betuwe railway and the tunnels in the HSL (high velocity train) railway. The most prominent of these tunnels will be executed as bored tunnels. The Directorate-General

  3. Nanowire Tunnel Field Effect Transistors: Prospects and Pitfalls

    Science.gov (United States)

    Sylvia, Somaia Sarwat

    The tunnel field effect transistor (TFET) has the potential to operate at lower voltages and lower power than the field effect transistor (FET). The TFET can circumvent the fundamental thermal limit of the inverse subthreshold slope (S) by exploiting interband tunneling of non-equilibrium "cold" carriers. The conduction mechanism in the TFET is governed by band-to-band tunneling which limits the drive current. TFETs built with III-V materials like InAs and InSb can produce enough tunneling current because of their small direct bandgap. Our simulation results show that although they require highly degenerate source doping to support the high electric fields in the tunnel region, the devices achieve minimum inverse subthreshold slopes of 30 mV/dec. In subthreshold, these devices experience both regimes of voltage-controlled tunneling and cold-carrier injection. Numerical results based on a discretized 8-band k.p model are compared to analytical WKB theory. For both regular FETs and TFETs, direct channel tunneling dominates the leakage current when the physical gate length is reduced to 5 nm. Therefore, a survey of materials is performed to determine their ability to suppress the direct tunnel current through a 5 nm barrier. The tunneling effective mass gives the best indication of the relative size of the tunnel currents. Si gives the lowest overall tunnel current for both the conduction and valence band and, therefore, it is the optimum choice for suppressing tunnel current at the 5 nm scale. Our numerical simulation shows that the finite number, random placement, and discrete nature of the dopants in the source of an InAs nanowire (NW) TFET affect both the mean value and the variance of the drive current and the inverse subthreshold slope. The discrete doping model gives an average drive current and an inverse subthreshold slope that are less than those predicted from the homogeneous doping model. The doping density required to achieve a target drive current is

  4. Three nested randomized controlled trials of peer-only or multiple stakeholder group feedback within Delphi surveys during core outcome and information set development.

    Science.gov (United States)

    Brookes, Sara T; Macefield, Rhiannon C; Williamson, Paula R; McNair, Angus G; Potter, Shelley; Blencowe, Natalie S; Strong, Sean; Blazeby, Jane M

    2016-08-17

    Methods for developing a core outcome or information set require involvement of key stakeholders to prioritise many items and achieve agreement as to the core set. The Delphi technique requires participants to rate the importance of items in sequential questionnaires (or rounds) with feedback provided in each subsequent round such that participants are able to consider the views of others. This study examines the impact of receiving feedback from different stakeholder groups, on the subsequent rating of items and the level of agreement between stakeholders. Randomized controlled trials were nested within the development of three core sets each including a Delphi process with two rounds of questionnaires, completed by patients and health professionals. Participants rated items from 1 (not essential) to 9 (absolutely essential). For round 2, participants were randomized to receive feedback from their peer stakeholder group only (peer) or both stakeholder groups separately (multiple). Decisions as to which items to retain following each round were determined by pre-specified criteria. Whilst type of feedback did not impact on the percentage of items for which a participant subsequently changed their rating, or the magnitude of change, it did impact on items retained at the end of round 2. Each core set contained discordant items retained by one feedback group but not the other (3-22 % discordant items). Consensus between patients and professionals in items to retain was greater amongst those receiving multiple group feedback in each core set (65-82 % agreement for peer-only feedback versus 74-94 % for multiple feedback). In addition, differences in round 2 scores were smaller between stakeholder groups receiving multiple feedback than between those receiving peer group feedback only. Variability in item scores across stakeholders was reduced following any feedback but this reduction was consistently greater amongst the multiple feedback group. In the development of

  5. Multiple-modality exercise and mind-motor training to improve cardiovascular health and fitness in older adults at risk for cognitive impairment: A randomized controlled trial.

    Science.gov (United States)

    Boa Sorte Silva, Narlon C; Gregory, Michael A; Gill, Dawn P; Petrella, Robert J

    The effects of multiple-modality exercise on arterial stiffening and cardiovascular fitness has not been fully explored. To explore the influence of a 24-week multiple-modality exercise program associated with a mind-motor training in cardiovascular health and fitness in community-dwelling older adults, compared to multiple-modality exercise (M2) alone. Participants (n=127, aged 67.5 [7.3] years, 71% females) were randomized to either M4 or M2 groups. Both groups received multiple-modality exercise intervention (60min/day, 3days/week for 24-weeks); however, the M4 group underwent additional 15min of mind-motor training, whereas the M2 group received 15min of balance training. Participants were assessed at 24-weeks and after a 28-week non-contact follow-up (52-weeks). at 52-weeks, the M4 group demonstrated a greater VO2max (ml/kg/min) compared to the M2 group (mean difference: 2.39, 95% CI: 0. 61 to 4.16, p=0.009). Within-group analysis indicated that the M4 group demonstrated a positive change in VO2max at 24-weeks (mean change: 1.93, 95% CI: 0.82 to 3.05, p=0.001) and 52-weeks (4.02, 95% CI: 2.71 to 5.32, p=0.001). Similarly, the M2 group increased VO2max at 24-weeks (2.28, 95% CI: 1.23 to 3.32, pMind-motor training associated with multiple-modality exercise can positively impact cardiovascular fitness to the same extent as multiple-modality exercise alone. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Managerial Ownership Influencing Tunnelling Behaviour

    Directory of Open Access Journals (Sweden)

    Agung Juliarto

    2013-06-01

    Full Text Available This study investigates the extent and the determinants of tunnelling behaviour in five ASEAN countries (i.e. Indonesia, Malaysia, Philippines, Singapore, and Thailand. Related party transactions (RPTs in the form of loans to related parties are used as the proxy for tunnelling. With 200 firm-year observations over the period 2006-2009, this study finds a positive association between managerial ownership and the extent of tunnelling.The other important findings are that business environment (BE, foreign ownership, and independent directors are ineffective governance mechanisms to rein in tunnelling behaviour. This suggests that regulators need to evolve more effective governance mechanisms.

  7. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial.

    Science.gov (United States)

    Stockton, Kellie A; Mengersen, Kerrie A

    2009-10-01

    Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. To determine whether increasing physiotherapy input from once to twice per day will result in earlier achievement of functional milestones (ie, independence in mobility and transfers) and decreased length of stay (LOS) in patients undergoing a primary total hip replacement. Randomized controlled trial. Metropolitan private hospital. Patients (N=57) with primary total hip replacement were randomly assigned to the twice daily (treatment, n=30) and once daily (control, n=27) groups. Patients who chose to attend hydrotherapy were excluded from the randomization process; however, they gave consent for outcome measures to be collected for comparison with the randomized groups. The control group received usual care, and the treatment group received twice-daily physiotherapy from day 1 after surgery to discharge. The Iowa Level of Assistance at postoperative days 3 and 6 and LOS. This study demonstrates that patients who received twice-daily land-based physiotherapy after primary total hip replacement attained earlier achievement of functional milestones than patients that received once-daily physiotherapy. A statistically significant (P=.041) but not clinically significant difference was evident in the Iowa Level of Assistance score at day 3. There was no difference between the groups in Iowa Level of Assistance measures on day 6 or on LOS. Patients who received twice-daily physiotherapy showed a trend toward earlier achievement of functional milestones; however, this finding did not translate to decreased LOS.

  8. A group-delivered self-management program reduces spasticity in people with multiple sclerosis: A randomized, controlled pilot trial

    OpenAIRE

    Hugos, Cinda L; Bourdette, Dennis; Chen, Yiyi; Chen, Zunqiu; Cameron, Michelle

    2017-01-01

    Background Spasticity affects more than 80% of people with multiple sclerosis (MS), affecting activity, participation, and quality of life. Based on an international guideline, an MS spasticity group education and stretching program, MS Spasticity: Take Control (STC), has been developed. Objective The objective of this paper is to determine whether STC with home stretching is associated with greater changes in spasticity than usual care (UC), consisting of an illustrated stretching booklet an...

  9. Multiple micronutrient supplementation improves vitamin B12 and folate concentrations of HIV infected children in Uganda: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bolann Bjørn J

    2011-05-01

    Full Text Available Abstract Background The effect of multiple micronutrient supplementation on vitamin B12 and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B12 and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B12 and folate concentrations. Methods Of 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B12 and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA of a 14 multiple micronutrient supplement (MMS and 114 to a 'standard of care' supplement of 6 multivitamins (MV. Serum vitamin B12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche automatic analyzer. Vitamin B12 concentrations were considered low if less than 221picomoles per litre (pmol/L and folate if Results Vitamin B12 was low in 60/214 (28% and folate in 62/214 (29.0% children. In the MMS group, the median concentration (IQR of vitamin B12 at 6 months was 401.5 (264.3 - 518.8 pmol/L compared to the baseline of 285.5 (216.5 - 371.8 pmol/L, p 12 at 6 months was 288.5 (198.8 - 391.0 pmol/L compared to the baseline of 280.0 (211.5 - 386.3 pmol/L while the median (IQR folate concentrations at 6 months were 16.5 (11.7 - 22.1 nmol/L compared to 15.7 (11.9 - 22.1 nmol/L at baseline. There was a significant difference in the MMS group in both vitamin B12 and folate concentrations but no difference in the MV group. Conclusions Almost a third of the HIV infected Ugandan children aged 1-5 years had low serum concentrations of vitamin B12 and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B12 and folate status of HIV infected children in Uganda

  10. Endoscopic cubital tunnel release: a systematic review.

    Science.gov (United States)

    Smeraglia, Francesco; Del Buono, Angelo; Maffulli, Nicola

    2015-01-01

    Theoretical advantages of endoscopic cubital tunnel release are the short incision, lower risk of nerve damage, reduced manipulation of the nerve and possible faster recovery. We systematically searched Medline (PubMed), Web of Science and Scopus databases using the following keywords: 'endoscopic ulnar nerve', 'endoscopic cubital nerve', 'endoscopic ulnar compression' and 'endoscopic ulnar neuropathy'. Twenty-one studies were included in this review. The quality of the studies was assessed using the Coleman Methodological Score. Endoscopic release is effective for cubital tunnel entrapment and allows adequate visualization of the site of entrapment. There is a negative association between the severity of the compression and reported outcomes. Injury to the medial branch of the antebrachial cutaneous nerve is less frequent thanks to the limited dissection. The most frequent complication is the development of a hematoma. It is unclear whether ulnar nerve instability is a contraindication to simple decompression. The shorter time to return to work and the cosmetic appearance of the scar can be considered advantages of the endoscopic technique. There is a need to perform randomized clinical trials with common and validated scoring system with a longer duration of follow-up. The literature pertinent to endoscopic cubital tunnel release is lacking in the evaluation of the learning curve. Further investigations are necessary to assess the role of ulnar nerve instability. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Hyperventilation provokes symptoms of carpal tunnel syndrome.

    Science.gov (United States)

    Aslam, U; Afzal, S; Syed, Shakir

    2012-01-01

    Hyperventilation causes respiratory alkalosis. The nervous system is more excitable in alkalosis. This phenomenon can be observed as paraesthesia in fingers and toes as well as around the lips in anxious patients breathing rapidly. We wanted to test this phenomenon on already irritable nerves like the median nerve in carpal tunnel syndrome (CTS). We deployed 50 patients who came in to the day case unit for carpal tunnel decompression with electro-physiologically proven diagnosis. We devised a test whereby patients were made to hyperventilate under prescribed conditions and repeated Phalen's test and Tinel's sign for comparison. These were compared with a control group chosen randomly among hospital staff. 86% patients had a positive result which was just behind Phalen's test in sensitivity. It was also 100% specific as there were no false positives. Hyperventilation is a phenomenon which provokes carpal tunnel syndrome. Its clinical value remains to be seen due to cumbersome method and probable patient non-compliance but it is a new discovery. It may be useful in other irritable-nerve-syndromes as a test to add to our available armament. It may be an additional factor or a primary reason for nocturnal paraesthesias in CTS patients.

  12. Application of single-step genomic best linear unbiased prediction with a multiple-lactation random regression test-day model for Japanese Holsteins.

    Science.gov (United States)

    Baba, Toshimi; Gotoh, Yusaku; Yamaguchi, Satoshi; Nakagawa, Satoshi; Abe, Hayato; Masuda, Yutaka; Kawahara, Takayoshi

    2017-08-01

    This study aimed to evaluate a validation reliability of single-step genomic best linear unbiased prediction (ssGBLUP) with a multiple-lactation random regression test-day model and investigate an effect of adding genotyped cows on the reliability. Two data sets for test-day records from the first three lactations were used: full data from February 1975 to December 2015 (60 850 534 records from 2 853 810 cows) and reduced data cut off in 2011 (53 091 066 records from 2 502 307 cows). We used marker genotypes of 4480 bulls and 608 cows. Genomic enhanced breeding values (GEBV) of 305-day milk yield in all the lactations were estimated for at least 535 young bulls using two marker data sets: bull genotypes only and both bulls and cows genotypes. The realized reliability (R 2 ) from linear regression analysis was used as an indicator of validation reliability. Using only genotyped bulls, R 2 was ranged from 0.41 to 0.46 and it was always higher than parent averages. The very similar R 2 were observed when genotyped cows were added. An application of ssGBLUP to a multiple-lactation random regression model is feasible and adding a limited number of genotyped cows has no significant effect on reliability of GEBV for genotyped bulls. © 2016 Japanese Society of Animal Science.

  13. Modeling a Shallow Rock Tunnel Using Terrestrial Laser Scanning and Discrete Fracture Networks

    Science.gov (United States)

    Cacciari, Pedro Pazzoto; Futai, Marcos Massao

    2017-05-01

    Discontinuity mapping and analysis are extremely important for modeling shallow tunnels constructed in fractured rock masses. However, the limited exposure and variability of rock face orientation in tunnels must be taken into account. In this paper, an automatic method is proposed to generate discrete fracture networks (DFNs) using terrestrial laser scanner (TLS) geological mapping and to continuously calculate the volumetric intensities ( P 32) along a tunnel. The number of fractures intersecting rectangular sampling planes with different orientations, fitted in tunnel sections of finite lengths, is used as the program termination criteria to create multiple DFNs and to calculate the mean P 32. All traces and orientations from three discontinuity sets of the Monte Seco tunnel (Vitória Minas Railway) were mapped and the present method applied to obtain the continuous variation in P 32 along the tunnel. A practical approach to creating single and continuous DFNs (for each discontinuity set), considering the P 32 variations, is also presented, and the results are validated by comparing the trace intensities ( P 21) from the TLS mapping and DFNs generated. Three examples of 3DEC block models generated from different sections of the tunnel are shown, including the ground surface and the bedrock topographies. The results indicate that the proposed method is a practical and powerful tool for modeling fractured rock masses of uncovered tunnels. It is also promising for application during tunnel construction when TLS mapping is a daily task (for as-built tunnel controls), and the complete geological mapping (traces and orientations) is available.

  14. Icing Research Tunnel

    Science.gov (United States)

    Chennault, Jonathan

    2004-01-01

    The Icing Research Tunnel in Building 11 at the NASA Glenn Research Center is committed to researching the effects of in flight icing on aircraft and testing ways to stop the formation of hazardous icing conditions on planes. During this summer, I worked here with Richard DelRosa, the lead engineer for this area. address one of the major concerns of aviation: icing conditions. During the war, many planes crashed (especially supply planes going over the.Himalayas) because ice built up in their wings and clogged the engines. To this day, it remains the largest ice tunnel in the world, with a test section that measures 6 feet high, 9 feet long, and 20 feet wide. It can simulate airspeeds from 50 to 300 miles per hour at temperatures as low as -50 Fahrenheit. Using these capabilities, IRT can simulate actual conditions at high altitudes. The first thing I did was creating a cross reference in Microsoft Excel. It lists commands for the DPU units that control the pressure and temperature variations in the tunnel, as well as the type of command (keyboard, multiplier, divide, etc). The cross reference also contains the algorithm for every command, and which page it is listed in on the control sheet (visual Auto-CAD graphs, which I helped to make). I actually spent most of the time on the computer using Auto-CAD. I drew a diagram of the entire icing tunnel and then drew diagrams of its various parts. Between my mentor and me, we have drawings of every part of it, from the spray bars to the thermocouples, power cabinets, input-output connectors for power systems, and layouts of various other machines. I was also responsible for drawing schematics for the Escort system (which controls the spray bars), the power system, DPUs, and other electrical systems. In my spare time, I am attempting to build and program the "toddler". Toddler is a walking robot that I have to program in PBASIC language. When complete, it should be able to walk on level terrain while avoiding obstacles in

  15. Wind tunnel AVERT model

    Directory of Open Access Journals (Sweden)

    Adrian DOBRE

    2009-09-01

    Full Text Available The AVERT project aims to asses the oscillatory blowing on the flap for a high-lift configuration (wing with flap, and involves both experimental (low speed wind tunnel INCAS and numerical activities.At low speed the active flow control may lead to a reduction or elimination of the flow separation on the high-lift devices, such as flaps, and involves the introduction or re distribution of momentum within the boundary layer.High-lift systems utilized as particular profiles at a certain offset of the main wing may solve the disagreement between the requirements of cruise flight and landing, especially for low velocity take-off.

  16. Magnetic tunnel junctions with monolayer hexagonal boron nitride tunnel barriers

    Energy Technology Data Exchange (ETDEWEB)

    Piquemal-Banci, M.; Galceran, R.; Bouzehouane, K.; Anane, A.; Petroff, F.; Fert, A.; Dlubak, B.; Seneor, P. [Unité Mixte de Physique, CNRS, Thales, Univ. Paris-Sud, Université Paris-Saclay, Palaiseau 91767 (France); Caneva, S.; Martin, M.-B.; Weatherup, R. S.; Kidambi, P. R.; Robertson, J.; Hofmann, S. [Department of Engineering, University of Cambridge, Cambridge CB21PZ (United Kingdom); Xavier, S. [Thales Research and Technology, 1 avenue Augustin Fresnel, Palaiseau 91767 (France)

    2016-03-07

    We report on the integration of atomically thin 2D insulating hexagonal boron nitride (h-BN) tunnel barriers into Co/h-BN/Fe magnetic tunnel junctions (MTJs). The h-BN monolayer is directly grown by chemical vapor deposition on Fe. The Conductive Tip Atomic Force Microscopy (CT-AFM) measurements reveal the homogeneity of the tunnel behavior of our h-BN layers. As expected for tunneling, the resistance depends exponentially on the number of h-BN layers. The h-BN monolayer properties are also characterized through integration into complete MTJ devices. A Tunnel Magnetoresistance of up to 6% is observed for a MTJ based on a single atomically thin h-BN layer.

  17. A randomized phase III study of carfilzomib vs low-dose corticosteroids with optional cyclophosphamide in relapsed and refractory multiple myeloma (FOCUS).

    Science.gov (United States)

    Hájek, R; Masszi, T; Petrucci, M T; Palumbo, A; Rosiñol, L; Nagler, A; Yong, K L; Oriol, A; Minarik, J; Pour, L; Dimopoulos, M A; Maisnar, V; Rossi, D; Kasparu, H; Van Droogenbroeck, J; Yehuda, D B; Hardan, I; Jenner, M; Calbecka, M; Dávid, M; de la Rubia, J; Drach, J; Gasztonyi, Z; Górnik, S; Leleu, X; Munder, M; Offidani, M; Zojer, N; Rajangam, K; Chang, Y-L; San-Miguel, J F; Ludwig, H

    2017-01-01

    This randomized, phase III, open-label, multicenter study compared carfilzomib monotherapy against low-dose corticosteroids and optional cyclophosphamide in relapsed and refractory multiple myeloma (RRMM). Relapsed and refractory multiple myeloma patients were randomized (1:1) to receive carfilzomib (10-min intravenous infusion; 20 mg/m2 on days 1 and 2 of cycle 1; 27 mg/m2 thereafter) or a control regimen of low-dose corticosteroids (84 mg of dexamethasone or equivalent corticosteroid) with optional cyclophosphamide (1400 mg) for 28-day cycles. The primary endpoint was overall survival (OS). Three-hundred and fifteen patients were randomized to carfilzomib (n=157) or control (n=158). Both groups had a median of five prior regimens. In the control group, 95% of patients received cyclophosphamide. Median OS was 10.2 (95% confidence interval (CI) 8.4-14.4) vs 10.0 months (95% CI 7.7-12.0) with carfilzomib vs control (hazard ratio=0.975; 95% CI 0.760-1.249; P=0.4172). Progression-free survival was similar between groups; overall response rate was higher with carfilzomib (19.1 vs 11.4%). The most common grade ⩾3 adverse events were anemia (25.5 vs 30.7%), thrombocytopenia (24.2 vs 22.2%) and neutropenia (7.6 vs 12.4%) with carfilzomib vs control. Median OS for single-agent carfilzomib was similar to that for an active doublet control regimen in heavily pretreated RRMM patients.

  18. Effect of high dose vitamin D intake on interleukin-17 levels in multiple sclerosis: a randomized, double-blind, placebo-controlled clinical trial.

    Science.gov (United States)

    Toghianifar, Nafiseh; Ashtari, Fereshteh; Zarkesh-Esfahani, Sayyed Hamid; Mansourian, Marjan

    2015-08-15

    Vitamin D has immunomodulatory effects in multiple sclerosis (MS). Vitamin D acts through various mechanisms such as secretion of cytokines. Interleukin-17 (IL-17) is a critical interleukin in inflammatory response in MS. This study assessed the effect of oral high dose vitamin D intake on IL-17 levels in MS patients in a double blind randomized clinical trial. 94 patients with a diagnosis of relapsing remitting multiple sclerosis (RRMS) were randomized to two groups. One group received 50,000 IU vitamin D3 every five days for 12weeks. The other group was given placebo. Both groups received interferon-β (IFN-β) treatment. Serum levels of IL-17 were measured at the beginning of the study and after 12weeks. IL-17 serum levels were 56.75±28.72pg/ml and 30.31±75.85pg/ml in the intervention and placebo group at the beginning of the study, respectively (Median±IQR, p=0.338). After 12weeks, IL-17 levels were 58.93±67.93pg/ml and 46.13±94.70pg/ml in the intervention and placebo group, respectively (Median±IQR, p=0.960). The multiple linear regression analysis indicated that the consumption of vitamin D3 was positively and significantly associated with the logarithm of IL-17 measures (β=1.719; p=0.002 and R2=0.91), adjusted by EDSS scores. IL-17 levels showed significant change in RRMS patients after receiving high dose vitamin D3 for 12weeks. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. High dose vitamin D supplementation does not affect biochemical bone markers in multiple sclerosis - a randomized controlled trial.

    Science.gov (United States)

    Holmøy, Trygve; Lindstrøm, Jonas Christoffer; Eriksen, Erik Fink; Steffensen, Linn Hofsøy; Kampman, Margitta T

    2017-04-04

    People with multiple sclerosis have high risk of osteoporosis and fractures. A poor vitamin D status is a risk factor for MS, and vitamin D supplementation has been recommended both to prevent MS progression and to maintain bone health. We assessed the effect of 20,000 IU vitamin D3 weekly compared to placebo on biochemical markers of bone metabolism in 68 persons with relapsing remitting multiple sclerosis. Serum levels of 25-hydroxyvitamin D more than doubled in the vitamin D group, and parathyroid hormone decreased in the vitamin D group compared to the placebo group at week 48 and week 96. There was however no effect on bone formation as measured by procollagen type I N propeptide (PINP), or on bone resorption as measured by C-terminal cross-linking telopeptide of type I collagen (CTX1). Neither PINP nor CTX1 predicted bone loss from baseline to week 96. These findings corroborate the previously reported lack of effect of weekly high dose vitamin D supplementation on bone mass density in the same patients, and suggest that such vitamin D supplementation does not prevent bone loss in persons with MS who are not vitamin D deficient. The trial was registered at ClinicalTrials.gov on April 4 2008, registration number NCT00785473 .

  20. Transcranial pulsed electromagnetic fields for multiple chemical sensitivity: Study protocol for a randomized, double-blind, placebo-controlled trial

    DEFF Research Database (Denmark)

    Tran, Marie Thi Dao; Skovbjerg, Sine; Arendt-Nielsen, Lars

    2013-01-01

    a promising new treatment for refractory depression and can be targeted at the brain, thereby activating biochemical cell processes.Methods/Design: In a parallel, randomized, double-blind, placebo-controlled trial conducted at the Danish Research Centre for Chemical Sensitivities, the effects of PEMF in MCS...... follow-up according to a predefined timetable. The primary outcome will be a measurement of the impact of MCS on everyday life. The secondary outcomes will be measurements of MCS symptoms, psychological distress (stress, anxiety or depressive symptoms), capsaicin-induced secondary punctate hyperalgesia......, immunological markers in serum, and quality of life.Discussion: This trial will assess the effects of PEMF therapy for MCS. Currently, there is no treatment with a documented effect on MCS, and in terms of healthcare there is very little to offer these patients. There is thus a great need for well...

  1. Ventilatory function during exercise in multiple sclerosis and impact of training intervention: cross-sectional and randomized controlled trial.

    Science.gov (United States)

    Hansen, D; Wens, I; Keytsman, C; Verboven, K; Dendale, P; Eijnde, B O

    2015-10-01

    Patients with MS (pwMS) often experience resting ventilatory anomalies. Ventilatory function during exercise and impact of long-term training intervention remains however uncertain. The aim of this study was to examine the ventilatory function during exercise and impact of a 6-month training intervention in pwMS. Combination of a cross-sectional (part 1) and randomized controlled trial (part 2). University rehabilitation facility. Caucasian patients with MS and healthy controls. In part 1, the ventilatory function during submaximal endurance exercise was compared between pwMS (N.=37) and healthy participants (N.=15). In part 2, pwMS were then randomly assigned to a 6-month training intervention (N.=16) or usual care (N.=11). Following training intervention, ventilatory function during exercise was re-evaluated. Despite comparable relative exercise testing intensities between groups in part 1, significantly elevated steady-state exercise dead space/tidal volume ratio, O2 uptake and CO2 output equivalent, end-tidal O2 pressure, ratings of perceived exertion and lowered end-tidal CO2 pressure and O2 pulse was observed in pwMS (Ptraining intervention, ventilatory dysfunction remained present during endurance exercise (P>0.05). Patients with MS experience a ventilatory dysfunction during endurance exercise, which is related to worse exercise tolerance. This ventilatory anomaly remains present after long-term training intervention. Patients with MS experience ventilatory dysfunction during exercise. This dysfunction is related to exercise tolerance and ratings of perceived exertion. Long-term exercise training did not remediate this ventilatory dysfunction. The systematic examination of the pulmonary/cardiovascular system at rest and during exercise is recommended in MS.

  2. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits

    Science.gov (United States)

    Takahashi, Paul Y.; Pecina, Jennifer L.; Upatising, Benjavan; Chaudhry, Rajeev; Shah, Nilay D.; Van Houten, Holly; Cha, Steve; Croghan, Ivana; Naessens, James M.; Hanson, Gregory J.

    2014-01-01

    Background Efficiently caring for frail, older adults will become an increasingly important part of healthcare reform; telemonitoring within homes may be an answer to improve outcomes. This study sought to determine the difference in hospitalizations and emergency room (ER) visits in older adults using telemonitoring versus usual care. Methods This was a randomized trial of adults older than 60 years with high-risk for rehospitalization. Subjects were randomized to telemonitoring with daily input versus patient-driven usual care. Telemonitoring was accomplished by daily biometrics, symptom reporting and videoconference. The primary outcome included a composite end-point of hospitalization and ER visits in the 12 months following enrollment. Secondary end-points included hospital days, hospital admissions, and ER visits. Intention to treat analysis was performed. Results Two hundred and five subjects were enrolled with a mean age of 80.3 years. There was no difference in hospitalizations and ER visits between the telemonitoring group (63.7%) and the group receiving usual care (57.3%) (P value 0.345). There was no difference in individual outcomes including hospital days, hospital admissions and ER visits. There also was no significant change between hospitalizations and ER visits in the pre-enrollment and post-enrollment period. Mortality was higher in the telemonitoring group (14.7%), compared to usual care (3.9%) (P value 0.008). Conclusions Among elderly patients, telemonitoring did not result in lower hospitalizations or ER visits. There were no differences determined within the secondary outcomes. The cause of the mortality difference is unknown. PMID:22507696

  3. Digital Control System For Wind-Tunnel Model

    Science.gov (United States)

    Hoadley, Sherwood T.; Mcgraw, Sandra

    1995-01-01

    Multiple functions performed by multiple coordinated processors for real-time control. Multiple input, multiple-output, multiple-function digital control system developed for wind-tunnel model of advanced fighter airplane with actively controlled flexible wings. Digital control system provides flexibility in selection of control laws, sensors, and actuators, plus some redundancy to accommodate failures in some of its subsystems. Implements feedback control scheme providing simultaneously for suppression of flutter, control of roll angle, roll-rate tracking during maximized roll maneuvers, and alleviation of loads during roll maneuvers.

  4. Modeling Indirect Tunneling in Silicon

    Science.gov (United States)

    Chen, Edward

    Indirect tunneling in silicon p-n junctions catches people's attention again in recent years. First, the phenomenon induces a serious leakage problem, so called gate-induced drain leakage (GIDL) effect, in modern metal-oxide-semiconductor field-effect transistors (MOSFETs). Second, it is utilized to develop a novel tunneling transistor with the sharp turn-on ability for continuing ITRS roadmap. Although the indirect tunneling is important for the state-of-the-art transistor-technology, the accuracy of the present tunneling models in technology computer-aided design (TCAD) tools is still vague. In the research work, the theory of indirect tunneling in silicon has been thoroughly studied. The phonon-assisted tunneling model has been developed and compared with the existing ones in the Sentaurus-Synopsys, Medici-Synopsys, and Atlas-Silvaco TCAD tools. Beyond these existing models, ours successfully predicts the indirect tunneling current under the different field direction in silicon. In addition, bandgap narrowing in heavily-doped p-n junctions under the reverse-biased condition is also studied during the model development. At the end of the research work, the application to low standby power (LSTP) transistors is demonstrated to show the capability of our tunneling model in the device level.

  5. Results of carpal tunnel release

    NARCIS (Netherlands)

    Prick, J.J.W; Blaauw, G.; Vredeveld, J.W.; Oosterloo, Sebe J.

    We evaluated, by means of a prospective study, the results of carpal tunnel release both clinically and electrophysiologically in 188 patients with a carpal tunnel syndrome. A questionnaire was completed by patient and surgeon pre- and post-operatively (6 and 12 months after operation), when

  6. Early Childhood: Funnels and Tunnels.

    Science.gov (United States)

    Fowlkes, Mary Anne

    1985-01-01

    Suggests using funnels and tunnels in combination with water, blocks, transportation toys, and other materials to help teach preschoolers to make predictions. Many examples are included for using funnels to understand properties of liquids and for using tunnels to predict order. (DH)

  7. Tunneling magnetic force microscopy

    Science.gov (United States)

    Burke, Edward R.; Gomez, Romel D.; Adly, Amr A.; Mayergoyz, Isaak D.

    1993-01-01

    We have developed a powerful new tool for studying the magnetic patterns on magnetic recording media. This was accomplished by modifying a conventional scanning tunneling microscope. The fine-wire probe that is used to image surface topography was replaced with a flexible magnetic probe. Images obtained with these probes reveal both the surface topography and the magnetic structure. We have made a thorough theoretical analysis of the interaction between the probe and the magnetic fields emanating from a typical recorded surface. Quantitative data about the constituent magnetic fields can then be obtained. We have employed these techniques in studies of two of the most important issues of magnetic record: data overwrite and maximizing data-density. These studies have shown: (1) overwritten data can be retrieved under certain conditions; and (2) improvements in data-density will require new magnetic materials. In the course of these studies we have developed new techniques to analyze magnetic fields of recorded media. These studies are both theoretical and experimental and combined with the use of our magnetic force scanning tunneling microscope should lead to further breakthroughs in the field of magnetic recording.

  8. Comparing the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Afrasiabifar, Ardashir; Karami, Fatemeh; Najafi Doulatabad, Shahla

    2018-01-01

    To evaluate the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis. It was a three-arm parallel randomized controlled trial study. Outpatient clinic. Patients with multiple sclerosis. Subjects in the intervention groups completed a 12-week program consisted of Cawthorne-Cooksey or Frenkel exercises. The control group only received routine care. The outcome measure was the Berg Balance Scale. Seventy-two patients completed the study. At the end of the intervention, there was a statistically significant improvement in Berg Balance Scale in the Cawthorne-Cooksey group ( n = 24) in comparison with the other two groups ( P = 0.001). In the Frenkel group ( n = 23), the improvement was statistically greater than the changes in the control group ( n = 25), but it did not appear to be clinically significant. The Berg Balance Scale score increased to 8.9 in the Cawthorne-Cooksey group and 2.3 in the Frenkel group, while it decreased to 1.2 in the control group. When comparing inter-group changes, Berg Balance Scale showed significant improvements in favor of the Cawthorne-Cooksey group after the intervention ( P Frenkel and the control groups, a program of Cawthorne-Cooksey exercise is more effective in improving balance in patients with multiple sclerosis.

  9. Antibacterial activity of chensinin-1b, a peptide with a random coil conformation, against multiple-drug-resistant Pseudomonas aeruginosa.

    Science.gov (United States)

    Shang, Dejing; Meng, Xin; Zhang, Dongdong; Kou, Zhiru

    2017-11-01

    Nosocomial infections caused by Pseudomonas aeruginosa are difficult to treat due to the low permeability of its outer membrane as well as to its remarkable ability to acquire further resistance to antibiotics. Chensinin-1b exhibited antibacterial activity against the tested multiple-drug-resistant bacteria with a MIC ranging between 1.56 and 50μM, except E. cloacae strain 0320 (MREC0320), P. fluorescens strain 0322 (MRPF0322) and E. aerogenes strain 0320 (MREA0320). However, the MIC (25μM) of chensinin-1b to multiple-drug-resistant P. aeruginosa strain (MRPA 0108) was 16-fold higher than that observed to P. aeruginosa susceptible strain CGMCC 1.860 (PA1860). Chensinin-1b was able to disturb the integration of the cytoplasmic membrane of PA1860 and MRPA0108 cells similarly, but the outer membrane permeability of MRPA0108 cells was significantly lower. This low permeability was associated with increased expression of lipopolysaccharide (LPS) in the outer membrane and a decrease in negatively charged phospholipids in the outer membrane leaflet. In addition, the biofilm of MRPA0108 was responsible for the reduced susceptibility to chensinin-1b. A higher concentration of chensinin-1b (12.5µM) was required to maximally inhibit the formation of MRPA0108 biofilm. Notably, chensinin-1b inhibited the formation of MRPA0108 biofilm at concentrations below its MIC value by down-regulating the level of PelA, algD, and PslA gene transcription. Importantly, chensinin-1b had a significant antibacterial effect against MRPA0108 in vivo. Administration of chensinin-1b to mice infected with MRPA 0108 significantly increased survival by 50-70%. Moreover, chensinin-1b reduced the production of pro-inflammatory mediators and correspondingly reduced lung and liver tissue damage in the mouse model of septic shock induced by MRPA 0108. Collectively, these results suggest that chensinin-1b could be an effective antibiotic against multiple-drug-resistant bacterial strains. Copyright

  10. Tunneling Ionization of Diatomic Molecules

    DEFF Research Database (Denmark)

    Svensmark, Jens Søren Sieg

    2016-01-01

    When a molecule is subject to a strong laser field, there is a probability that an electron can escape, even though the electrons are bound by a large potential barrier. This is possible because electrons are quantum mechanical in nature, and they are therefore able to tunnel through potential...... barriers, an ability classical particles do not possess. Tunnelling is a fundamental quantum mechanical process, a process that is distinctly non-classical, so solving this tunnelling problem is not only relevant for molecular physics, but also for quantum theory in general. In this dissertation the theory...... of tunneling ionizaion of molecules is presented and the results of numerical calculations are shown. One perhaps surprising result is, that the frequently used Born-Oppenheimer approximation breaks down for weak fields when describing tunneling ionization. An analytic theory applicable in the weak-field limit...

  11. Effects of barrier fluctuation on the tunneling dynamics in the ...

    Indian Academy of Sciences (India)

    Tunneling through fluctuating barrier has received considerable attention because of its potential use for modeling in many branches of physics and chemistry [1–24]. ... fluctuating potential barrier in the presence of both white and multiplicative noises. [20,21]. They have shown that the mean first passage time over the ...

  12. Treatment with Antiangiogenic Drugs in Multiple Lines in Patients with Metastatic Colorectal Cancer: Meta-Analysis of Randomized Trials

    Directory of Open Access Journals (Sweden)

    R.-D. Hofheinz

    2016-01-01

    Full Text Available Background. In metastatic colorectal cancer (mCRC, continuing antiangiogenic drugs beyond progression might provide clinical benefit. We synthesized the available evidence in a meta-analysis. Patients and Methods. We conducted a meta-analysis of studies investigating the use of antiangiogenic drugs beyond progression. Eligible studies were randomized phase II/III trials. Primary endpoints were overall survival (OS and progression-free survival (PFS. Secondary endpoints were the impact of continuing antiangiogenic drugs (i in subgroups, (ii in different types of compounds targeting the VEGF-axis (monoclonal antibodies versus tyrosine kinase inhibitors, and (iii on remission rates and prevention of progression. Results. Eight studies (3,668 patients were included. Continuing antiangiogenic treatment beyond progression significantly improved PFS (HR 0.64; 95%-CI, 0.55–0.75 and OS (HR 0.83; 95%-CI, 0.76–0.89. PFS was significantly improved in all subgroups with comparable HR. OS was improved in all subgroups stratified by age, gender, and ECOG status. The rate of patients achieving at least stable disease was improved with an OR of 2.25 (95%-CI, 1.41–3.58. Conclusions. This analysis shows a significant PFS and OS benefit as well as a benefit regarding disease stabilization when using antiangiogenic drugs beyond progression in mCRC. Future studies should focus on the optimal sequence of administering antiangiogenic drugs.

  13. Conditional Random Field (CRF-Boosting: Constructing a Robust Online Hybrid Boosting Multiple Object Tracker Facilitated by CRF Learning

    Directory of Open Access Journals (Sweden)

    Ehwa Yang

    2017-03-01

    Full Text Available Due to the reasonably acceptable performance of state-of-the-art object detectors, tracking-by-detection is a standard strategy for visual multi-object tracking (MOT. In particular, online MOT is more demanding due to its diverse applications in time-critical situations. A main issue of realizing online MOT is how to associate noisy object detection results on a new frame with previously being tracked objects. In this work, we propose a multi-object tracker method called CRF-boosting which utilizes a hybrid data association method based on online hybrid boosting facilitated by a conditional random field (CRF for establishing online MOT. For data association, learned CRF is used to generate reliable low-level tracklets and then these are used as the input of the hybrid boosting. To do so, while existing data association methods based on boosting algorithms have the necessity of training data having ground truth information to improve robustness, CRF-boosting ensures sufficient robustness without such information due to the synergetic cascaded learning procedure. Further, a hierarchical feature association framework is adopted to further improve MOT accuracy. From experimental results on public datasets, we could conclude that the benefit of proposed hybrid approach compared to the other competitive MOT systems is noticeable.

  14. Safety and pharmacodynamics of venetoclax (ABT-199) in a randomized single and multiple ascending dose study in women with systemic lupus erythematosus.

    Science.gov (United States)

    Lu, P; Fleischmann, R; Curtis, C; Ignatenko, S; Clarke, S H; Desai, M; Wong, S L; Grebe, K M; Black, K; Zeng, J; Stolzenbach, J; Medema, J K

    2018-02-01

    Objective The anti-apoptotic protein B-cell lymphoma 2 (Bcl-2) may contribute to the pathogenesis of systemic lupus erythematosus. The safety, tolerability, and pharmacodynamics of the selective Bcl-2 inhibitor venetoclax (ABT-199) were assessed in women with systemic lupus erythematosus. Methods A phase 1, double-blind, randomized, placebo controlled study evaluated single ascending doses (10, 30, 90, 180, 300, and 500 mg) and multiple ascending doses (2 cycles; 30, 60, 120, 240, 400, and 600 mg for 1 week, and then 3 weeks off per cycle) of orally administered venetoclax. Eligible participants were aged 18-65 years with a diagnosis of systemic lupus erythematosus for 6 months or more receiving stable therapy for systemic lupus erythematosus (which could have included corticosteroids and/or stable antimalarials). Results All patients (48/48) completed the single ascending dose, 25 continued into the multiple ascending dose, and 44/50 completed the multiple ascending dose; two of the withdrawals (venetoclax 60 mg and 600 mg cohorts) were due to adverse events. Adverse event incidences were slightly higher in the venetoclax groups compared with the placebo groups, with no dose dependence. There were no serious adverse events with venetoclax. The most common adverse events were headache, nausea, and fatigue. Venetoclax 600 mg multiple ascending dose treatment depleted total lymphocytes and B cells by approximately 50% and 80%, respectively. Naive, switched memory, and memory B-cell subsets enriched in autoreactive B cells exhibited dose-dependent reduction of up to approximately 80%. There were no consistent or marked changes in neutrophils, natural killer cells, hemoglobin, or platelets. Conclusions Venetoclax was generally well tolerated in women with systemic lupus erythematosus and reduced total lymphocytes and disease-relevant subsets of antigen-experienced B cells. Registration ClinicalTrials.gov: NCT01686555.

  15. Time Dependent Tunneling in Laser Irradiated Scanning Tunneling Microscope Junction

    Science.gov (United States)

    Park, Sookyung Hur

    A principal motivation for the studies reported in this thesis was to obtain a theoretical explanation for the experimental results obtained by Nguyen et al. (1989) to determine the traversal time of an electron tunneling through a quantum mechanical barrier in a laser irradiated STM junction. The work therefore focused on the calculation of tunneling in a time-dependent oscillating barrier, and more specifically on the inelastic contributions to the tunneling current. To do so the kinetic formalism for tunneling was modified and extended to calculate inelastic processes in an irradiated tunneling junction. Furthermore, there is significant absorption of power from the laser beam in the junction electrodes resulting in thermal effects which can influence the tunneling. Extensive analysis of the spatial and temporal temperature distributions was first done for a realistic model of the diode emitter and anode using the Green function method. Specifically we considered (i) thermal effects due to surface heating of the absorbed laser radiation, (ii) the thermoelectric emf produced in the junction due to differential heating, and (iii) resistive and Thomson heat produced in the junction by laser induced currents. Using first-order time-dependent perturbation theory we also (iv) calculated the inelastic tunneling current due to a time dependent oscillating barrier produced by the antenna geometry of the STM junction. Lastly, we (v) formulated photo-assisted tunneling due to the electron -photon interaction in the junction using the second-quantization formalism. Although quite significant results were obtained for the tunneling current density as a function of frequency, gap distance and other junction parameters which gave insights into important features of the Nguyen et al. experiment (and tunneling characteristics of an irradiated STM in general), no single expression was derived or calculated results obtained which explains or fits all their observed data, or

  16. The Effectiveness of a Body-Affective Mindfulness Intervention for Multiple Sclerosis Patients with Depressive Symptoms: A Randomized Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Sara Carletto

    2017-11-01

    Full Text Available Purpose: Mindfulness interventions have been shown to treat depressive symptoms and improve quality of life in patients with several chronic diseases, including multiple sclerosis, but to date most evaluation of the effectiveness of mindfulness interventions in multiple sclerosis have used patients receiving standard care as the control group. Hence we decided to evaluate the effectiveness of a group-based body-affective mindfulness intervention by comparing it with a psycho-educational intervention, by means of a randomized controlled clinical trial. The outcome variables (i.e., depression, anxiety, perceived stress, illness perception, fatigue and quality of life were evaluated at the end of the interventions (T1 and after a further 6 months (T2.Methods: Of 90 multiple sclerosis patients with depressive symptoms (Beck Depression Inventory-II score greater than 13 who were randomized, 71 completed the intervention (mindfulness group n = 36; psycho-educational group n = 35. The data were analyzed with GLM repeated-measures ANOVA followed by pairwise comparisons.Results: Per-protocol analysis revealed a time by group interaction on Beck Depression Inventory-II score, with the mindfulness intervention producing a greater reduction in score than the psycho-educational intervention, both at T1 and at T2. Furthermore, the mindfulness intervention improved patients’ quality of life and illness perception at T1 relative to the baseline and these improvements were maintained at the follow-up assessment (T2. Lastly, both interventions were similarly effective in reducing anxiety and perceived stress; these reductions were maintained at T2. A whole-sample intention-to-treat (ITT analysis broadly confirmed the effectiveness of the mindfulness intervention.Conclusion: In conclusion, these results provide methodologically robust evidence that in multiple sclerosis patients with depressive symptoms mindfulness interventions improve symptoms of depression

  17. Effect on longitudinal growth and anemia of zinc or multiple micronutrients added to vitamin A: a randomized controlled trial in children aged 6-24 months

    Science.gov (United States)

    2010-01-01

    Background The benefits of zinc or multiple micronutrient supplementations in African children are uncertain. African children may differ from other populations of children in developing countries because of differences in the prevalence of zinc deficiency, low birth weight and preterm delivery, recurrent or chronic infections such as HIV, or the quality of complementary diets and genetic polymorphisms affecting iron metabolism. The aim of this study was to ascertain whether adding zinc or multiple micronutrients to vitamin A supplementation improves longitudinal growth or reduces prevalence of anemia in children aged 6-24 months. Methods Randomized, controlled double-blinded trial of prophylactic micronutrient supplementation to children aged 6-24 months. Children in three cohorts - 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers, and 187 uninfected children born to HIV-uninfected mothers - were separately randomly assigned to receive daily vitamin A (VA) [n = 124], vitamin A plus zinc (VAZ) [n = 123], or multiple micronutrients that included vitamin A and zinc (MM) [n = 126]. Results Among all children there were no significant differences between intervention arms in length-for-age Z scores (LAZ) changes over 18 months. Among stunted children (LAZ below -2) [n = 62], those receiving MM had a 0.7 Z-score improvement in LAZ versus declines of 0.3 in VAZ and 0.2 in VA (P = 0.029 when comparing effects of treatment over time). In the 154 HIV-uninfected children, MM ameliorated the effect of repeated diarrhea on growth. Among those experiencing more than six episodes, those receiving MM had no decline in LAZ compared to 0.5 and 0.6 Z-score declines in children receiving VAZ and VA respectively (P = 0.06 for treatment by time interaction). After 12 months, there was 24% reduction in proportion of children with anemia (hemoglobin below 11 g/dL) in MM arm (P = 0.001), 11% in VAZ (P = 0.131) and 18% in VA (P = 0.019). Although the

  18. Effect on longitudinal growth and anemia of zinc or multiple micronutrients added to vitamin A: a randomized controlled trial in children aged 6-24 months

    Directory of Open Access Journals (Sweden)

    Luabeya Kany-Kany A

    2010-03-01

    Full Text Available Abstract Background The benefits of zinc or multiple micronutrient supplementations in African children are uncertain. African children may differ from other populations of children in developing countries because of differences in the prevalence of zinc deficiency, low birth weight and preterm delivery, recurrent or chronic infections such as HIV, or the quality of complementary diets and genetic polymorphisms affecting iron metabolism. The aim of this study was to ascertain whether adding zinc or multiple micronutrients to vitamin A supplementation improves longitudinal growth or reduces prevalence of anemia in children aged 6-24 months. Methods Randomized, controlled double-blinded trial of prophylactic micronutrient supplementation to children aged 6-24 months. Children in three cohorts - 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers, and 187 uninfected children born to HIV-uninfected mothers - were separately randomly assigned to receive daily vitamin A (VA [n = 124], vitamin A plus zinc (VAZ [n = 123], or multiple micronutrients that included vitamin A and zinc (MM [n = 126]. Results Among all children there were no significant differences between intervention arms in length-for-age Z scores (LAZ changes over 18 months. Among stunted children (LAZ below -2 [n = 62], those receiving MM had a 0.7 Z-score improvement in LAZ versus declines of 0.3 in VAZ and 0.2 in VA (P = 0.029 when comparing effects of treatment over time. In the 154 HIV-uninfected children, MM ameliorated the effect of repeated diarrhea on growth. Among those experiencing more than six episodes, those receiving MM had no decline in LAZ compared to 0.5 and 0.6 Z-score declines in children receiving VAZ and VA respectively (P = 0.06 for treatment by time interaction. After 12 months, there was 24% reduction in proportion of children with anemia (hemoglobin below 11 g/dL in MM arm (P = 0.001, 11% in VAZ (P = 0.131 and 18% in VA (P = 0

  19. Substituting random forest for multiple linear regression improves binding affinity prediction of scoring functions: Cyscore as a case study.

    Science.gov (United States)

    Li, Hongjian; Leung, Kwong-Sak; Wong, Man-Hon; Ballester, Pedro J

    2014-08-27

    State-of-the-art protein-ligand docking methods are generally limited by the traditionally low accuracy of their scoring functions, which are used to predict binding affinity and thus vital for discriminating between active and inactive compounds. Despite intensive research over the years, classical scoring functions have reached a plateau in their predictive performance. These assume a predetermined additive functional form for some sophisticated numerical features, and use standard multivariate linear regression (MLR) on experimental data to derive the coefficients. In this study we show that such a simple functional form is detrimental for the prediction performance of a scoring function, and replacing linear regression by machine learning techniques like random forest (RF) can improve prediction performance. We investigate the conditions of applying RF under various contexts and find that given sufficient training samples RF manages to comprehensively capture the non-linearity between structural features and measured binding affinities. Incorporating more structural features and training with more samples can both boost RF performance. In addition, we analyze the importance of structural features to binding affinity prediction using the RF variable importance tool. Lastly, we use Cyscore, a top performing empirical scoring function, as a baseline for comparison study. Machine-learning scoring functions are fundamentally different from classical scoring functions because the former circumvents the fixed functional form relating structural features with binding affinities. RF, but not MLR, can effectively exploit more structural features and more training samples, leading to higher prediction performance. The future availability of more X-ray crystal structures will further widen the performance gap between RF-based and MLR-based scoring functions. This further stresses the importance of substituting RF for MLR in scoring function development.

  20. Multiple Volume Scattering in Random Media and Periodic Structures with Applications in Microwave Remote Sensing and Wave Functional Materials

    Science.gov (United States)

    Tan, Shurun

    The objective of my research is two-fold: to study wave scattering phenomena in dense volumetric random media and in periodic wave functional materials. For the first part, the goal is to use the microwave remote sensing technique to monitor water resources and global climate change. Towards this goal, I study the microwave scattering behavior of snow and ice sheet. For snowpack scattering, I have extended the traditional dense media radiative transfer (DMRT) approach to include cyclical corrections that give rise to backscattering enhancements, enabling the theory to model combined active and passive observations of snowpack using the same set of physical parameters. Besides DMRT, a fully coherent approach is also developed by solving Maxwell's equations directly over the entire snowpack including a bottom half space. This revolutionary new approach produces consistent scattering and emission results, and demonstrates backscattering enhancements and coherent layer effects. The birefringence in anisotropic snow layers is also analyzed by numerically solving Maxwell's equation directly. The effects of rapid density fluctuations in polar ice sheet emission in the 0.5˜2.0 GHz spectrum are examined using both fully coherent and partially coherent layered media emission theories that agree with each other and distinct from incoherent approaches. For the second part, the goal is to develop integral equation based methods to solve wave scattering in periodic structures such as photonic crystals and metamaterials that can be used for broadband simulations. Set upon the concept of modal expansion of the periodic Green's function, we have developed the method of broadband Green's function with low wavenumber extraction (BBGFL), where a low wavenumber component is extracted and results a non-singular and fast-converging remaining part with simple wavenumber dependence. We've applied the technique to simulate band diagrams and modal solutions of periodic structures, and to

  1. Topical methyl-aminolevulinate photodynamic therapy using red light-emitting diode light for treatment of multiple actinic keratoses: A randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    Pariser, David; Loss, Robert; Jarratt, Michael; Abramovits, William; Spencer, James; Geronemus, Roy; Bailin, Philip; Bruce, Suzanne

    2008-10-01

    The use of light-emitting diode light offers practical advantages in photodynamic therapy (PDT) with topical methyl-aminolevulinate (MAL) for management of actinic keratoses (AK). We sought to evaluate the efficacy of MAL PDT using red light-emitting diode light. We conducted a multicenter, double-blind, randomized study. A total of 49 patients with 363 AK lesions had 16.8% MAL cream applied under occlusion for 3 hours, and 47 patients with 360 AK lesions had vehicle cream similarly applied. The lesions were then illuminated (630 nm, light dose 37 J/cm2) with repeated treatment 1 week later. Complete lesion and patient (all lesions showing complete response) response rates were evaluated 3 months after last treatment. MAL PDT was superior (Pred light-emitting diode light is an appropriate treatment alternative for multiple AK lesions.

  2. Thalidomide for previously untreated elderly patients with multiple myeloma: meta-analysis of 1685 individual patient data from 6 randomized clinical trials

    DEFF Research Database (Denmark)

    Fayers, Peter M; Palumbo, Antonio; Hulin, Cyrille

    2011-01-01

    The role of thalidomide for previously untreated elderly patients with multiple myeloma remains unclear. Six randomized controlled trials, launched in or after 2000, compared melphalan and prednisone alone (MP) and with thalidomide (MPT). The effect on overall survival (OS) varied across trials. We...... carried out a meta-analysis of the 1685 individual patients in these trials. The primary endpoint was OS, and progression-free survival (PFS) and 1-year response rates were secondary endpoints. There was a highly significant benefit to OS from adding thalidomide to MP (hazard ratio = 0.83; 95% confidence...... interval 0.73-0.94, P = .004), representing increased median OS time of 6.6 months, from 32.7 months (MP) to 39.3 months (MPT). The thalidomide regimen was also associated with superior PFS (hazard ratio = 0.68, 95% confidence interval 0.61-0.76, P

  3. Fusing Markov random fields with anatomical knowledge and shape-based analysis to segment multiple sclerosis white matter lesions in magnetic resonance images of the brain

    Science.gov (United States)

    AlZubi, Stephan; Toennies, Klaus D.; Bodammer, N.; Hinrichs, Herman

    2002-05-01

    This paper proposes an image analysis system to segment multiple sclerosis lesions of magnetic resonance (MR) brain volumes consisting of 3 mm thick slices using three channels (images showing T1-, T2- and PD -weighted contrast). The method uses the statistical model of Markov Random Fields (MRF) both at low and high levels. The neighborhood system used in this MRF is defined in three types: (1) Voxel to voxel: a low-level heterogeneous neighborhood system is used to restore noisy images. (2) Voxel to segment: a fuzzy atlas, which indicates the probability distribution of each tissue type in the brain, is registered elastically with the MRF. It is used by the MRF as a-priori knowledge to correct miss-classified voxels. (3) Segment to segment: Remaining lesion candidates are processed by a feature based classifier that looks at unary and neighborhood information to eliminate more false positives. An expert's manual segmentation was compared with the algorithm.

  4. Microbuckle tunnelling in fibre composites

    Science.gov (United States)

    Fleck, N. A.; Zhao, L. G.

    2000-09-01

    The propagation of compressive failure in multi-directional composite laminates is modelled by the tunnelling of a microbuckle within the load-bearing axial plies, with concomitant delamination of the neighbouring off-axis plies. The microbuckle tunnels at its tip in a crack-like mode III manner, and the steady state tunnelling stress is estimated by calculating the energy difference between the upstream unbuckled state and the downstream buckled state. The downstream state is analysed in detail using a plane strain analysis of a microbuckle with delaminations from its tips. In the downstream 2D problem, microbuckling of the axial plies is represented by the generation of an inclined mode II crack, with an associated microbuckling tip toughness and a constant sliding stress across its flanks. The delaminations at the interface between the axial and adjacent off-axis plies are idealised as traction-free mixed-mode interfacial cracks. Predictions of the steady-state tunnelling stress are obtained for an isotropic solid by solving an integral equation and by the finite element method; finite element techniques are then used to solve the tunnelling problem for an orthotropic solid and for a cross-ply laminate. For each case, the tunnelling stress and the delamination crack length are obtained as functions of the ratio of delamination to microbuckle toughness, and of the inclination of the microbuckle band. The tunnelling stress provides a useful lower bound for the compressive strength of a thick laminated structure.

  5. Patterns of white matter damage are non-random and associated with cognitive function in secondary progressive multiple sclerosis.

    Science.gov (United States)

    Meijer, K A; Cercignani, M; Muhlert, N; Sethi, V; Chard, D; Geurts, J J G; Ciccarelli, O

    2016-01-01

    In multiple sclerosis (MS), white matter damage is thought to contribute to cognitive dysfunction, which is especially prominent in secondary progressive MS (SPMS). While studies in healthy subjects have revealed patterns of correlated fractional anisotropy (FA) across white matter tracts, little is known about the underlying patterns of white matter damage in MS. In the present study, we aimed to map the SPMS-related covariance patterns of microstructural white matter changes, and investigated whether or not these patterns were associated with cognitive dysfunction. Diffusion MRI was acquired from 30 SPMS patients and 32 healthy controls (HC). A tensor model was fitted and FA maps were processed using tract-based spatial statistics (TBSS) in order to obtain a skeletonised map for each subject. The skeletonised FA maps of patients only were decomposed into 18 spatially independent components (ICs) using independent component analysis. Comprehensive cognitive assessment was conducted to evaluate five cognitive domains. Correlations between cognitive performance and (1) severity of FA abnormalities of the extracted ICs (i.e. z-scores relative to FA values of HC) and (2) IC load (i.e. FA covariance of a particular IC) were examined. SPMS patients showed lower FA values of all examined patterns of correlated FA (i.e. spatially independent components) than HC (p memory and verbal memory. Despite the presence of white matter damage, it was possible to reveal patterns of FA covariance across SPMS patients. This could indicate that white matter tracts belonging to the same cluster, and thus with similar characteristics, tend to follow similar trends during neurodegeneration. Furthermore, these underlying FA patterns might help to explain cognitive dysfunction in SPMS.

  6. Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial

    Science.gov (United States)

    Heine, Martin; Verschuren, Olaf; Hoogervorst, Erwin LJ; van Munster, Erik; Hacking, Hub GA; Visser-Meily, Anne; Twisk, Jos WR; Beckerman, Heleen; de Groot, Vincent; Kwakkel, Gert

    2017-01-01

    Background: Evidence supporting the effectiveness of aerobic training, specific for fatigue, in severely fatigued patients with multiple sclerosis (MS) is lacking. Objective: To estimate the effectiveness of aerobic training on MS-related fatigue and societal participation in ambulant patients with severe MS-related fatigue. Methods: Patients (N = 90) with severe MS-related fatigue were allocated to 16-week aerobic training or control intervention. Primary outcomes were perceived fatigue (Checklist Individual Strength (CIS20r) fatigue subscale) and societal participation. An improvement of ⩾8 points on the CIS20r fatigue subscale was considered clinically relevant. Outcomes were assessed by a blinded observer at baseline, 2, 4, 6 and 12 months. Results: Of the 89 patients that started treatment (median Expanded Disability Status Scale (interquartile range), 3.0 (2.0–3.6); mean CIS20r fatigue subscale (standard deviation (SD)), 42.6 (8.0)), 43 received aerobic training and 46 received the control intervention. A significant post-intervention between-group mean difference (MD) on the CIS20r fatigue subscale of 4.708 (95% confidence interval (CI) = 1.003–8.412; p = 0.014) points was found in favour of aerobic training that, however, was not sustained during follow-up. No effect was found on societal participation. Conclusion: Aerobic training in MS patients with severe fatigue does not lead to a clinically meaningful reduction in fatigue or societal participation when compared to a low-intensity control intervention. PMID:28528566

  7. Effects of dual-task balance training on postural performance in patients with Multiple Sclerosis: a double-blind, randomized controlled pilot trial.

    Science.gov (United States)

    Monjezi, Saeideh; Negahban, Hossein; Tajali, Shirin; Yadollahpour, Nava; Majdinasab, Nastaran

    2017-02-01

    To investigate the effects of dual-task balance training on postural performance in patients with multiple sclerosis as compared with single-task balance training. Double-blind, pretest-posttest, randomized controlled pilot trial. Local Multiple Sclerosis Society. A total of 47 patients were randomly assigned to two equal groups labeled as single-task training and dual-task training groups. All patients received supervised balance training sessions, 3 times per week for 4 weeks. The patients in the single-task group performed balance activities, alone. However, patients in dual-task group practiced balance activities while simultaneously performing cognitive tasks. The 10-Meter Walk Test and Timed Up-and-Go under single-task and dual-task conditions, in addition to Activities-specific Balance Confidence, Berg Balance Scale, and Functional Gait Assessment were assessed pre-, and post intervention and also 6-weeks after the end of intervention. Only 38 patients completed the treatment plan. There was no difference in the amount of improvement seen between the two study groups. In both groups there was a significant effect of time for dual-10 Meter Walk Test (F1, 36=11.33, p=0.002) and dual-Timed Up-and-Go (F1, 36=14.27, p=0.001) but not for their single-tasks. Moreover, there was a significant effect of time for Activities-specific Balance Confidence, Berg Balance Scale, and Functional Gait Assessment ( P<0.01). This pilot study did not show more benefits from undertaking dual-task training than single-task training. A power analysis showed 71 patients per group would be needed to determine whether there was a clinically relevant difference for dual-task gait speed between the groups.

  8. Pomalidomide alone or in combination with low-dose dexamethasone in relapsed and refractory multiple myeloma: a randomized phase 2 study.

    Science.gov (United States)

    Richardson, Paul G; Siegel, David S; Vij, Ravi; Hofmeister, Craig C; Baz, Rachid; Jagannath, Sundar; Chen, Christine; Lonial, Sagar; Jakubowiak, Andrzej; Bahlis, Nizar; Song, Kevin; Belch, Andrew; Raje, Noopur; Shustik, Chaim; Lentzsch, Suzanne; Lacy, Martha; Mikhael, Joseph; Matous, Jeffrey; Vesole, David; Chen, Min; Zaki, Mohamed H; Jacques, Christian; Yu, Zhinuan; Anderson, Kenneth C

    2014-03-20

    This multicenter, open-label, randomized phase 2 study assessed the efficacy and safety of pomalidomide (POM) with/without low-dose dexamethasone (LoDEX) in patients with relapsed/refractory multiple myeloma (RRMM). Patients who had received ≥2 prior therapies (including lenalidomide [LEN] and bortezomib [BORT]) and had progressed within 60 days of their last therapy were randomized to POM (4 mg/day on days 1-21 of each 28-day cycle) with/without LoDEX (40 mg/week). The primary end point was progression-free survival (PFS). In total, 221 patients (median 5 prior therapies, range 1-13) received POM+LoDEX (n = 113) or POM (n = 108). With a median follow-up of 14.2 months, median PFS was 4.2 and 2.7 months (hazard ratio = 0.68, P = .003), overall response rates (ORRs) were 33% and 18% (P = .013), median response duration was 8.3 and 10.7 months, and median overall survival (OS) was 16.5 and 13.6 months, respectively. Refractoriness to LEN, or resistance to both LEN and BORT, did not affect outcomes with POM+LoDEX (median PFS 3.8 months for both; ORRs 30% and 31%; and median OS 16 and 13.4 months). Grade 3-4 neutropenia occurred in 41% (POM+LoDEX) and 48% (POM); no grade 3-4 peripheral neuropathy was reported. POM+LoDEX was effective and generally well tolerated and provides an important new treatment option for RRMM patients who have received multiple prior therapies. This trial was registered at www.clinicaltrials.gov as #NCT00833833.

  9. Comparison of enamel matrix derivative (Emdogain) and subepithelial connective tissue graft for root coverage in patients with multiple gingival recession defects: A randomized controlled clinical study.

    Science.gov (United States)

    Alexiou, Angeliki; Vouros, Ioannis; Menexes, Georgios; Konstantinidis, Antonis

    2017-01-01

    The purpose of the present study was to compare the clinical efficiency of enamel matrix derivative (EMD) placed under a coronally advanced flap (CAF; test group), to a connective tissue graft (CTG) placed under a CAF (control group), in patients with multiple recession defects. Twelve patients with multiple Miller's Class I or II gingival recessions in contralateral quadrants of the maxilla were selected. The primary outcome variable was the change in depth of the buccal recession (REC), at 6 months (T6) after surgery. The secondary outcome parameters included the clinical attachment level (CAL), the probing pocket depth (PPD), and the width of keratinized gingiva (WKT) apical to the recession. Recession defects were randomly divided to the test or control group by using a computer-generated randomization list. Data were analyzed within the frame of Mixed Linear Models with the ANOVA method. There were no statistically significantly differences observed between test and control groups in regards with the depth of buccal recession with a mean REC of 1.82 mm (CTG) and 1.72 mm (EMD) respectively. Similarly the mean PPD value was 1.3 mm for both groups at T6, while the respective value for CAL was 1.7 mm (EMD) and 1.8 mm (CTG). Statistically significant differences were observed only for the WKT, which were 3.0 mm and 3.6 mm for the test and control groups respectively (P < .001) at T6. The use of EMD in conjunction with a CAF resulted in similar results as compared to the CTG plus CAF.

  10. Endoscopic cubital tunnel recurrence rates.

    Science.gov (United States)

    Cobb, Tyson K; Sterbank, Patrick T; Lemke, Jon H

    2010-06-01

    Cubital tunnel syndrome is the second most common nerve entrapment in the upper extremity. There are no current publications concerning the recurrence rates after endoscopic cubital tunnel release. The purpose of this study is to evaluate the recurrence rate of endoscopic cubital tunnel release compared to published reports of recurrence following open cubital tunnel procedures. We reviewed 134 consecutive cases of endoscopic cubital tunnel release in 117 patients. There were 104 cases in 94 patients with greater than 3 months follow-up. The mean follow-up time was 736 days. They were grouped using Dellon's classification. Two literature control groups were used from published reports of recurrence rate following open cubital tunnel release. A recurrence was identified if the patient was symptom-free following surgery but had symptoms reappear 3 months or more after surgery as defined in the literature. Of the 104 cases, 92.31% had more than a 4-month follow-up. One case (0.96%) met the criteria for recurrence at 4 months postprocedure. Data were then compared to the literature control groups used from published reports of recurrence rates following open cubital tunnel release. Pooled, the combined controls had 22 of 180 cases (12.22%) with recurrences. The percentage of procedure recurrence varied significantly with p value equal to 0.0004. It is recognized that there is a lack of common classification and comparative analysis of these studies, but they do classify preoperative grading and recurrence similarly. We are 95% confident that our true recurrence rate is between 0.02% and 5.24% and that endoscopic cubital tunnel release has a recurrence rate, which is not higher than open cubital tunnel release literature controls.

  11. The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: a randomized-controlled trial.

    Science.gov (United States)

    Kos, Daphne; Duportail, Marijke; Meirte, Jill; Meeus, Mira; D'hooghe, Marie B; Nagels, Guy; Willekens, Barbara; Meurrens, Tom; Ilsbroukx, Stephan; Nijs, Jo

    2016-09-01

    Purpose to evaluate the effectiveness of an individual self-management occupational therapy intervention program (SMOoTh) versus relaxation on the performance of and satisfaction with relevant daily activities in individuals with multiple sclerosis (MS)-related fatigue. in a single-blind randomized-controlled trial, 31 patients with MS (SMOoTh: n=17, relaxation: n=14) were randomly allocated to three individual sessions focusing on pacing, prioritizing, ergonomics, and self-management (SMOoTh) or on stress management and relaxation (relaxation). Outcomes (blind assessor): Canadian Occupational Performance Measure (COPM) (primary), Modified Fatigue Impact Scale, Checklist Individual Strength and Short-Form Health Measure. COPM improved in the SMOoTh and relaxation group after the intervention and 3 months later (COPM performance: F=13.1, P=0.001 and COPM satisfaction: F=10.4, P=0.001); nonsignificant group differences showed a trend in favor of SMOoTh. Modified Fatigue Impact Scale, Checklist Individual Strength, and most of the Short-Form Health Measure subscales did not change. Clinically relevant changes in COPM performance scores were found in 71 and 27% of patients in the SMOoTh versus the relaxation group. Both interventions seem to be feasible approaches to improve performance of and satisfaction with relevant daily activities in people with MS, with a sustained effect after 3 months. Neither program altered change fatigue (impact) or quality of life. Future studies with larger sample sizes are needed.

  12. Comparison of the effect of aspirin and amantadine for the treatment of fatigue in multiple sclerosis: a randomized, blinded, crossover study.

    Science.gov (United States)

    Shaygannejad, Vahid; Janghorbani, Mohsen; Ashtari, Fereshteh; Zakeri, Hasanali

    2012-11-01

    The purpose of this study was to compare the relative efficacy of acetylsalicylic acid (ASA) and amantadine for the treatment of fatigue in multiple sclerosis (MS). A 10-week, randomized double-blind crossover clinical trial conducted from October 2009 to September 2010. Fifty-two patients with MS presenting fatigue at 21 to 53 years of age were randomly allocated to the two treatment groups. The first group received amantadine (100 mg twice daily) for a total of 4 weeks. The second group received ASA (500 mg once daily) for four weeks. After a 2-week washout period, they crossed over to the alternative treatment for 4 weeks. Patients were rated at baseline and the end of each phase with the Fatigue Severity Scale (FSS). ASA appeared to be equivalent in efficacy and safety to amantadine. A significant decrease in FSS occurred in both groups. Of the 26 patients treated with amantadine, the mean (SD) of FSS decreased from 4·8 (1·4) to 4·0 (1·4) (Pamantadine significantly reduce MS-related fatigue. Both ASA and amantadine have previously been shown to reduce fatigue, and we postulate that treatment with ASA and amantadine may have similar benefits.

  13. Randomized controlled trial of exercise interventions to improve sleep quality and daytime sleepiness in individuals with multiple sclerosis: A pilot study.

    Science.gov (United States)

    Siengsukon, Catherine F; Aldughmi, Mayis; Kahya, Melike; Bruce, Jared; Lynch, Sharon; Ness Norouzinia, Abigail; Glusman, Morgan; Billinger, Sandra

    2016-01-01

    Nearly 70% of individuals with multiple sclerosis (MS) experience sleep disturbances. Increasing physical activity in people with MS has been shown to produce a moderate improvement in sleep quality, and exercise has been shown to improve sleep quality in non-neurologically impaired adults. The purpose of this pilot randomized controlled trial study was to examine the effect of two exercise interventions on sleep quality and daytime sleepiness in individuals with MS. Twenty-eight individuals with relapsing-remitting or secondary progressive MS were randomized into one of two 12-week exercise interventions: a supervised, moderate-intensity aerobic exercise (AE) program or an unsupervised, low-intensity walking and stretching (WS) program. Only individuals who were ≥ 70% compliant with the programs were included in analysis (n = 12 AE; n = 10 WS). Both groups demonstrated a moderate improvement in sleep quality, although only the improvement by the WS group was statistically significant. Only the AE group demonstrated a significant improvement in daytime sleepiness. Change in sleep quality and daytime sleepiness was not correlated with disease severity or with change in cardiovascular fitness, depression, or fatigue. The mechanisms for improvement in sleep quality and daytime sleepiness need further investigation, but may be due to introduction of zeitgebers to improve circadian rhythm.

  14. High dose Vitamin D intake and quality of life in relapsing-remitting multiple sclerosis: a randomized, double-blind, placebo-controlled clinical trial.

    Science.gov (United States)

    Ashtari, Fereshteh; Toghianifar, Nafiseh; Zarkesh-Esfahani, Sayyed Hamid; Mansourian, Marjan

    2016-10-01

    Low level of vitamin D is associated with a more severe course and low quality of life in relapsing-remitting multiple sclerosis (RRMS). Low dose vitamin D intake has improved quality of life in RRMS patients. This study explored the effect of high dose vitamin D intake on quality of life in RRMS patients in a double blind randomized clinical trial. 94 RRMS patients were randomized to two groups. One group received 50,000 IU vitamin D3 every five days for 3 months. The other group received placebo. Interferon-β (IFN-β) continued as the main treatment in both groups. Quality of life was assessed using MSQOL-54 Persian version at the beginning and at the end of the study. After 3 months, the vitamin D group had a significant difference in mental health composite with placebo group, 62.41 ± 13.99 vs. 60.99 ± 17.99 (p-value = 0.041). Change in health was 75.74 ± 25.73 and 70.59 ± 26.45 in vitamin D and placebo group, respectively (p-value = 0.036). Mental QOL improved significantly after taking high dose vitamin D for 3 months in vitamin D group relative to placebo.

  15. Effects of Adjunct Low-Dose Vitamin D on Relapsing-Remitting Multiple Sclerosis Progression: Preliminary Findings of a Randomized Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Vahid Shaygannejad

    2012-01-01

    Full Text Available The aim of this preliminary study was to evaluate the effect of low-dose oral vitamin D in combination with current disease-modifying therapy on the prevention of progression of relapsing-remitting multiple sclerosis (RRMS. A phase II double-blind placebo-controlled randomized clinical trial conducted between October 2007 and October 2008 included 50 patients with confirmed RRMS aged 25 to 57 years and normal serum 25-hydroxyvitamin D. They were randomly allocated to receive 12 months of treatment with either escalating calcitriol doses up to 0.5 μg/day or placebo combined with disease-modifying therapy. Response to treatment was assessed at eight-week intervals. In both groups, the mean relapse rate decreased significantly (P<0.001. In the 25 patients treated with placebo, the mean (SD Expanded Disability Status Scale (EDSS increased from 1.70 (1.21 at baseline to 1.94 (1.41 at the end of study period (P<0.01. Average EDSS and relapse rate at the end of trial did not differ between groups. Adding low-dose vitamin D to routine disease-modifying therapy had no significant effect on the EDSS score or relapse rate. A larger phase III multicenter study of vitamin D in RRMS is warranted to more assess the efficacy of this intervention.

  16. Variance results for the second and third reduced sample moments in neutron multiplicity counting for randomly triggered or signal-triggered counting gates

    Energy Technology Data Exchange (ETDEWEB)

    Burr, T. [Statistical Sciences Group, Los Alamos National Laboratory, Mail Stop F600, Los Alamos, NM 87545 (United States)], E-mail: tburr@lanl.gov; Butterfield, K. [Advanced Nuclear Technology Group, Los Alamos National Laboratory, Mail Stop F600, Los Alamos, NM 87545 (United States)

    2008-09-01

    Neutron multiplicity counting is an established method to estimate the spontaneous fission rate, and therefore also the plutonium mass for example, in a sample that includes other neutron sources. The extent to which the sample and detector obey the 'point model' assumptions impacts the estimate's total measurement error, but, in nearly all cases, for the random error contribution, it is useful to evaluate the variances of the second and third reduced sample moments of the neutron source strength. Therefore, this paper derives exact expressions for the variances and covariances of the second and third reduced sample moments for either randomly triggered or signal-triggered non-overlapping counting gates, and compares them to the corresponding variances in simulated data. Approximate expressions are also provided for the case of overlapping counting gates. These variances and covariances are useful in figure of merit calculations to predict assay performance prior to data collection. In addition, whenever real data are available, a bootstrap method is presented as an alternate but effective way to estimate these variances.

  17. Tunnel fire testing and modeling the Morgex North tunnel experiment

    CERN Document Server

    Borghetti, Fabio; Gandini, Paolo; Frassoldati, Alessio; Tavelli, Silvia

    2017-01-01

    This book aims to cast light on all aspects of tunnel fires, based on experimental activities and theoretical and computational fluid dynamics (CFD) analyses. In particular, the authors describe a transient full-scale fire test (~15 MW), explaining how they designed and performed the experimental activity inside the Morgex North tunnel in Italy. The entire organization of the experiment is described, from preliminary evaluations to the solutions found for management of operational difficulties and safety issues. This fire test allowed the collection of different measurements (temperature, air velocity, smoke composition, pollutant species) useful for validating and improving CFD codes and for testing the real behavior of the tunnel and its safety systems during a diesel oil fire with a significant heat release rate. Finally, the fire dynamics are compared with empirical correlations, CFD simulations, and literature measurements obtained in other similar tunnel fire tests. This book will be of interest to all ...

  18. Dynamical tunneling theory and experiment

    CERN Document Server

    Keshavamurthy, Srihari

    2011-01-01

    A prominent aspect of quantum theory, tunneling arises in a variety of contexts across several fields of study, including nuclear, atomic, molecular, and optical physics and has led to technologically relevant applications in mesoscopic science. Exploring mechanisms and consequences, Dynamical Tunneling: Theory and Experiment presents the work of international experts who discuss the considerable progress that has been achieved in this arena in the past two decades.Highlights in this volume include:A historical introduction and overview of dynamical tunneling, with case histories ranging from

  19. Pathophysiology of carpal tunnel syndrome

    Science.gov (United States)

    Aboonq, Moutasem S.

    2015-01-01

    Carpal tunnel syndrome (CTS) is the most common median nerve neuropathy, accounting for 90% of all neuropathies. Carpal tunnel syndrome presents in 3.8% of the general population, with a higher prevalence among women. There are several risk factors associated with CTS, including both medical and non medical factors. The pathophysiologic mechanisms involved in the median nerve compression and traction are thought to be complex, and as yet are not fully understood. The present review aimed to provide an overview of the pathophysiology of median nerve neuropathy in the carpal tunnel, and subsequent development of CTS. PMID:25630774

  20. Finding optimal ventilation control for highway tunnels

    NARCIS (Netherlands)

    Ferki, Lukáš; Meinsma, Gjerrit

    2007-01-01

    A control scheme for highway tunnels is designed based on a static model of the highway tunnel. The controller is designed to keep the exhaust levels inside the tunnel below given limits. The control is then simulated on a dynamical model of a highway tunnel.

  1. Long-term effects of delayed-release dimethyl fumarate in multiple sclerosis: Interim analysis of ENDORSE, a randomized extension study.

    Science.gov (United States)

    Gold, Ralf; Arnold, Douglas L; Bar-Or, Amit; Hutchinson, Michael; Kappos, Ludwig; Havrdova, Eva; MacManus, David G; Yousry, Tarek A; Pozzilli, Carlo; Selmaj, Krysztof; Sweetser, Marianne T; Zhang, Ray; Yang, Minhua; Potts, James; Novas, Mark; Miller, David H; Kurukulasuriya, Nuwan C; Fox, Robert J; Phillips, Theodore J

    2017-02-01

    Delayed-release dimethyl fumarate (DMF) demonstrated strong efficacy and a favorable benefit-risk profile for patients with relapsing-remitting multiple sclerosis (RRMS) in phase 3 DEFINE/CONFIRM studies. ENDORSE is an ongoing long-term extension of DEFINE/CONFIRM. We report efficacy and safety results of a 5-year interim analysis of ENDORSE (2 years DEFINE/CONFIRM; minimum 3 years ENDORSE). In ENDORSE, patients randomized to DMF 240 mg twice (BID) or thrice daily (TID) in DEFINE/CONFIRM continued this dosage, and those initially randomized to placebo (PBO) or glatiramer acetate (GA) were re-randomized to DMF 240 mg BID or TID. For patients continuing DMF BID (BID/BID), annualized relapse rates were 0.202, 0.163, 0.139, 0.143, and 0.138 (years 1-5, respectively) and 63%, 73%, and 88% were free of new or enlarging T2 hyperintense lesions, new T1 hypointense lesions, and gadolinium-enhanced lesions, respectively, at year 5. Adverse events (AEs; serious adverse events (SAEs)) were reported in 91% (22%; BID/BID), 95% (24%; PBO/BID), and 88% (16%; GA/BID) of the patients. One case of progressive multifocal leukoencephalopathy was reported in the setting of severe, prolonged lymphopenia. Treatment with DMF was associated with continuously low clinical and magnetic resonance imaging (MRI) disease activity in patients with RRMS. These interim data demonstrate a sustained treatment benefit and an acceptable safety profile with DMF.

  2. Thalidomide treatment for patients with previously untreated multiple myeloma: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Gao, Minjie; Kong, Yuanyuan; Wang, Houcai; Xie, Bingqian; Yang, Guang; Gao, Lu; Zhang, Yiwen; Zhan, Fenghuang; Dai, Bojie; Tao, Yi; Shi, Jumei

    2016-08-01

    The efficacy and safety of thalidomide as an initial treatment in myeloma patients who were unsuitable for autologous stem cell transplantation (ASCT), as induction treatment prior to ASCT, or as a maintenance treatment was unclear. The purpose of this study was to assess the benefits and risks of thalidomide for previously untreated myeloma patients. MEDLINE, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) of thalidomide used in either induction or maintenance therapy for previously untreated myeloma patients. Twenty-two RCTs enrolling 9098 patients were identified, including 15 RCTs of induction thalidomide, 6 RCTs of maintenance thalidomide, and 1 RCT of induction and maintenance thalidomide. Induction thalidomide improved overall response rate (ORR) (risk ratio (RR) 1.54, 95 % confidence interval (CI) 1.30-1.83), complete response rate (CRR) (RR 3.03, 95 % CI 1.91-4.80), progression-free survival (PFS) (hazard ratio (HR) 0.65, 95 % CI 0.56-0.76), and overall survival (OS) (HR 0.78, 95 % CI 0.67-0.91) in patients who were not allowed to receive ASCT. Induction thalidomide improved pre-ASCT ORR (RR 1.20, 95 % CI 1.11-1.30), pre-ASCT and post-ASCT CRR (RR 1.47, 95 % CI 1.12-1.93 and RR 1.23, 95 % CI 1.00-1.50, respectively), and PFS (HR 0.73, 95 % CI 0.59-0.91) in patients who were allowed to receive ASCT, but it did not improve post-ASCT ORR (RR 1.04, 95 % CI 0.99-1.09) and OS (HR 0.91, 95 % CI 0.79-1.05). Improved PFS and prolonged OS were observed (HR 0.61, 95 % CI 0.53-0.70 and HR 0.77, 95 % CI 0.62-0.95, respectively) when thalidomide was added to maintenance therapy. More patients experienced venous thromboembolism (VTE) of grade 3/4 when thalidomide was added to induction or maintenance therapy (HR 2.15, 95 % CI 1.58-2.92 and RR 1.96, 95 % CI 1.13-3.40, respectively). Induction thalidomide still increased the risk of VTE (RR 1.53, 95 % CI 1.12-2.08) after VTE prophylaxis was used. Induction thalidomide

  3. An Ant Colony Optimization algorithm for solving the fixed destination multi-depot multiple traveling salesman problem with non-random parameters

    Science.gov (United States)

    Ramadhani, T.; Hertono, G. F.; Handari, B. D.

    2017-07-01

    The Multiple Traveling Salesman Problem (MTSP) is the extension of the Traveling Salesman Problem (TSP) in which the shortest routes of m salesmen all of which start and finish in a single city (depot) will be determined. If there is more than one depot and salesmen start from and return to the same depot, then the problem is called Fixed Destination Multi-depot Multiple Traveling Salesman Problem (MMTSP). In this paper, MMTSP will be solved using the Ant Colony Optimization (ACO) algorithm. ACO is a metaheuristic optimization algorithm which is derived from the behavior of ants in finding the shortest route(s) from the anthill to a form of nourishment. In solving the MMTSP, the algorithm is observed with respect to different chosen cities as depots and non-randomly three parameters of MMTSP: m, K, L, those represents the number of salesmen, the fewest cities that must be visited by a salesman, and the most number of cities that can be visited by a salesman, respectively. The implementation is observed with four dataset from TSPLIB. The results show that the different chosen cities as depots and the three parameters of MMTSP, in which m is the most important parameter, affect the solution.

  4. Comparison of two methods of femoral tunnel preparation in single-bundle anterior cruciate ligament reconstruction: a prospective randomized study Comparação entre dois métodos de preparação de túnel femoral na reconstrução do ligamento cruzado anterior em feixe único: estudo prospectivo randomizado

    Directory of Open Access Journals (Sweden)

    Qiang Zhang

    2012-08-01

    Full Text Available PURPOSE: To prospectively compare therapeutic effect of femoral tunnel preparation through the tibial tunnel and the anteromedial (AM portal in single-bundle anterior cruciate ligament (ACL reconstruction. METHODS: Between June 2008 and October 2010, 76 patients underwent single-bundle ACL reconstruction by autogenous grafting of semitendinosus and gracilis tendon. All cases were randomly divided into two groups according to the method of femoral tunnel preparation: transtibial (TT group (n=38 and anteromedial (AM group (n=38. Lysholm knee score and the KT-1000 anterior laxity at 30° of pre-and post-operation were assessed for two groups. RESULTS: Sixty-five patients (TT group, 34; AM group, 31 were followed up for more than 12 months, with a follow-up rate of 86%. The Lysholm knee score and the KT-1000 anterior laxity 12 months after operation were significantly better than before reconstruction. The Lysholm knee score and the KT-1000 anterior laxity were not significantly different between the TT and AM groups after operation. CONCLUSION: Femoral tunnel preparation through tibial tunnel or the anteromedial portal in single-bundle anterior cruciate ligament reconstruction shows same therapeutic effects.OBJETIVO: Comparar prospectivamente o efeito terapêutico da preparação do túnel femoral através do túnel tibial (TT ou da porta ântero-medial(AM na reconstrução do ligamento cruzado anterior(LCA em feixe único. MÉTODOS: Entre junho de 2008 e outubro de 2010, 76 pacientes foram submetidos à reconstrução do LCA em feixe único pelo enxerto autógeno de tendão semitendíneo egrácil.Todos os casos foram divididos aleatoriamente em dois grupos de acordo como método de preparação do túnel femoral: grupo transtibial (TT (n=38 e grupo ântero-medial (AM (n=38. Foi usado o escore Lysholm para joelho. O relaxamento anterior do joelho a 30° sob força tênsil de 133,32N foi determinado com o medidor KT-1000 no pré e no p

  5. Electron Tunneling Counting Statistics of a GaAs Quantum Dot at Thermal Equilibrium

    Science.gov (United States)

    Zhang, Xinchang; Xiao, Ming; Yablonovitch, Eli; Jiang, Hongwen

    2008-03-01

    Full counting statistics (FCS) is an innovative way to investigate current fluctuations of mesoscopic conductors which can provide additional information beyond the conventional average current measurement [1]. Suppression of the 2nd moment and the 3rd moment were observed in a many-electron quantum dot(QD)under nonequilibrium conditions [1]. Here we studied the FCS of single electron tunneling of a GaAs QD in the few electron regime at thermal equilibrium in the in-plane magnetic fields. The device consists of a multiple-surface-gates defined GaAs QD integrated with a very sensitive, high bandwidth field effect transitor (FET) channel for the QD charge state read-out. Monitoring the FET current revealed two sequences of random telegraph signals which represent the electron tunneling onto and off the QD in real time. When the QD level is aligned with Fermi level of the reservoir, the statistics shows a maximum value of both mean () and standard deviation (sigma), but a minimum skewness in its distribution function. It was also found that an in-plane magnetic field suppresses both and sigma, but enhances the skewness. [1], S. Gustavsson et. al, PRL 96, 76695(2006). .

  6. Comparison of Anterior Cruciate Ligament Graft Isometry between Paired Femoral and Tibial Tunnels.

    Science.gov (United States)

    Cain, E Lyle; Biggers, Marcus D; Beason, David P; Emblom, Benton A; Dugas, Jeffrey R

    2017-11-01

    Accurate tunnel placement is important for a successful anterior cruciate ligament (ACL) reconstruction. Controversy exists concerning the preferred method of femoral tunnel preparation, with proponents of both medial portal and transtibial drilling techniques. Current ACL literature suggests that placement of the femoral ACL attachment site posterior or "low" in the ACL footprint leads to more anatomically correct ACL mechanics and better rotational control. There is limited literature focusing on ACL graft displacement through knee range of motion based on specific paired placement of femoral and tibial tunnels. Our purpose was to assess ACL isometry between multiple combinations of femoral and tibial tunnels. We hypothesized that placement of the graft at the posterior aspect of the ACL footprint on the femur would be significantly less isometric and lead to more graft displacement as compared with central or anterior placement. The ACL of matched pairs of cadaveric knees was arthroscopically debrided while leaving the soft tissue footprint on the femur and tibia intact. One knee from each pair underwent notchplasty. In all knees, three femoral and three tibial tunnels were created at the anterior, central, and posterior aspects of the ACL footprint. A suture was passed through each tunnel combination (nine potential pairs), and the change in isometry was measured throughout full knee range of motion. Placement of the femoral tunnel along the posterior aspect of the ACL footprint was less isometric compared with a central or anterior position in the femoral footprint. Placement of a posterior tibial tunnel also led to decreased isometry, but tibial tunnel placement affected isometry to a lesser extent than femoral tunnel placement. The combination of a posterior femoral and posterior tibial tunnel resulted in greater than 1 cm of graft excursion from full flexion to extension. Placement of ACL tunnels at anisometric sites may adversely affect the mechanical

  7. Induction regimens for transplant-eligible patients with newly diagnosed multiple myeloma: a network meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Zeng ZH

    2017-07-01

    Full Text Available Zi-Hang Zeng,1,2 Jia-Feng Chen,1,2 Yi-Xuan Li,1,2 Ran Zhang,1,2 Ling-Fei Xiao,1,2 Xiang-Yu Meng1,2 1Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, 2Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College of Wuhan University, Wuhan, People’s Republic of China Objective: The aim of this study was to compare the early efficacy and survivals of induction regimens for transplant-eligible patients with untreated multiple myeloma. Materials and methods: A comprehensive literature search in electronic databases was conducted for relevant randomized controlled trials (RCTs. Eligible studies were selected according to the predefined selection criteria, before they were evaluated for methodological quality. Basic characteristics and data for network meta-analysis (NMA were extracted from included trials and pooled in our meta-analysis. The end points were the overall response rate (ORR, progression-free survival (PFS, and overall survival (OS. Results: A total of 14 RCTs that included 4,763 patients were analyzed. The post-induction ORR was higher with bortezomib plus thalidomide plus dexamethasone (VTD regimens, and VTD was better than the majority of other regimens. For OS, VTD plus cyclophosphamide (VTDC regimens showed potential superiority over other regimens, but the difference was not statistically significant. The PFS was longer with thalidomide plus doxorubicin plus dexamethasone (TAD regimens for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM. Conclusion: The NMA demonstrated that the VTD, VTDC, and TAD regimens are most beneficial in terms of ORR, OS, and PFS for transplant-eligible patients with NDMM, respectively. Keywords: multiple myeloma, newly diagnosed, transplant-eligible, induction therapies, network meta-analysis

  8. Analyses of tunnel stability under dynamic loads

    OpenAIRE

    Oraee, B; Hosseini, N.; Oraee, K; Gholinejad, M

    2011-01-01

    Tunnels as any other structures are affected by different loads and stresses. Generally, the loads on tunnels consist of both static and dynamic loads. These loads must both be considered in the tunnel design process. In this paper, the stability state of Jiroft water-transform tunnel is evaluated. Firstly, the in-situ stresses and then using Kirschs equations the induced stresses due to static loads in walls and crown of tunnel are calculated. Consequently, the strain caused by probable eart...

  9. Deep Tunnel in Transversely Anisotropic Rock with Groundwater Flow

    Science.gov (United States)

    Bobet, Antonio

    2016-12-01

    Closed-form solutions for the stresses and deformations induced in the ground and tunnel liner are provided for a deep tunnel in a transversely anisotropic elastic rock, with anisotropic permeability, when subjected to groundwater seepage. Complex variable theory and conformal mapping are used to obtain the solutions; additional complex functions, necessary to prevent multiple solutions of the displacements, are included. The analytical solutions are verified by comparing their results from those of a finite element method. Simplified formulations are presented for tunnels with a perfectly flexible and completely incompressible liner. A spreadsheet is included that can be used to obtain stresses and displacements of the liner due to groundwater flow and far-field geostatic stresses.

  10. Free Surface Water Tunnel (FSWT)

    Data.gov (United States)

    Federal Laboratory Consortium — Description: The Free Surface Water Tunnel consists of the intake plenum, the test section and the exit plenum. The intake plenum starts with a perforated pipe that...

  11. Flatback airfoil wind tunnel experiment.

    Energy Technology Data Exchange (ETDEWEB)

    Mayda, Edward A. (University of California, Davis, CA); van Dam, C.P. (University of California, Davis, CA); Chao, David D. (University of California, Davis, CA); Berg, Dale E.

    2008-04-01

    A computational fluid dynamics study of thick wind turbine section shapes in the test section of the UC Davis wind tunnel at a chord Reynolds number of one million is presented. The goals of this study are to validate standard wind tunnel wall corrections for high solid blockage conditions and to reaffirm the favorable effect of a blunt trailing edge or flatback on the performance characteristics of a representative thick airfoil shape prior to building the wind tunnel models and conducting the experiment. The numerical simulations prove the standard wind tunnel corrections to be largely valid for the proposed test of 40% maximum thickness to chord ratio airfoils at a solid blockage ratio of 10%. Comparison of the computed lift characteristics of a sharp trailing edge baseline airfoil and derived flatback airfoils reaffirms the earlier observed trend of reduced sensitivity to surface contamination with increasing trailing edge thickness.

  12. Bijzondere belastingen in tunnels : Eindrapport

    NARCIS (Netherlands)

    Molenaar, D.J.; Weerheijm, J.; Vervuurt, A.; Burggraaf, H.; Roekaerts, D.; Meijers, P.

    2009-01-01

    Verkeerstunnels en overkapte wegen (landtunnels) komen de milieukundige en stedenbouwkundige inpassing ten goede en maken meervoudig ruimtegebruik in de stad mogelijk. Het aantal tunnels en overkappingen groeit dan ook. Dit maakt het vervoer van explosiegevaarlijke stoffen en onder hoge druk

  13. Long-term tunnel behaviour and ground movements after tunnelling in clayey soils

    Directory of Open Access Journals (Sweden)

    Kenichi Soga

    2017-09-01

    Full Text Available Long term ground movements above a tunnel may continue to increase with time after tunnelling in clayey soils as the tunnelling-induced excess pore water pressures dissipate, whilst the changing earth pressure acting on the tunnel leads to further tunnel deformation during consolidation. Furthermore the tunnel itself introduces new drainage conditions; that is, depending on the drainage condition of the tunnel lining, the effective stresses around the tunnel change with time, inducing further soil consolidation. A seepage rate from low permeability clayey soil is often very small and the groundwater seeping into the tunnel can evaporate quickly. Although a tunnel may look impermeable because the surface looks dry, it is possible that the tunnel drainage conditions are actually permeable. This paper summarises the investigation of soil-tunnel consolidation interaction, particularly focusing on ground surface movements and tunnel lining deformation in the interest of engineering concerns. Analysis results show that tunnel lining permittivity relative to the permeability of the surrounding ground plays an important role on both long-term ground movements as well as tunnel lining behaviour. The findings published in literature are reviewed step by step starting from a single tunnel, twin tunnels to complex cross passage structures. The mechanisms of tunnelling-induced soil consolidation for these structures are identified and, where applicable, possible engineering methodologies to assess the magnitude of long-term ground surface settlements and tunnel lining loads are proposed.

  14. Active damper wind tunnel test

    Science.gov (United States)

    2008-01-01

    Active damper wind tunnel test in support of the development of Constellation/Ares. Testing of the 1% and .548% models for active damper and wall interference assessment in support of the Ares/CLV integrated vehicle. This test occurred at the 11 foot wind tunnel at the Ames Research Center, California. This image is extracted from high definition video file and is the highest resolution available.

  15. Anatomic femoral tunnels in posterior cruciate ligament reconstruction: inside-out versus outside-in drilling.

    Science.gov (United States)

    Tompkins, Marc; Keller, Thomas C; Milewski, Matthew D; Gaskin, Cree M; Brockmeier, Stephen F; Hart, Joseph M; Miller, Mark D

    2013-01-01

    During posterior cruciate ligament (PCL) reconstruction, the placement and orientation of the femoral tunnel is critical to postoperative PCL function. To compare the ability of outside-in (OI) versus inside-out (IO) femoral tunnel drilling in placing the femoral tunnel aperture within the anatomic femoral footprint of the PCL, and to evaluate the orientation of the tunnels within the medial femoral condyle. Controlled laboratory study. Ten matched pairs of cadaver knees were randomized such that within each pair, 1 knee underwent arthroscopic OI drilling and the other underwent IO drilling. All knees underwent computed tomography (CT) both pre- and postoperatively with a technique optimized for ligament evaluation (80 keV with maximum mAs). Commercially available third-party software was used to fuse the pre- and postoperative CT scans, allowing comparison of the PCL footprint to the drilled tunnel. The percentage of tunnel aperture contained within the native footprint, as well as the distance from the center of the tunnel aperture to the center of the footprint, were measured. In addition, the orientation of the tunnels in the coronal and axial planes was evaluated. The OI technique placed 70.4% ± 23.7% of the tunnel within the native femoral footprint compared with 79.8% ± 16.7% for the IO technique (P = .32). The OI technique placed the center of the femoral tunnel 4.9 ± 2.2 mm from the center of the native footprint compared to 5.3 ± 2.0 mm for the IO technique (P = .65). The femoral tunnel angle in the coronal plane was 21.0° ± 9.9° for the OI technique and 37.0° ± 10.3° for the IO technique (P = .002). The tunnel angle in the axial plane was 27.3° ± 4.8° for the OI technique and 39.1° ± 11.5° for the IO technique (P = .01). This study demonstrates no difference in the ability of the OI and IO techniques to place the femoral tunnel within the PCL femoral footprint during PCL reconstruction. With the technique parameters used in this study

  16. Safety in tunnels : transport of dangerous goods through road tunnels : highlights

    Science.gov (United States)

    2001-10-01

    A serious incident involving dangerous goods in a tunnel can be extremely costly in terms of loss of human lives, environmental degradation, tunnel damage and transport disruption. On the other hand, needlessly banning dangerous goods from tunnels ma...

  17. Improving Executive Functioning in Children with ADHD: Training Multiple Executive Functions within the Context of a Computer Game. A Randomized Double-Blind Placebo Controlled Trial

    Science.gov (United States)

    Dovis, Sebastiaan; Van der Oord, Saskia; Wiers, Reinout W.; Prins, Pier J. M.

    2015-01-01

    Introduction Executive functions (EFs) training interventions aimed at ADHD-symptom reduction have yielded mixed results. Generally, these interventions focus on training a single cognitive domain (e.g., working memory [WM], inhibition, or cognitive-flexibility). However, evidence suggests that most children with ADHD show deficits on multiple EFs, and that these EFs are largely related to different brain regions. Therefore, training multiple EFs might be a potentially more effective strategy to reduce EF-related ADHD symptoms. Methods Eighty-nine children with a clinical diagnosis of ADHD (aged 8–12) were randomized to either a full-active-condition where visuospatial WM, inhibition and cognitive-flexibility were trained, a partially-active-condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebo-mode, or to a full placebo-condition. Short-term and long-term (3-months) effects of this gamified, 25-session, home-based computer-training were evaluated on multiple outcome domains. Results During training compliance was high (only 3% failed to meet compliance criteria). After training, only children in the full-active condition showed improvement on measures of visuospatial short-term-memory (STM) and WM. Inhibitory performance and interference control only improved in the full-active- and the partially-active condition. No Treatment-condition x Time interactions were found for cognitive-flexibility, verbal WM, complex-reasoning, nor for any parent-, teacher-, or child-rated ADHD behaviors, EF-behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time-effects, including the teacher-ratings. Conclusions Improvements on inhibition and visuospatial STM and WM were specifically related to the type of treatment received. However, transfer to untrained EFs and behaviors was mostly nonspecific (i.e., only interference control improved exclusively in the two EF

  18. Five-day regimen of intramuscular or subcutaneous self-administered adrenocorticotropic hormone gel for acute exacerbations of multiple sclerosis: a prospective, randomized, open-label pilot trial

    Directory of Open Access Journals (Sweden)

    Simsarian JP

    2011-07-01

    Full Text Available James P Simsarian, Carol Saunders, D Michelle SmithNeurology Center of Fairfax Ltd, Fairfax, VA, USABackground: Despite over 50 years of experience with adrenocorticotropic hormone (ACTH as a treatment for acute exacerbations of multiple sclerosis, there have been no trials examining the options of the 2–3-week dosing regimen or intramuscular injection protocol used in the original trials. At our clinic, we performed a small, prospective, randomized pilot study to examine the efficacy and safety of, and patient satisfaction with, a short (five-day self-administered ACTH dosing protocol for exacerbations of multiple sclerosis, and to compare the subcutaneous and intramuscular routes of administration.Methods: Patients for this study were recruited from an outpatient treatment clinic. Each patient self-administered natural ACTH gel 80 U/day by subcutaneous or intramuscular injection for five consecutive days and was evaluated at baseline and on days 7 and 14. Patient feedback was collected using the Patient Global Impression of Change (PGI-C, the primary efficacy measure, a patient global visual analog scale, the Expanded Disability Status Scale, a timed walk, the Nine-hole Peg Test, and the Clinical Global Impression of Change.Results: Of the 20 enrolled patients (mean age 39.5 years, 19 completed the study. On day 14, 61.1% of patients (11 of 18 with day 14 scores were treatment responders, and rated their condition as "very much improved" or "much improved" on the PGI-C. The intramuscular group had numerically more responders, but there was no significant difference in the proportion of responders between the intramuscular and subcutaneous groups at day 14 (P = 0.3. The intramuscular route of injection was associated with more injection site pain than the subcutaneous route.Conclusion: A shorter five-day course of intramuscular or subcutaneous ACTH gel may improve symptoms associated with acute exacerbations of multiple sclerosis. Larger

  19. Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. a randomized double-blind placebo controlled trial.

    Directory of Open Access Journals (Sweden)

    Sebastiaan Dovis

    Full Text Available Executive functions (EFs training interventions aimed at ADHD-symptom reduction have yielded mixed results. Generally, these interventions focus on training a single cognitive domain (e.g., working memory [WM], inhibition, or cognitive-flexibility. However, evidence suggests that most children with ADHD show deficits on multiple EFs, and that these EFs are largely related to different brain regions. Therefore, training multiple EFs might be a potentially more effective strategy to reduce EF-related ADHD symptoms.Eighty-nine children with a clinical diagnosis of ADHD (aged 8-12 were randomized to either a full-active-condition where visuospatial WM, inhibition and cognitive-flexibility were trained, a partially-active-condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebo-mode, or to a full placebo-condition. Short-term and long-term (3-months effects of this gamified, 25-session, home-based computer-training were evaluated on multiple outcome domains.During training compliance was high (only 3% failed to meet compliance criteria. After training, only children in the full-active condition showed improvement on measures of visuospatial short-term-memory (STM and WM. Inhibitory performance and interference control only improved in the full-active- and the partially-active condition. No Treatment-condition x Time interactions were found for cognitive-flexibility, verbal WM, complex-reasoning, nor for any parent-, teacher-, or child-rated ADHD behaviors, EF-behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time-effects, including the teacher-ratings.Improvements on inhibition and visuospatial STM and WM were specifically related to the type of treatment received. However, transfer to untrained EFs and behaviors was mostly nonspecific (i.e., only interference control improved exclusively in the two EF training conditions. As such

  20. MANAGEMENT OF TUNNELS ON THE ZAGREB – MACELJ MOTORWAY IN THE COURSE OF TUNNELS EXPLOITATION

    OpenAIRE

    Deković, Zvonimir; Pili, Igor

    2012-01-01

    The paper focuses on the features of management of tunnels on the Zagreb-Macelj motorway. Management of tunnels is represented trough public-private partnership model that is applied on the Zagreb-Macelj motorway. In the course of tunnel operation and maintenance in the first five years of tunnels exploitation, the emphasis is put on the maintenance of the tunnel equipment systems. Tunnels as part of the motorway alignment are the most demanding facilities for maintaining appropriate safety a...

  1. MANAGEMENT OF TUNNELS ON THE ZAGREB – MACELJ MOTORWAY IN THE COURSE OF TUNNELS EXPLOITATION

    OpenAIRE

    Zvonimir Deković; Igor Pili

    2012-01-01

    he paper focuses on the features of management of tunnels on the Zagreb-Macelj motorway. Management of tunnels is represented trough public-private partnership model that is applied on the Zagreb-Macelj motorway. In the course of tunnel operation and maintenance in the first five years of tunnels exploitation, the emphasis is put on the maintenance of the tunnel equipment systems. Tunnels as part of the motorway alignment are the most demanding facilities for maintaining appropriate safety an...

  2. Ligand tunnels in T. brucei and human CYP51: Insights for parasite-specific drug design.

    Science.gov (United States)

    Yu, Xiaofeng; Nandekar, Prajwal; Mustafa, Ghulam; Cojocaru, Vlad; Lepesheva, Galina I; Wade, Rebecca C

    2016-01-01

    Cytochrome P450 sterol 14α-demethylase (CYP51) is an essential enzyme for sterol biosynthesis and a target for anti-parasitic drug design. However, the design of parasite-specific drugs that inhibit parasitic CYP51 without severe side effects remains challenging. The active site of CYP51 is situated in the interior of the protein. Here, we characterize the potential ligand egress routes and mechanisms in Trypanosoma brucei and human CYP51 enzymes. We performed Random Acceleration Molecular Dynamics simulations of the egress of four different ligands from the active site of models of soluble and membrane-bound T. brucei CYP51 and of soluble human CYP51. In the simulations, tunnel 2f, which leads to the membrane, was found to be the predominant ligand egress tunnel for all the ligands studied. Tunnels S, 1 and W, which lead to the cytosol, were also used in T. brucei CYP51, whereas tunnel 1 was the only other tunnel used significantly in human CYP51. The common tunnels found previously in other CYPs were barely used. The ligand egress times were shorter for human than T. brucei CYP51, suggesting lower barriers to ligand passage. Two gating residues, F105 and M460, in T. brucei CYP51 that modulate the opening of tunnels 2f and S were identified. Although the main egress tunnel was the same, differences in the tunnel-lining residues, ligand passage and tunnel usage were found between T. brucei and human CYP51s. The results provide a basis for the design of selective anti-parasitic agents targeting the ligand tunnels. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Optically controlled electroresistance and electrically controlled photovoltage in ferroelectric tunnel junctions

    KAUST Repository

    Jin Hu, Wei

    2016-02-29

    Ferroelectric tunnel junctions (FTJs) have recently attracted considerable interest as a promising candidate for applications in the next-generation non-volatile memory technology. In this work, using an ultrathin (3 nm) ferroelectric Sm0.1Bi0.9FeO3 layer as the tunnelling barrier and a semiconducting Nb-doped SrTiO3 single crystal as the bottom electrode, we achieve a tunnelling electroresistance as large as 105. Furthermore, the FTJ memory states could be modulated by light illumination, which is accompanied by a hysteretic photovoltaic effect. These complimentary effects are attributed to the bias- and light-induced modulation of the tunnel barrier, both in height and width, at the semiconductor/ferroelectric interface. Overall, the highly tunable tunnelling electroresistance and the correlated photovoltaic functionalities provide a new route for producing and non-destructively sensing multiple non-volatile electronic states in such FTJs.

  4. Make Better Choices (MBC): study design of a randomized controlled trial testing optimal technology-supported change in multiple diet and physical activity risk behaviors.

    Science.gov (United States)

    Spring, Bonnie; Schneider, Kristin; McFadden, H G; Vaughn, Jocelyn; Kozak, Andrea T; Smith, Malaina; Moller, Arlen C; Epstein, Leonard; Russell, Stephanie W; DeMott, Andrew; Hedeker, Donald

    2010-09-29

    Suboptimal diet and physical inactivity are prevalent, co-occurring chronic disease risk factors, yet little is known about how to maximize multiple risk behavior change. Make Better Choices, a randomized controlled trial, tests competing hypotheses about the optimal way to promote healthy change in four bundled risk behaviors: high saturated fat intake, low fruit and vegetable intake, low physical activity, and high sedentary leisure screen time. The study aim is to determine which combination of two behavior change goals--one dietary, one activity--yields greatest overall healthy lifestyle change. Adults (n = 200) with poor quality diet and sedentary lifestyle will be recruited and screened for study eligibility. Participants will be trained to record their diet and activities onto a personal data assistant, and use it to complete two weeks of baseline. Those who continue to show all four risk behaviors after baseline recording will be randomized to one of four behavior change prescriptions: 1) increase fruits and vegetables and increase physical activity, 2) decrease saturated fat and increase physical activity, 3) increase fruits and vegetable and decrease saturated fat, or 4) decrease saturated fat and decrease sedentary activity. They will use decision support feedback on the personal digital assistant and receive counseling from a coach to alter their diet and activity during a 3-week prescription period when payment is contingent upon meeting behavior change goals. They will continue recording on an intermittent schedule during a 4.5-month maintenance period when payment is not contingent upon goal attainment. The primary outcome is overall healthy lifestyle change, aggregated across all four risk behaviors. The Make Better Choices trial tests a disseminable lifestyle intervention supported by handheld technology. Findings will fill a gap in knowledge about optimal goal prescription to facilitate simultaneous diet and activity change. Results will shed

  5. An intensive social cognitive program (can do treatment) in people with relapsing remitting multiple sclerosis and low disability: a randomized controlled trial protocol.

    Science.gov (United States)

    Jongen, Peter Joseph; Heerings, Marco; Ruimschotel, Rob; Hussaarts, Astrid; Evers, Silvia; Duyverman, Lotte; Valkenburg-Vissers, Joyce; Cornelissen, Job; Bos, Michel; van Droffelaar, Maarten; Lemmens, Wim A; Donders, Rogier; van der Zande, Anneke; Visser, Leo H

    2016-05-28

    In people with multiple sclerosis (MS) disabilities and limitations may negatively affect self-efficacy. Lowered self-efficacy has been associated with decreases in health-related quality of life, physical activity and cognitive performance. In an explorative observational study we found that a 3-day intensive social cognitive program (Can Do Treatment [CDT]) with the participation of support partners was followed by substantial increases in self-efficacy control and health-related quality of life 6 months after treatment in those people with MS who had relapsing remitting disease and low disability. CDT is a sociologically oriented approach, its goal is to uncover and promote existing capabilities, and the notion "stressor" is the central concept. CDT's components are plenary group sessions, small group sessions, consultations, a theatre evening, and start of the day with a joint activity. The small group sessions form the actual training. Depending on their individual goals the participants join the training groups 'Body', 'Feeling' or 'Life', to work out their aims and to reduce their stressors. The multidisciplinary team includes a psychiatrist, psychiatric nurse, neurologist, specialized MS nurse, physiotherapist, dance therapist, and a person with MS. To evaluate the (cost)effectiveness of CDT in persons with relapsing remitting MS and low disability we perform a single-centre, randomized controlled trial in 140 patients, with or without support partners. The primary outcome is self-efficacy control. The secondary outcomes are self-efficacy function, health-related quality of life, autonomy and participation, anxiety, depression, cost effectiveness and cost utility. The tertiary outcome is care-related strain to support partners. Outcomes are assessed at baseline and at 1, 3 and 6 months after CDT. This randomized controlled trial will adequately evaluate the clinical and cost effectiveness of a 3-day intensive social cognitive program in people with

  6. Effects of long-term whole-body vibration training on mobility in patients with multiple sclerosis: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Kantele, Sini; Karinkanta, Saija; Sievänen, Harri

    2015-11-15

    This meta-analysis evaluated feasibility and efficacy of long-term whole-body vibration (WBV) training in improving mobility of multiple sclerosis (MS) patients. The primary search of this meta-analysis was conducted from four electronic databases (PubMed, Sport, CINAHL and Cochrane) in order to find all relevant randomized, controlled WBV intervention trials of MS patients published between January 2000 and October 2013. The primary search was complemented by a recent (Aug 2015) PubMed search. Data on patients' characteristics and type of WBV intervention were extracted from the published reports and supplementary material. Two researchers independently assessed the methodological quality of these studies and outcomes. Standardized mean differences based on the baseline-adjusted follow-up results were calculated as indicators of the effect size (ES) of WBV training. Seven randomized controlled trials (RCTs) involving 250 MS patients were found. Relevant group-based data for analysis were available from 109 patients in WBV groups and from 100 control patients; 41 patients withdrew from the studies. Quality assessment revealed that the WBV training protocols were heterogeneous and the methodological quality of the studies was generally poor. We found borderline indication for improved 2-6 min walking endurance [ES=0.25 (95% CI=-0.06-0.0.55)] favoring WBV training whereas no benefits were indicated for short-distance (20m or less) walking speed or balance. This meta-analysis suggests that WBV training has potential in improving walking endurance in MS patients with low disability status. However, evidence for more severely disabled MS patients is lacking, and further well-designed, long-term RCTs with adequate sample sizes are needed. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis.

    Science.gov (United States)

    Kiropoulos, Litza A; Kilpatrick, Trevor; Holmes, Alex; Threader, Jennifer

    2016-12-07

    To examine the effectiveness and acceptability of an 8-week individual tailored cognitive behavioural therapy (CBT) intervention for the treatment of depressive symptoms in those newly diagnosed with multiple sclerosis. The current study presents a pilot, parallel group randomized controlled trial (RCT) with an allocation ratio of 1:1 conducted in a large research and teaching hospital in Melbourne, Australia. 30 individuals with a mean age of 36.93 years (SD = 9.63) who were newly diagnosed with multiple sclerosis (MS) (X = 24.87 months, SD = 15.61) were randomized to the CBT intervention (n = 15) or treatment as usual (TAU) (n = 15). The primary outcome was level of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Secondary outcomes were level of anxiety, fatigue and pain impact, sleep quality, coping, acceptance of MS illness, MS related quality of life, social support, and resilience. Tertiary outcomes were acceptability and adherence to the intervention. Large between group treatment effects were found for level of depressive symptoms at post and at 20 weeks follow-up (d = 1.66-1.34). There were also small to large group treatment effects for level of anxiety, fatigue and pain impact, sleep quality, MS related quality of life, resilience, and social support at post and at 20 weeks follow-up (d = 0.17-1.63). There were no drop-outs and participants completed all treatment modules. All participants reported the treatment as 'very useful', and most (73.4%) reported that the intervention had addressed their problems 'completely'. These data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted. The pilot trial has been retrospectively registered on 28

  8. The Calculating Boluses on Multiple Daily Injections (CBMDI) study: A randomized controlled trial on the effect on metabolic control of adding a bolus calculator to multiple daily injections in people with type 1 diabetes.

    Science.gov (United States)

    Vallejo-Mora, María Del Rosario; Carreira-Soler, Mónica; Linares-Parrado, Francisca; Olveira, Gabriel; Rojo-Martínez, Gemma; Domínguez-López, Marta; Ruiz-de-Adana-Navas, María Soledad; González-Romero, María Stella

    2017-01-01

    Although the insulin bolus calculator is increasingly being used by people with type 1 diabetes (T1D) on multiple daily injection (MDI) therapy, few studies have investigated its effects on glycemic control. The aim of this study was to determine whether adding this device to therapeutic intensification could further improve metabolic control. A 4-month randomized controlled clinical trial was performed comparing subjects undergoing therapeutic intensification and either using the bolus calculator (Cb group) or not (active control [Co] group). Metabolic control, fear of hypoglycemia, and treatment acceptance were evaluated. In all, 70 people completed the study (42 in the Cb group, 28 in the Co group). There was a significant decrease in HbA1c in both the Cb and Co groups (-7 mmol/mol [-0.7 %] vs -4 mmol/mol [-0.4 %], respectively). There were no significant differences in HbA1c at baseline or the end of the study, or in the decrease in HbA1c, glycemia, or changes in blood glucose levels at the end of the study between the two groups. There was a significant increase in the number of participants with good metabolic control (HbA1c metabolic control and slightly decreased the number of hypoglycemic episodes. Metabolic control also improved in the Co group. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  9. Modified coronally advanced flap with and without orthodontic button application in management of multiple proximate gingival recession defects: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Sumedh Khobragade

    2016-01-01

    Full Text Available Background: Gingival recession indicates oral display of the root surface due to apical movement of gingival margin. Coronally advanced flap (CAF is often used periodontal plastic surgical technique to accomplish root coverage. The purpose of this clinical trial is to assess and compare the effectiveness of modified CAF with orthodontic button application (CAF*B and without orthodontic button application (CAF for the correction of multiple recession defects. Materials and Methods: Twenty patients exhibiting bilateral multiple proximate Millers Class I and/or Class II gingival recession defects were included in the study. Each set of proximate recession defects was designated randomly to test or control group. Control group was treated by CAF alone and test group by CAF*B. Baseline and postoperative clinical parameters at 2, 4, and 6 months time interval were recorded. Results: Mean root coverage percentage from baseline to 6 months in control group was 78.30% ± 20.75% and in test group was 92.23% ± 15.6%. Complete root coverage was 43.8% in control group and 77.47% in test group. Visual analog scale pain measurements did not reveal any difference among both the groups. Patient satisfaction with esthetics was very high in CAF*B group when compared with CAF group. Conclusion: Both treatment modalities, i.e., CAF and CAF*B are effectual in the treatment of proximate Miller's Class I and Class II gingival recession defects, but CAF*B showed significantly superior clinical results.

  10. The Use of Platelet-Rich Fibrin Versus Subepithelial Connective Tissue Graft in Treatment of Multiple Gingival Recessions: A Randomized Clinical Trial.

    Science.gov (United States)

    Öncü, Elif

    The objective of this study was to evaluate the clinical effectiveness of platelet-rich fibrin (PRF) membrane used in combination with a modified coronally advanced flap (MCAF) and to compare it with the use of a subepithelial connective tissue graft (SCTG) in combination with a MCAF in treatment of Miller Class I and II bilateral multiple gingival recessions. A total of 20 patients with multiple Miller Class I and II maxillary gingival recession defects participated in this randomized, split-mouth, controlled study. A total of 60 defects received either PRF + MCAF (test group, n = 30) or MCAF with SCTG (control group, n = 30). Gingival recession depth (RD), keratinized tissue width (KTW), probing depth (PD), clinical attachment level (CAL), and gingival thickness (GT) were evaluated at baseline and after 6 months. Patients' discomfort postsurgery was measured by comparing visual analog scale scores. The percentage of root coverage was 84% in the control group and 77.12% in the test group (P = .007). Complete root coverage of the control and test groups was 60% and 50%, respectively (P = .112). KTW and GT increased in both groups from baseline to 6 months (P < .001). At 6 months postoperative, KTW was greater in the control group (P = .024) and GT was higher in the test group (P = .005). Use of a PRF membrane in gingival recession treatment decreased postoperative discomfort compared to SCTG-treated gingival recessions (P < .001). Within the limitations of the present study, it was concluded that localized gingival recessions could be successfully treated with MCAF + PRF as well as MCAF + SCTG. The PRF technique has the bonus advantage of being more comfortable during the postoperative period. The author suggests that the use of PRF is a valid alternative to SCTG for the treatment of localized gingival recessions.

  11. Macroscopic resonant tunnelling through Andreev interferometers.

    Science.gov (United States)

    Goorden, M C; Jacquod, Ph; Weiss, J

    2008-04-02

    We investigate the conductance through and the spectrum of ballistic chaotic quantum dots attached to two s-wave superconductors, as a function of the phase difference phi between the two order parameters. A combination of analytical techniques-random matrix theory, Nazarov's circuit theory and the trajectory-based semiclassical theory-allows us to explore the quantum-to-classical crossover in detail. When the superconductors are not phase-biased, phi = 0, we recover known results that the spectrum of the quantum dot exhibits an excitation gap, while the conductance across two normal leads carrying N(N) channels and connected to the dot via tunnel contacts of transparency Gamma(N) is [Formula: see text]. In contrast, when phi = pi, the excitation gap closes and the conductance becomes [Formula: see text] in the universal regime. For [Formula: see text], we observe an order-of-magnitude enhancement of the conductance towards [Formula: see text] in the short-wavelength limit. We relate this enhancement to resonant tunnelling through a macroscopic number of levels close to the Fermi energy. Our predictions are corroborated by numerical simulations.

  12. Effects of Pilates-Based Core Stability Training in Ambulant People With Multiple Sclerosis: Multicenter, Assessor-Blinded, Randomized Controlled Trial.

    Science.gov (United States)

    Fox, Esther E; Hough, Alan D; Creanor, Siobhan; Gear, Margaret; Freeman, Jennifer A

    2016-08-01

    Pilates exercise is often undertaken by people with multiple sclerosis (MS) who have balance and mobility difficulties. The primary aim of the study was to compare the effects of 12 weeks of Pilates exercises with relaxation on balance and mobility. Secondary aims were: (1) to compare standardized exercises with relaxation and (2) to compare Pilates exercises with standardized exercises. A multicenter, assessor-blinded, randomized controlled trial was conducted. Participants with Expanded Disability Status Scale scores of 4.0 to 6.5 were randomly allocated to groups receiving 12 weeks of Pilates exercises, standardized exercises, or relaxation. Assessments were undertaken at baseline and weeks 12 and 16 (primary outcome measure: 10-Meter Timed Walk Test [10MTW]). One hundred participants (mean age=54 years, 74% female) were randomized to study groups. Six participants relapsed (withdrew from the study), leaving 94 participants for intention-to-treat analysis. There was no significant difference in mean 10MTW measurements between the Pilates and relaxation groups. At 12 weeks, there was a mean reduction of 4.2 seconds for the standardized exercise group compared with the relaxation group (95% confidence interval [relaxation group minus standardized exercise group measurements]=0.0, 8.4) and a mean reduction of 3.7 seconds for the Pilates group compared with the standardized exercise group (95% confidence interval [Pilates group minus standardized exercise group measurements]=-0.4 to 7.8). At 16 weeks, mean 10MTW times for the standardized exercise group remained quicker than those for the Pilates and relaxation groups, although the differences were nonsignificant. There were no significant differences between the Pilates and relaxation groups for any secondary outcome measure. In this study, therapists were limited to a standardized basket of exercises that may have affected the study outcomes. Furthermore, choosing measures such as posturography to assess balance

  13. Thirty-Month Complete Response as a Surrogate End Point in First-Line Follicular Lymphoma Therapy: An Individual Patient-Level Analysis of Multiple Randomized Trials.

    Science.gov (United States)

    Shi, Qian; Flowers, Christopher R; Hiddemann, Wolfgang; Marcus, Robert; Herold, Michael; Hagenbeek, Anton; Kimby, Eva; Hochster, Howard; Vitolo, Umberto; Peterson, Bruce A; Gyan, Emmanuel; Ghielmini, Michele; Nielsen, Tina; De Bedout, Sabine; Fu, Tommy; Valente, Nancy; Fowler, Nathan H; Hoster, Eva; Ladetto, Marco; Morschhauser, Franck; Zucca, Emanuele; Salles, Gilles; Sargent, Daniel J

    2017-02-10

    Purpose Follicular lymphoma (FL) is an indolent cancer, with effective but rarely curative treatment options. As a standard study end point for first-line FL therapy, progression-free survival (PFS) requires extended follow-up (median PFS, > 7 years). To provide patients with earlier access to newer therapies, an earlier end point to expedite clinical trials is needed. Our objective was to formally assess the complete response rate at 30 months (CR30) after initiation of induction therapy as a potential surrogate end point for PFS in first-line FL therapy. Patients and Methods We analyzed individual patient data from 13 randomized multicenter trials of induction and maintenance regimens in first-line FL therapy published after 1990 and with sufficient data to evaluate whether CR30 could predict treatment effects on PFS. Correlation of the CR30 odds ratio with the PFS hazard ratio was evaluated by both linear regression (R2WLS) and bivariate copula (R2Copula) models. Prespecified criteria for surrogacy required either R2WLS or R2Copula ≥ 0.80, with a lower-bound 95% CI > 0.60. Results Data from eight induction and five maintenance randomized trials in 3,837 evaluable patients were analyzed. The prespecified surrogacy threshold was met, with an R2WLS of 0.88 (95% CI, 0.77 to 0.96) and an R2Copula of 0.86 (95% CI, 0.72 to 1.00). Multiple sensitivity and supplemental analyses supported the robustness of the findings. A minimum 11% absolute improvement in CR30 from a 50% control rate predicted a significant treatment effect on PFS (hazard ratio, 0.69). Conclusion This large, prospective, pooled analysis of randomized chemotherapy, immunotherapy, and chemoimmunotherapy trials demonstrates that CR30 is a surrogate end point for PFS in first-line FL treatment trials. Use of this end point may expedite therapeutic development with the intent of bringing novel therapies to this patient population years before PFS results are mature.

  14. Computed tomography analysis of the femoral tunnel position and aperture shape of transportal and outside-in ACL reconstruction: do different anatomic reconstruction techniques create similar femoral tunnels?

    Science.gov (United States)

    Kim, Jae Gyoon; Chang, Min Ho; Lim, Hong Chul; Bae, Ji Hoon; Ahn, Jin Hwan; Wang, Joon Ho

    2013-11-01

    The desire to perform independent femoral drilling in anterior cruciate ligament (ACL) reconstruction has prompted interest in both the transportal (TP) and outside-in (OI) techniques. However, there have been no in vivo studies on the differences in femoral aperture shape between the 2 techniques. To evaluate the femoral tunnel aperture shape and femoral tunnel position between ACL reconstruction using the TP and OI techniques. Randomized controlled trial; Level of evidence, 1. A total of 80 patients were randomized to undergo double-bundle ACL reconstruction using either the TP (n = 40) or OI (n = 40) technique. The femoral tunnel aperture shape (height/width ratio), aperture axis angle (angle between the aperture axis and femoral shaft axis), and femoral tunnel position were assessed by computed tomography. The mean height/width ratio of the anteromedial (AM) femoral tunnels in the TP group (1.35 ± 0.16) was significantly more ellipsoidal than that in the OI group (1.22 ± 0.16) (P = .008). There was no difference between the 2 groups in the posterolateral (PL) tunnels (TP, 1.32 ± 0.23; OI, 1.35 ± 0.29; P = .99). The mean aperture axis angle of the PL femoral tunnels in the OI group was significantly more perpendicular to the femoral shaft axis and had a more variable range than that in the TP group (P = .007). The mean PL femoral tunnel position in the OI group was significantly shallower and a little higher than that in the TP group (P = .006). The TP technique revealed a more ellipsoidal AM femoral tunnel aperture than the OI technique. The mean PL femoral tunnel position in the OI group was significantly shallower than that in the TP group, with a more variable and more perpendicular aperture axis angle to the femoral shaft axis. The TP technique might be more advantageous than the OI technique in terms of graft coverage, with a more ellipsoidal AM femoral tunnel and more horizontal and consistent PL aperture axis angle. In addition, it may be useful to

  15. Random matrices

    CERN Document Server

    Mehta, Madan Lal

    1990-01-01

    Since the publication of Random Matrices (Academic Press, 1967) so many new results have emerged both in theory and in applications, that this edition is almost completely revised to reflect the developments. For example, the theory of matrices with quaternion elements was developed to compute certain multiple integrals, and the inverse scattering theory was used to derive asymptotic results. The discovery of Selberg's 1944 paper on a multiple integral also gave rise to hundreds of recent publications. This book presents a coherent and detailed analytical treatment of random matrices, leading

  16. Pharmacodynamic consequences of administration of VLA-4 antagonist CDP323 to multiple sclerosis subjects: a randomized, double-blind phase 1/2 study.

    Directory of Open Access Journals (Sweden)

    Christian Wolf

    Full Text Available Lymphocyte inhibition by antagonism of α4 integrins is a validated therapeutic approach for relapsing multiple sclerosis (RMS.Investigate the effect of CDP323, an oral α4-integrin inhibitor, on lymphocyte biomarkers in RMS.Seventy-one RMS subjects aged 18-65 years with Expanded Disability Status Scale scores ≤6.5 were randomized to 28-day treatment with CDP323 100 mg twice daily (bid, 500 mg bid, 1000 mg once daily (qd, 1000 mg bid, or placebo.Relative to placebo, all dosages of CDP323 significantly decreased the capacity of lymphocytes to bind vascular adhesion molecule-1 (VCAM-1 and the expression of α4-integrin on VCAM-1-binding cells. All but the 100-mg bid dosage significantly increased total lymphocytes and naive B cells, memory B cells, and T cells in peripheral blood compared with placebo, and the dose-response relationship was shown to be linear. Marked increases were also observed in natural killer cells and hematopoietic progenitor cells, but only with the 500-mg bid and 1000-mg bid dosages. There were no significant changes in monocytes. The number of samples for regulator and inflammatory T cells was too small to draw any definitive conclusions.CDP323 at daily doses of 1000 or 2000 mg induced significant increases in total lymphocyte count and suppressed VCAM-1 binding by reducing unbound very late antigen-4 expression on lymphocytes.ClinicalTrials.gov NCT00726648.

  17. Treating Post-traumatic Stress Disorder in Patients with Multiple Sclerosis: A Randomized Controlled Trial Comparing the Efficacy of Eye Movement Desensitization and Reprocessing and Relaxation Therapy.

    Science.gov (United States)

    Carletto, Sara; Borghi, Martina; Bertino, Gabriella; Oliva, Francesco; Cavallo, Marco; Hofmann, Arne; Zennaro, Alessandro; Malucchi, Simona; Ostacoli, Luca

    2016-01-01

    Multiple Sclerosis (MS) is a demyelinating autoimmune disease that imposes a significant emotional burden with heavy psychosocial consequences. Several studies have investigated the association between MS and mental disorders such as depression and anxiety, and recently researchers have focused also on Post-traumatic Stress Disorder (PTSD). This is the first study that investigates the usefulness of proposing a treatment for PTSD to patients with MS. A randomized controlled trial with patients with MS diagnosed with PTSD comparing Eye Movement Desensitization and Reprocessing (EMDR; n = 20) and Relaxation Therapy (RT; n = 22). The primary outcome measure was the proportion of participants that no longer meet PTSD diagnosis as measured with Clinician Administered PTSD Scale 6-months after the treatment. The majority of patients were able to overcome their PTSD diagnosis after only 10 therapy sessions. EMDR treatment appears to be more effective than RT in reducing the proportion of patients with MS suffering from PTSD. Both treatments are effective in reducing PTSD severity, anxiety and depression symptoms, and to improve Quality of Life. Although our results can only be considered preliminary, this study suggests that it is essential that PTSD symptoms are detected and that brief and cost-effective interventions to reduce PTSD and associated psychological symptoms are offered to patients, in order to help them to reduce the psychological burden associated with their neurological condition. NCT01743664, https://clinicaltrials.gov/ct2/show/NCT01743664.

  18. Treating Post-traumatic Stress Disorder in patients with Multiple Sclerosis: a randomized controlled trial comparing the efficacy of Eye Movement Desensitization and Reprocessing and Relaxation Therapy.

    Directory of Open Access Journals (Sweden)

    Sara eCarletto

    2016-04-01

    Full Text Available Objective: Multiple Sclerosis (MS is a demyelinating autoimmune disease that imposes a significant emotional burden with heavy psychosocial consequences. Several studies have investigated the association between MS and mental disorders such as depression and anxiety, and recently researchers have focused also on Post-traumatic Stress Disorder (PTSD. This is the first study that investigates the usefulness of proposing a treatment for PTSD to patients with MS. Methods: A randomized controlled trial with patients with MS diagnosed with PTSD comparing Eye Movement Desensitization and Reprocessing (EMDR; n = 20 and Relaxation Therapy (RT; n = 22. The primary outcome measure was the proportion of participants that no longer meet PTSD diagnosis as measured with Clinician Administered PTSD Scale six-months after the treatment.Results: The majority of patients were able to overcome their PTSD diagnosis after only 10 therapy sessions. EMDR treatment appears to be more effective than RT in reducing the proportion of patients with MS suffering from PTSD. Both treatments are effective in reducing PTSD severity, anxiety symptoms and to improve Quality of Life (QoL. Conclusions: Although our results can only be considered preliminary, this study suggests that it is essential that PTSD symptoms are detected and that brief and cost-effective interventions to reduce PTSD and associated psychological symptoms are offered to patients, in order to help them to reduce the psychological burden associated with their neurological condition.Trail registration: NCT01743664, https://clinicaltrials.gov/ct2/show/NCT01743664

  19. Randomized Controlled Trial to Examine the Impact of Aquatic Exercise Training on Functional Capacity, Balance, and Perceptions of Fatigue in Female Patients With Multiple Sclerosis.

    Science.gov (United States)

    Kargarfard, Mehdi; Shariat, Ardalan; Ingle, Lee; Cleland, Joshua A; Kargarfard, Mina

    2018-02-01

    To assess the effects of an 8-week aquatic exercise training program on functional capacity, balance, and perceptions of fatigue in women with multiple sclerosis (MS). Randomized controlled design. Referral center of an MS society. Women (N=32; mean age ± SD, 36.4±8.2y) with diagnosed relapsing-remitting MS. After undergoing baseline testing by a neurologist, participants were allocated to either an intervention (aquatic training program, n=17) or a control group (n=15). The intervention consisted of an 8-week aquatic training program (3 supervised training sessions per week; session duration, 45-60min; 50%-75% estimated maximum heart rate). Six-minute walk test (6-MWT), balance (Berg Balance Scale [BBS]), and perceptions of fatigue (Modified Fatigue Impact Scale; [MFIS]) at baseline and after the 8-week intervention. Differences over time between the experimental and control groups were assessed by a 2×2 (group by time) repeated-measures analysis of variance. Thirty-two women completed the 8-week aquatic training intervention (experimental group, n=17; control group, n=15). All outcome measures improved in the experimental group: 6-MWT performance (pretest mean ± SD, 451±58m; posttest mean ± SD, 503±57m; PAquatic exercise training improved functional capacity, balance, and perceptions of fatigue in women with MS. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Current noise in tunnel junctions

    Energy Technology Data Exchange (ETDEWEB)

    Frey, Moritz; Grabert, Hermann [Physikalisches Institut, Universitaet Freiburg, Hermann-Herder-Strasse 3, 79104, Freiburg (Germany)

    2017-06-15

    We study current fluctuations in tunnel junctions driven by a voltage source. The voltage is applied to the tunneling element via an impedance providing an electromagnetic environment of the junction. We use circuit theory to relate the fluctuations of the current flowing in the leads of the junction with the voltage fluctuations generated by the environmental impedance and the fluctuations of the tunneling current. The spectrum of current fluctuations is found to consist of three parts: a term arising from the environmental Johnson-Nyquist noise, a term due to the shot noise of the tunneling current and a third term describing the cross-correlation between these two noise sources. Our phenomenological theory reproduces previous results based on the Hamiltonian model for the dynamical Coulomb blockade and provides a simple understanding of the current fluctuation spectrum in terms of circuit theory and properties of the average current. Specific results are given for a tunnel junction driven through a resonator. (copyright 2016 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  1. Development of a 3D modeling algorithm for tunnel deformation monitoring based on terrestrial laser scanning

    Directory of Open Access Journals (Sweden)

    Xiongyao Xie

    2017-03-01

    Full Text Available Deformation monitoring is vital for tunnel engineering. Traditional monitoring techniques measure only a few data points, which is insufficient to understand the deformation of the entire tunnel. Terrestrial Laser Scanning (TLS is a newly developed technique that can collect thousands of data points in a few minutes, with promising applications to tunnel deformation monitoring. The raw point cloud collected from TLS cannot display tunnel deformation; therefore, a new 3D modeling algorithm was developed for this purpose. The 3D modeling algorithm includes modules for preprocessing the point cloud, extracting the tunnel axis, performing coordinate transformations, performing noise reduction and generating the 3D model. Measurement results from TLS were compared to the results of total station and numerical simulation, confirming the reliability of TLS for tunnel deformation monitoring. Finally, a case study of the Shanghai West Changjiang Road tunnel is introduced, where TLS was applied to measure shield tunnel deformation over multiple sections. Settlement, segment dislocation and cross section convergence were measured and visualized using the proposed 3D modeling algorithm.

  2. TunnelVision: LHC Tunnel Photogrammetry System for Structural Monitoring

    CERN Document Server

    Fallas, William

    2014-01-01

    In this document an algorithm to detect deformations in the LHC Tunnel of CERN is presented. It is based on two images, one represents the ideal state of the tunnel and the other one the actual state. To find the differences between both, the algorithm is divided in three steps. First, an image enhancement is applied to make easier the detection. Second, two different approaches to reduce noise are applied to one or both images. And third, it is defined a group of characteristics about the type of deformation desired to detect. Finally, the conclusions show the effectiveness of the algorithm in the experimental results.

  3. Resonant Tunneling Analog-To-Digital Converter

    Science.gov (United States)

    Broekaert, T. P. E.; Seabaugh, A. C.; Hellums, J.; Taddiken, A.; Tang, H.; Teng, J.; vanderWagt, J. P. A.

    1995-01-01

    As sampling rates continue to increase, current analog-to-digital converter (ADC) device technologies will soon reach a practical resolution limit. This limit will most profoundly effect satellite and military systems used, for example, for electronic countermeasures, electronic and signal intelligence, and phased array radar. New device and circuit concepts will be essential for continued progress. We describe a novel, folded architecture ADC which could enable a technological discontinuity in ADC performance. The converter technology is based on the integration of multiple resonant tunneling diodes (RTD) and hetero-junction transistors on an indium phosphide substrate. The RTD consists of a layered semiconductor hetero-structure AlAs/InGaAs/AlAs(2/4/2 nm) clad on either side by heavily doped InGaAs contact layers. Compact quantizers based around the RTD offer a reduction in the number of components and a reduction in the input capacitance Because the component count and capacitance scale with the number of bits N, rather than by 2 (exp n) as in the flash ADC, speed can be significantly increased, A 4-bit 2-GSps quantizer circuit is under development to evaluate the performance potential. Circuit designs for ADC conversion with a resolution of 6-bits at 25GSps may be enabled by the resonant tunneling approach.

  4. Efficacy and safety of venous angioplasty of the extracranial veins for multiple sclerosis. Brave dreams study (brain venous drainage exploited against multiple sclerosis: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zamboni Paolo

    2012-10-01

    Full Text Available Abstract Background Multiple sclerosis (MS is a chronic inflammatory demyelinating disease of the central nervous system with a disabling progressive course. Chronic cerebrospinal venous insufficiency (CCSVI has recently been described as a vascular condition characterized by restricted venous outflow from the brain, mainly due to blockages of the internal jugular and azygos veins. Despite a wide variability among studies, it has been found to be associated with MS. Data from a few small case series suggest possible improvement of the clinical course and quality of life by performing percutaneous balloon angioplasty (PTA of the stenotic veins. Study design and methods This is a multicenter, randomized, parallel group, blinded, sham-controlled trial to assess the efficacy and safety of PTA. Participants with relapsing remitting MS or secondary progressive MS and a sonographic diagnosis of CCSVI will be enrolled after providing their informed consent. Each participant will be centrally randomized to receive catheter venography and PTA or catheter venography and sham PTA. Two primary end points with respect to efficacy at 12 months are (1 a combined end point obtained through the integration of five functional indicators, walking, balance, manual dexterity, bladder control, and visual acuity, objectively measured by instruments; and (2 number of new brain lesions measured by T2-weighted MRI sequences. Secondary end points include annual relapse rate, change in Expanded Disability Status Scale score, proportion of patients with zero, one or two, or more than two relapses; fatigue; anxiety and depression; general cognitive state; memory/attention/calculus; impact of bladder incontinence; and adverse events. Six hundred seventy-nine patients will be recruited. The follow-up is scheduled at 12 months. Patients, treating neurologists, trained outcome assessors, and the statistician in charge of data analysis will be masked to the assigned treatment

  5. Optimal management of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Shimpei Ono

    2010-08-01

    Full Text Available Shimpei Ono, Philip J Clapham, Kevin C ChungSection of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USAAbstract: In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS published a guideline for treatment of carpal tunnel syndrome (CTS in 2009 based on review of the literature up to April 6, 2007. We have now reviewed the material published since then. Through reviewing evidence-based articles published during this period, this paper examines the current options and trends for treating CTS. We performed a systematic review of the randomized controlled trials, meta-analyses, systematic reviews, and practice guidelines to present the outcomes of current treatments for this disease. Twenty-five studies met our inclusion criteria. Thirteen randomized, controlled trials and 12 systematic reviews, including three Cochrane database systematic reviews, were retrieved. Our review revealed that most of the recent studies support the AAOS guideline. However, the recent literature demonstrates a trend towards recommending early surgery for CTS cases with or without median nerve denervation, although the AAOS guideline recommends early surgical treatment only for cases with denervation. The usefulness of splinting and steroids as initial treatments for improving patients’ symptoms are also supported by the recent literature, but these effects are temporary. The evidence level for ultrasound treatment is still low, and further studies are needed to determine the effectiveness of this treatment. Finally, our review revealed a paucity of articles comparing the costs of CTS diagnosis and treatment. With the recent focus on health care reform and rising costs, attention to the direct and indirect costs of health care is important for all conditions. Future well designed studies

  6. Pseudomorphic Bipolar Quantum Resonant-Tunneling Transistor

    National Research Council Canada - National Science Library

    Seabaugh, Alan C; Frensley, William R; Randall, John N; Reed, Mark A; Farrington, Dewey L; Matyi, Richard J

    1989-01-01

    ...+ InGaAs quantum well of a double-barrier resonant-tunneling structure. The heterojunction transistor consists of an n-GaAs emitter and collector, undoped AlAs tunnel barriers, and a pseudomorphic p...

  7. Tunneling field effect transistor technology

    CERN Document Server

    Chan, Mansun

    2016-01-01

    This book provides a single-source reference to the state-of-the art in tunneling field effect transistors (TFETs). Readers will learn the TFETs physics from advanced atomistic simulations, the TFETs fabrication process and the important roles that TFETs will play in enabling integrated circuit designs for power efficiency. · Provides comprehensive reference to tunneling field effect transistors (TFETs); · Covers all aspects of TFETs, from device process to modeling and applications; · Enables design of power-efficient integrated circuits, with low power consumption TFETs.

  8. Nature of "superluminal" barrier tunneling.

    Science.gov (United States)

    Winful, Herbert G

    2003-01-17

    We show that the distortionless tunneling of electromagnetic pulses through a barrier is a quasistatic process in which the slowly varying envelope of the incident pulse modulates the amplitude of a standing wave. For pulses longer than the barrier width, the barrier acts as a lumped element with respect to the pulse envelope. The envelopes of the transmitted and reflected fields can adiabatically follow the incident pulse with only a small delay that originates from energy storage. The theory presented here provides a physical explanation of the tunneling process and resolves the mystery of apparent superluminality.

  9. Molecular series-tunneling junctions.

    Science.gov (United States)

    Liao, Kung-Ching; Hsu, Liang-Yan; Bowers, Carleen M; Rabitz, Herschel; Whitesides, George M

    2015-05-13

    Charge transport through junctions consisting of insulating molecular units is a quantum phenomenon that cannot be described adequately by classical circuit laws. This paper explores tunneling current densities in self-assembled monolayer (SAM)-based junctions with the structure Ag(TS)/O2C-R1-R2-H//Ga2O3/EGaIn, where Ag(TS) is template-stripped silver and EGaIn is the eutectic alloy of gallium and indium; R1 and R2 refer to two classes of insulating molecular units-(CH2)n and (C6H4)m-that are connected in series and have different tunneling decay constants in the Simmons equation. These junctions can be analyzed as a form of series-tunneling junctions based on the observation that permuting the order of R1 and R2 in the junction does not alter the overall rate of charge transport. By using the Ag/O2C interface, this system decouples the highest occupied molecular orbital (HOMO, which is localized on the carboxylate group) from strong interactions with the R1 and R2 units. The differences in rates of tunneling are thus determined by the electronic structure of the groups R1 and R2; these differences are not influenced by the order of R1 and R2 in the SAM. In an electrical potential model that rationalizes this observation, R1 and R2 contribute independently to the height of the barrier. This model explicitly assumes that contributions to rates of tunneling from the Ag(TS)/O2C and H//Ga2O3 interfaces are constant across the series examined. The current density of these series-tunneling junctions can be described by J(V) = J0(V) exp(-β1d1 - β2d2), where J(V) is the current density (A/cm(2)) at applied voltage V and βi and di are the parameters describing the attenuation of the tunneling current through a rectangular tunneling barrier, with width d and a height related to the attenuation factor β.

  10. Inelastic scattering in resonant tunneling

    DEFF Research Database (Denmark)

    Wingreen, Ned S.; Jacobsen, Karsten Wedel; Wilkins, John W.

    1989-01-01

    The exact resonant-tunneling transmission probability for an electron interacting with phonons is presented in the limit that the elastic coupling to the leads is independent of energy. The phonons produce transmission sidebands but do not affect the integrated transmission probability or the esc......The exact resonant-tunneling transmission probability for an electron interacting with phonons is presented in the limit that the elastic coupling to the leads is independent of energy. The phonons produce transmission sidebands but do not affect the integrated transmission probability...

  11. Complications of Carpal Tunnel Release.

    Science.gov (United States)

    Karl, John W; Gancarczyk, Stephanie M; Strauch, Robert J

    2016-04-01

    Carpal tunnel release for compression of the median nerve at the wrist is one of the most common and successful procedures in hand surgery. Complications, though rare, are potentially devastating and may include intraoperative technical errors, postoperative infection and pain, and persistent or recurrent symptoms. Patients with continued complaints after carpal tunnel release should be carefully evaluated with detailed history and physical examination in addition to electrodiagnostic testing. For those with persistent or recurrent symptoms, a course of nonoperative management including splinting, injections, occupational therapy, and desensitization should be considered prior to revision surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Pharmacokinetics of armodafinil and modafinil after single and multiple doses in patients with excessive sleepiness associated with treated obstructive sleep apnea: a randomized, open-label, crossover study.

    Science.gov (United States)

    Darwish, Mona; Kirby, Mary; D'Andrea, Denise M; Yang, Ronghua; Hellriegel, Edward T; Robertson, Philmore

    2010-11-01

    Armodafinil (the R-isomer of racemic modafinil) and modafinil are wakefulness-promoting medications for excessive sleepiness associated with treated obstructive sleep apnea (OSA). The R-isomer of racemic modafinil has a half-life of approximately15 hours; the S-isomer has a half-life of 4 to 5 hours. The R-and S-isomers are equipotent, producing equivalent pharmacologic activity at equal concentrations. The aim of this work was to compare the pharmacokinetic profiles of armodafinil (R-modafinil) and modafinil (racemic mixture with equal quantities of R- and S-isomers) at equal doses in patients with residual excessive sleepiness associated with continuous positive airway pressure-treated OSA. This open-label study was conducted at 5 US centers from July 2008 to March 2009. Patients were randomized to 1 of 2 crossover administration sequences, ABCD or BADC, where A was a single armodafinil 200-mg dose, B was a single modafinil 200-mg dose, C was multiple daily modafinil 200-mg doses, and D was multiple daily armodafinil 200-mg doses. During multiple-dose administration, patients received 100 mg once daily for days 1 and 2, and 200 mg once daily for days 3 through 10. The pharmacokinetic parameters of principal interest for assessing the bioequivalence of armodafinil and modafinil were maximum concentration at 7 to 11 hours after dosing and the concentration-versus-time curve for this period. Analysis was performed via achiral high-performance liquid chromatography with ultraviolet detection using blood samples obtained over 72 hours after single-dose administration and over 24 hours after the multiple-dose regimen. For post hoc evaluation of bioequivalence, 90% CI values were also constructed for the geometric mean ratios of armodafinil to modafinil. Tolerability was assessed by the reported adverse events, clinical laboratory testing, vital sign measurements, ECGs, and physical exams. The study population was 83.3% male (35/42) and 76.2% white (32/42) with a mean

  13. A crash-prediction model for road tunnels.

    Science.gov (United States)

    Caliendo, Ciro; De Guglielmo, Maria Luisa; Guida, Maurizio

    2013-06-01

    Considerable research has been carried out into open roads to establish relationships between crashes and traffic flow, geometry of infrastructure and environmental factors, whereas crash-prediction models for road tunnels, have rarely been investigated. In addition different results have been sometimes obtained regarding the effects of traffic and geometry on crashes in road tunnels. However, most research has focused on tunnels where traffic and geometric conditions, as well as driving behaviour, differ from those in Italy. Thus, in this paper crash prediction-models that had not yet been proposed for Italian road tunnels have been developed. For the purpose, a 4-year monitoring period extending from 2006 to 2009 was considered. The tunnels investigated are single-tube ones with unidirectional traffic. The Bivariate Negative Binomial regression model, jointly applied to non-severe crashes (accidents involving material-damage only) and severe crashes (fatal and injury accidents only), was used to model the frequency of accident occurrence. The year effect on severe crashes was also analyzed by the Random Effects Binomial regression model and the Negative Multinomial regression model. Regression parameters were estimated by the Maximum Likelihood Method. The Cumulative Residual Method was used to test the adequacy of the regression model through the range of annual average daily traffic per lane. The candidate set of variables was: tunnel length (L), annual average daily traffic per lane (AADTL), percentage of trucks (%Tr), number of lanes (NL), and the presence of a sidewalk. Both for non-severe crashes and severe crashes, prediction-models showed that significant variables are: L, AADTL, %Tr, and NL. A significant year effect consisting in a systematic reduction of severe crashes over time was also detected. The analysis developed in this paper appears to be useful for many applications such as the estimation of accident reductions due to improvement in existing

  14. Tunable tunneling electroresistance in ferroelectric tunnel junctions by mechanical loads.

    Science.gov (United States)

    Luo, Xin; Wang, Biao; Zheng, Yue

    2011-03-22

    Combining nonequilibrium Green function's approach with density functional theory, effects of the applied mechanical loads on polarization, electrostatic potential, and tunneling conductance of a ferroelectric tunneling junction (FTJ) have been investigated. Using the first principle calculations, we show that compressive strains can induce and enhance the polarization in ferroelectric tunnel barriers, and practically achieve ferroelectricity in two unit cell thickness under a -2.2% compressive strain. More importantly, mechanical strains can significantly change the effective electrostatic potential in FTJ and thus control its tunneling conductance, which is defined as giant piezoelectric resistance (GPR) effect. Our calculations indicate that GPR effect is particularly significant near the paraelectric/ferroelectric phase transition, and increases exponentially with the barrier thickness. Furthermore, it is also found that defects of oxygen vacancies and nitrogen doping have little impact on GPR ratio of strained FTJ. Because of its high-sensitivity to external mechanical loads, FTJ with GPR effect should be adequate for applications in agile mechanical sensors, transducers, and other multifunctional devices.

  15. Tunneling in high-K isomeric decays

    CERN Document Server

    Shizuma, T; Shimizu, Y R

    2002-01-01

    We have systematically investigated highly-K-forbidden transitions observed in the Hf, W and Os region, using the gamma-tunneling model in which low-K and high-k states interact through a process of quantum tunneling. The measured hindrance factors are compared with the values calculated using the gamma-tunneling model. Isotope dependences of gamma-tunneling probabilities particularly for neutron-rich nuclei and the relation to stimulated decays of isomers are discussed. (author)

  16. Wrist immobilization after carpal tunnel release: a prospective study.

    Science.gov (United States)

    Martins, Roberto S; Siqueira, Mario G; Simplício, Hougelli

    2006-09-01

    This prospective study evaluates the possible advantages of wrist immobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuously for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment was done pre-operatively and at 2 weeks follow-up and included the two-point discrimination test at the second finger and two questionnaires as an outcome measurement of symptoms severity and intensity. All the patients presented improvement in the postoperative evaluations in the three analyzed parameters. There was no significant difference between the two groups for any of the outcome measurements at the final follow-up. We conclude that wrist immobilization in the immediate post-operative period have no advantages when compared with no immobilization in the end result of carpal tunnel release.

  17. Tenosynovial osteochondromatosis of the tarsal tunnel

    Energy Technology Data Exchange (ETDEWEB)

    Sugimoto, Kazuya; Iwai, Makoto [Department of Orthopaedic Surgery, Saiseikai Nara Hospital, 4-643 Hachijo, Nara-shi, Nara (Japan); Kawate, Kenji; Yajima, Hiroshi; Takakura, Yoshinori [Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara (Japan)

    2003-02-01

    A case of tenosynovial osteochondromatosis in the tarsal tunnel in a 23-year-old man is presented. The lesion was treated surgically, and multiple osteochondromas were excised, which had no continuity with any tarsal bone or joint cavity but did with the sheaths of the flexor digitorum longus and flexor hallucis longus. Histologic examination of the lesion showed a fibrous capsule, hyaline cartilage and extensive areas of cancellous bone. Necrosis and mitosis were absent in the hyaline cartilage and there were no synovial nodules indicative of synovial metaplasia. The macroscopic findings showed ''end-stage'' tenosynovial osteochondromatosis. There was no evidence of recurrence 5 years after operation, and the patient remains free of symptoms. (orig.)

  18. Characterization of magnetic tunnel junction test pads

    DEFF Research Database (Denmark)

    Østerberg, Frederik Westergaard; Kjær, Daniel; Nielsen, Peter Folmer

    2015-01-01

    We show experimentally as well as theoretically that patterned magnetic tunnel junctions can be characterized using the current-in-plane tunneling (CIPT) method, and the key parameters, the resistance-area product (RA) and the tunnel magnetoresistance (TMR), can be determined. The CIPT method...

  19. Fiber coupled ultrafast scanning tunneling microscope

    DEFF Research Database (Denmark)

    Keil, Ulrich Dieter Felix; Jensen, Jacob Riis; Hvam, Jørn Märcher

    1997-01-01

    We report on a scanning tunneling microscope with a photoconductive gate in the tunneling current circuit. The tunneling tip is attached to a coplanar transmission line with an integrated photoconductive switch. The switch is illuminated through a fiber which is rigidly attached to the switch...

  20. 7 CFR 58.621 - Freezing tunnels.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Freezing tunnels. 58.621 Section 58.621 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....621 Freezing tunnels. Freezing tunnels for quick freezing at extremely low temperatures shall be...

  1. Vehicle fires and fire safety in tunnels

    Science.gov (United States)

    2002-09-20

    Tunnels present what is arguably the most hazardous environment, from the point of view of fire safety, that members of the public ever experience. The fire safety design of tunnels is carried out by tunnel engineers on the basis of a potential fire ...

  2. Railway tunnels in Europe and North America

    Science.gov (United States)

    2002-05-01

    This list of railway tunnels (longer than 1, 000 m) was compiled by the secretariat from various national and international sources. The list is intended to serve as a reference inventory for a long railway tunnels in Europe and North America. Tunnel...

  3. The road safety of motorway tunnels.

    NARCIS (Netherlands)

    2009-01-01

    This fact sheet discusses the safety of motorway tunnels in the Netherlands. Broadly speaking, it is not certain whether crashes in the Netherlands are relatively more frequent in tunnels than on open road stretches. However, there are certain factors that increase the risk in tunnels, such as the

  4. 49 CFR 177.810 - Vehicular tunnels.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Vehicular tunnels. 177.810 Section 177.810... Information and Regulations § 177.810 Vehicular tunnels. Except as regards Class 7 (radioactive) materials... through any urban vehicular tunnel used for mass transportation. [Amdt. 177-52, 46 FR 5316, Jan. 19, 1981...

  5. All NbN tunnel junction fabrication

    Science.gov (United States)

    Leduc, H. G.; Khanna, S. K.; Stern, J. A.

    1987-01-01

    The development of SIS tunnel junctions based on NbN for mixer applications in the submillimeter range is reported. The unique technological challenges inherent in the development of all refractory-compound superconductor-based tunnel junctions are highlighted. Current deposition and fabrication techniques are discussed, and the current status of all-NbN tunnel junctions is reported.

  6. Aeronautical Wind Tunnels, Europe and Asia

    Science.gov (United States)

    2006-02-01

    site: http://sop25.kaist.ac.kr/index.html. February 2006 Page 117 of 308 European and Asian Wind Tunnels KAIST Anechoic Wind Tunnel, Korea Advanced... KAIST Anechoic Wind Tunnel.” <http://acoustic.kaist.ac.kr/research/wind.php> Korea Advanced Institute of Science and Technology. “Low Turbulence Open

  7. Evaluation of the effectiveness of professionally guided self-care for people with multiple sclerosis living in the community: a randomized controlled trial.

    Science.gov (United States)

    O'Hara, Louise; Cadbury, Heather; De, Souza Lorraine; Ide, Lorely

    2002-03-01

    The aim of the study was to assess the efficacy of a patient-focused professionally guided self-care programme for the management of multiple sclerosis (MS) in the community. This was a single-blind randomized controlled trial. The study was conducted with people with MS living in the community. Two hundred and seventy-eight people with MS were invited to take part in the study. One hundred and eighty-nine people consented to take part (68%). Of these 183 began the study and 169 (92.3%) completed it. Seventy-three individuals were in the intervention group and 96 were in the control group. The intervention comprised discussion of self-care based on client priorities, using an information booklet about self-care. These included the Barthel Index, a measure of mobility, the SF-36, and the Standard Day Dependency Record (SDDR) which measures the need for assistance with daily activities. Assessments were conducted at baseline and again six months later. Changes in health status were small. However, at follow-up the intervention group had better SF-36 health scores, in mental health (p = 0.04), and vitality (p = 0.05) and considered help with daily activities to be less essential, as measured by the SDDR (p = 0.04), than the control group. Participants in the intervention group had maintained levels of independence at follow-up (p = 0.62) while the control group showed a significant decrease in independence (p= 0.001). This intervention could be a useful aid for health professionals who are supporting people with MS living in the community.

  8. Cost-effectiveness of invitation to food supplementation early in pregnancy combined with multiple micronutrients on infant survival: analysis of data from MINIMat randomized trial, Bangladesh.

    Science.gov (United States)

    Shaheen, Rubina; Persson, Lars Åke; Ahmed, Shakil; Streatfield, Peter Kim; Lindholm, Lars

    2015-05-28

    Absence of cost-effectiveness (CE) analyses limits the relevance of large-scale nutrition interventions in low-income countries. We analyzed if the effect of invitation to food supplementation early in pregnancy combined with multiple micronutrient supplements (MMS) on infant survival represented value for money compared to invitation to food supplementation at usual time in pregnancy combined with iron-folic acid. Outcome data, infant mortality (IM) rates, came from MINIMat trial (Maternal and Infant Nutrition Interventions, Matlab, ISRCTN16581394). In MINIMat, women were randomized to early (E around 9 weeks of pregnancy) or usual invitation (U around 20 weeks) to food supplementation and daily doses of 30 mg, or 60 mg iron with 400 μgm of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 μgm of folic acid. In MINIMat, EMMS significantly reduced IM compared to UFe60F (U plus 60 mg iron 400 μgm Folic acid). We present incremental CE ratios for incrementing UFe60F to EMMS. Costing data came mainly from a published study. By incrementing UFe60F to EMMS, one extra IM could be averted at a cost of US$907 and US$797 for NGO run and government run CNCs, respectively, and at US$1024 for a hypothetical scenario of highest cost. These comparisons generated one extra life year (LY) saved at US$30, US$27, and US$34, respectively. Incrementing UFe60F to EMMS in pregnancy seems worthwhile from health economic and public health standpoints. Maternal and Infant Nutrition Interventions, Matlab; ISRCTN16581394 ; Date of registration: Feb 16, 2009.

  9. Immune regulatory effects of high dose vitamin D3 supplementation in a randomized controlled trial in relapsing remitting multiple sclerosis patients receiving IFNβ; the SOLARIUM study.

    Science.gov (United States)

    Muris, Anne-Hilde; Smolders, Joost; Rolf, Linda; Thewissen, Marielle; Hupperts, Raymond; Damoiseaux, Jan

    2016-11-15

    Multiple sclerosis (MS) is characterized by a disturbed immune homeostasis and low serum vitamin D levels are associated with an increased disease activity. While vitamin D has been hypothesized to promote the maintenance of immune homeostasis, vitamin D supplementation could be of benefit to patients with MS. The SOLAR study investigated the effects of high dose vitamin D3 supplementation on clinical outcomes in a randomized controlled trial. Here we present the immune regulatory effects, investigated in the SOLARIUM sub-study. Thirty Dutch relapsing remitting (RR) MS patients treated with IFNβ-1a received high dose vitamin D3 supplementation and 23 patients received placebo during a period of 48weeks. Lymphocytes were phenotypically characterized by flow cytometry and in vitro cytokine secretion was assessed in the presence or absence of 1,25(OH)2D3 using Luminex technology. Changes in immune regulatory parameters were determined within subjects as well as between treatment groups. The proportion of cells in the immune regulatory cell compartment (nTreg, iTreg and Breg) was not altered upon high dose vitamin D3 supplementation. Proportions of T helper subsets were not affected by vitamin D3, except for the proportion of IL4+ Th cells, which decreased in the placebo but not in the vitamin D3 group. T cell cytokine secretion increased, most pronounced for IL5 and latency activated protein of TGFβ, in the placebo group but not in the vitamin D3 group. Lymphocytes remained equally reactive to in vitro 1,25(OH)2D3. In conclusion, high dose vitamin D3 supplementation did not result in a relative increase in lymphocytes with a regulatory phenotype. However, this study supports the hypothesis that vitamin D contributes to the maintenance of immune homeostasis by preventing further disturbance of the T cell compartment early in the disease course of MS. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Safety and efficacy of cladribine tablets in patients with relapsing-remitting multiple sclerosis: Results from the randomized extension trial of the CLARITY study.

    Science.gov (United States)

    Giovannoni, Gavin; Soelberg Sorensen, Per; Cook, Stuart; Rammohan, Kottil; Rieckmann, Peter; Comi, Giancarlo; Dangond, Fernando; Adeniji, Abidemi K; Vermersch, Patrick

    2017-08-01

    In the 2-year CLARITY study, cladribine tablets significantly improved clinical and magnetic resonance imaging (MRI) outcomes (vs placebo) in patients with relapsing-remitting multiple sclerosis (MS). To assess the safety and efficacy of cladribine treatment in a 2-year Extension study. In this 2-year Extension study, placebo recipients from CLARITY received cladribine 3.5 mg/kg; cladribine recipients were re-randomized 2:1 to cladribine 3.5 mg/kg or placebo, with blind maintained. A total of 806 patients were assigned to treatment. Adverse event rates were generally similar between groups, but lymphopenia Grade ⩾ 3 rates were higher with cladribine than placebo (Grade 4 lymphopenia occurred infrequently). In patients receiving cladribine 3.5 mg/kg in CLARITY and experiencing lymphopenia Grade ⩾ 3 in the Extension, >90% of those treated with cladribine 3.5 mg/kg and all treated with placebo in the Extension, recovered to Grade 0-1 by study end. Cladribine treatment in CLARITY produced efficacy improvements that were maintained in patients treated with placebo in the Extension; in patients treated with cladribine 3.5 mg/kg in CLARITY, approximately 75% remained relapse-free when given placebo during the Extension. Cladribine tablets treatment for 2 years followed by 2 years' placebo treatment produced durable clinical benefits similar to 4 years of cladribine treatment with a low risk of severe lymphopenia or clinical worsening. No clinical improvement in efficacy was apparent following further treatment with cladribine tablets after the initial 2-year treatment period in this trial setting.

  11. Effectiveness of a Web-Based Computer-Tailored Multiple-Lifestyle Intervention for People Interested in Reducing their Cardiovascular Risk: A Randomized Controlled Trial.

    Science.gov (United States)

    Storm, Vera; Dörenkämper, Julia; Reinwand, Dominique Alexandra; Wienert, Julian; De Vries, Hein; Lippke, Sonia

    2016-04-11

    Web-based computer-tailored interventions for multiple health behaviors can improve the strength of behavior habits in people who want to reduce their cardiovascular risk. Nonetheless, few randomized controlled trials have tested this assumption to date. The study aim was to test an 8-week Web-based computer-tailored intervention designed to improve habit strength for physical activity and fruit and vegetable consumption among people who want to reduce their cardiovascular risk. In a randomized controlled design, self-reported changes in perceived habit strength, self-efficacy, and planning across different domains of physical activity as well as fruit and vegetable consumption were evaluated. This study was a randomized controlled trial involving an intervention group (n=403) and a waiting control group (n=387). Web-based data collection was performed in Germany and the Netherlands during 2013-2015. The intervention content was based on the Health Action Process Approach and involved personalized feedback on lifestyle behaviors, which indicated whether participants complied with behavioral guidelines for physical activity and fruit and vegetable consumption. There were three Web-based assessments: baseline (T0, N=790), a posttest 8 weeks after the baseline (T1, n=206), and a follow-up 3 months after the baseline (T2, n=121). Data analysis was conducted by analyzing variances and structural equation analysis. Significant group by time interactions revealed superior treatment effects for the intervention group, with substantially higher increases in self-reported habit strength for physical activity (F1,199=7.71, P=.006, Cohen's d=0.37) and fruit and vegetable consumption (F1,199=7.71, P=.006, Cohen's d=0.30) at posttest T1 for the intervention group. Mediation analyses yielded behavior-specific sequential mediator effects for T1 planning and T1 self-efficacy between the intervention and habit strength at follow-up T2 (fruit and vegetable consumption: beta=0.12, 95

  12. Installation in the SPS tunnel

    CERN Multimedia

    1974-01-01

    The SPS tunnel is 6910 m in circumference and has a cross section of 4 m inner diameter. It is situated at an elevation of 400 m above sea level at a depth below the surface varying between 23 and 65 m. Its walls are lined with a concrete shell of about 30 cm thickness. See also 7410043X

  13. Time tunnels meet warped passages

    CERN Multimedia

    Kushner, David

    2006-01-01

    "Just in time for its 40th anniversary, the classic sci-fi television show "The time tunnel" is out on DVD. The conceit is something every engineer can relate to: a pulled plug. Scientists in an underground lab are working on a secret government experiment in time travel. (1 page)

  14. Travelling inside the SPS tunnel

    CERN Multimedia

    1974-01-01

    The golf cart proved to be a very useful form of transport around the 7 km circumference of the machine. It could carry four passengers and pull light equipment in its trailer. Here Peter Zettwoch is the driver along a mock-up tunnel for installation tests. (see photo 7401011X and Photo Archive 7401018)

  15. Josephson tunnel junction microwave attenuator

    DEFF Research Database (Denmark)

    Koshelets, V. P.; Shitov, S. V.; Shchukin, A. V.

    1993-01-01

    A new element for superconducting electronic circuitry-a variable attenuator-has been proposed, designed, and successfully tested. The principle of operation is based on the change in the microwave impedance of a superconductor-insulator-superconductor (SIS) Josephson tunnel junction when dc bias...

  16. Apparent tunneling in chemical reactions

    DEFF Research Database (Denmark)

    Henriksen, Niels Engholm; Hansen, Flemming Yssing; Billing, G. D.

    2000-01-01

    A necessary condition for tunneling in a chemical reaction is that the probability of crossing a barrier is non-zero, when the energy of the reactants is below the potential energy of the barrier. Due to the non-classical nature (i.e, momentum uncertainty) of vibrational states this is, however...

  17. Unitary Plan Wind Tunnel Test

    Science.gov (United States)

    2008-01-01

    Shown is a wind tunnel test of the Ares model for force/moment testing in support of the Ares/Clv integrated vehicle at Langley Research Center, Virginia. The image is extracted from a high definition video file and is the highest resolution available.

  18. Praktijkervaring met calamiteiten in tunnels

    NARCIS (Netherlands)

    De Waard, D.; Brookhuis, K.A.

    2000-01-01

    The first part of this report is about experience with (catastrophic) traffic accidents in tunnels and describes interviews with representatives of Police and the Department of Transportation, as well as the results of a short questionnaire among involved policemen and victims. The primary causes of

  19. Calculating the Number of Tunnels

    NARCIS (Netherlands)

    Li, Fajie; Klette, Reinhard; RuizShulcloper, J; Kropatsch, WG

    2008-01-01

    This paper considers 2-regions of grid cubes and proposes an algorithm for calculating the number of tunnels of such a. region. The graph-theoretical algorithm proceeds layer by layer; a proof of its correctness is provided, and its time complexity is also given.

  20. A Seamless Ubiquitous Telehealthcare Tunnel

    Directory of Open Access Journals (Sweden)

    Sao-Jie Chen

    2013-08-01

    Full Text Available Mobile handheld devices are rapidly using to implement healthcare services around the World. Fundamentally, these services utilize telemedicine technologies. A disconnection of a mobile telemedicine system usually results in an interruption, which is embarrassing, and reconnection is necessary during the communication session. In this study, the Stream Control Transmission Protocol (SCTP is adopted to build a stable session tunnel to guarantee seamless switching among heterogeneous wireless communication standards, such as Wi-Fi and 3G. This arrangement means that the telemedicine devices will not be limited by a fixed wireless connection and can switch to a better wireless channel if necessary. The tunnel can transmit plain text, binary data, and video streams. According to the evaluation of the proposed software-based SCTP-Tunnel middleware shown, the performance is lower than anticipated and is slightly slower than a fixed connection. However, the transmission throughput is still acceptable for healthcare professionals in a healthcare enterprise or home care site. It is necessary to build more heterogeneous wireless protocols into the proposed tunnel-switching scheme to support all possible communication protocols. In addition, SCTP is another good choice for promoting communication in telemedicine and healthcare fields.

  1. Spinoff from Wind Tunnel Technology

    Science.gov (United States)

    1985-01-01

    Douglas Juanarena, a former NASA Langley instrument design engineer, found a solution to the problem of long, repetitive tunnel runs needed to measure airflow pressures. Electronically scanned pressure (ESP) replaced mechanical systems with electronic sensors. Juanarena licensed the NASA-patented technology and now manufactures ESP modules for research centers, aerospace companies, etc.

  2. Rehabilitation following carpal tunnel release

    NARCIS (Netherlands)

    Peters, Susan; Page, Matthew J.; Coppieters, Michel W.; Ross, Mark; Johnston, Venerina

    2016-01-01

    Background: Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. This is the first update of a review first published in 2013. Objectives: To review the effectiveness and safety of rehabilitation

  3. Earth Pressure on Tunnel Crown

    DEFF Research Database (Denmark)

    Andersen, Lars

    Two different analyses have been carried out in order to find the vertical earth pressure, or overburden pressure, at the crown of a tunnel going through a dike. Firstly, a hand calculation is performed using a simple dispersion of the stresses over depth. Secondly, the finite‐element program...

  4. Introduction to scanning tunneling microscopy

    CERN Document Server

    Chen, C Julian

    2008-01-01

    The scanning tunneling and the atomic force microscope, both capable of imaging individual atoms, were crowned with the Physics Nobel Prize in 1986, and are the cornerstones of nanotechnology today. This is a thoroughly updated version of this 'bible' in the field.

  5. Inverse Analysis and Modeling for Tunneling Thrust on Shield Machine

    Directory of Open Access Journals (Sweden)

    Qian Zhang

    2013-01-01

    Full Text Available With the rapid development of sensor and detection technologies, measured data analysis plays an increasingly important role in the design and control of heavy engineering equipment. The paper proposed a method for inverse analysis and modeling based on mass on-site measured data, in which dimensional analysis and data mining techniques were combined. The method was applied to the modeling of the tunneling thrust on shield machines and an explicit expression for thrust prediction was established. Combined with on-site data from a tunneling project in China, the inverse identification of model coefficients was carried out using the multiple regression method. The model residual was analyzed by statistical methods. By comparing the on-site data and the model predicted results in the other two projects with different tunneling conditions, the feasibility of the model was discussed. The work may provide a scientific basis for the rational design and control of shield tunneling machines and also a new way for mass on-site data analysis of complex engineering systems with nonlinear, multivariable, time-varying characteristics.

  6. Multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, Egon; Stenager, E N; Knudsen, Lone

    1994-01-01

    In a cross-sectional study of 117 randomly selected patients (52 men, 65 women) with definite multiple sclerosis, it was found that 76 percent were married or cohabitant, 8 percent divorced. Social contacts remained unchanged for 70 percent, but outgoing social contacts were reduced for 45 percent......, need for structural changes in home and need for pension became greater with increasing physical handicap. No significant differences between gender were found. It is concluded that patients and relatives are under increased social strain, when multiple sclerosis progresses to a moderate handicap...

  7. ACL Roof Impingement Revisited: Does the Independent Femoral Drilling Technique Avoid Roof Impingement With Anteriorly Placed Tibial Tunnels?

    Science.gov (United States)

    Tanksley, John A; Werner, Brian C; Conte, Evan J; Lustenberger, David P; Burrus, M Tyrrell; Brockmeier, Stephen F; Gwathmey, F Winston; Miller, Mark D

    2017-05-01

    Anatomic femoral tunnel placement for single-bundle anterior cruciate ligament (ACL) reconstruction is now well accepted. The ideal location for the tibial tunnel has not been studied extensively, although some biomechanical and clinical studies suggest that placement of the tibial tunnel in the anterior part of the ACL tibial attachment site may be desirable. However, the concern for intercondylar roof impingement has tempered enthusiasm for anterior tibial tunnel placement. To compare the potential for intercondylar roof impingement of ACL grafts with anteriorly positioned tibial tunnels after either transtibial (TT) or independent femoral (IF) tunnel drilling. Controlled laboratory study. Twelve fresh-frozen cadaver knees were randomized to either a TT or IF drilling technique. Tibial guide pins were drilled in the anterior third of the native ACL tibial attachment site after debridement. All efforts were made to drill the femoral tunnel anatomically in the center of the attachment site, and the surrogate ACL graft was visualized using 3-dimensional computed tomography. Reformatting was used to evaluate for roof impingement. Tunnel dimensions, knee flexion angles, and intra-articular sagittal graft angles were also measured. The Impingement Review Index (IRI) was used to evaluate for graft impingement. Two grafts (2/6, 33.3%) in the TT group impinged upon the intercondylar roof and demonstrated angular deformity (IRI type 1). No grafts in the IF group impinged, although 2 of 6 (66.7%) IF grafts touched the roof without deformation (IRI type 2). The presence or absence of impingement was not statistically significant. The mean sagittal tibial tunnel guide pin position prior to drilling was 27.6% of the sagittal diameter of the tibia (range, 22%-33.9%). However, computed tomography performed postdrilling detected substantial posterior enlargement in 2 TT specimens. A significant difference in the sagittal graft angle was noted between the 2 groups. TT grafts were

  8. The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome.

    Science.gov (United States)

    Vanni, Daniele; Sirabella, Francesco Saverio; Galzio, Renato; Salini, Vincenzo; Magliani, Vincenzo

    2015-11-01

    The purpose of this study was to assess the effectiveness and safety of an alternative minimally invasive technique for the treatment of carpal tunnel syndrome (CTS). This was designed as a prospective, randomized, open-label, blinded end point evaluation (PROBE) study. The active comparison was double tunnels technique (DTT) (Group A, 110 patients) versus standard open decompression of the median nerve (control [Group B], 110 patients). Patient recruitment started in January 2011. The primary outcomes were the functional Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores and visual analog scale (VAS) scores for pain (pVAS) at Weeks 2 and 4, and at Months 3, 6, and 12. The secondary outcome was the aesthetics (aVAS) score at Weeks 2 and 4, and at Months 3, 6, and 12. The Student t-test and ANOVA were used, and the results were considered statistically significant if the p value was ≤0.05 for continuous variables. The DTT is a tissue-sparing approach that allows the surgeon to limit the length of the incision (0.6±0.05 cm) and to respect the palmar fascia and the subcutaneous tissue. Recovery from wrist pain, night pain, numbness, stiffness, and weakness was achieved more effectively and quickly compared with the standard approach. Better BCTSQ, pVAS, and aVAS scores were observed in Group A. The DTT is a safe and effective approach for the treatment of CTS. This technique entails faster recovery times, better aesthetic outcomes, and lower risks of complications.

  9. Tunneling Flight Time, Chemistry, and Special Relativity.

    Science.gov (United States)

    Petersen, Jakob; Pollak, Eli

    2017-09-07

    Attosecond ionization experiments have not resolved the question "What is the tunneling time?". Different definitions of tunneling time lead to different results. Second, a zero tunneling time for a material particle suggests that the nonrelativistic theory includes speeds greater than the speed of light. Chemical reactions, occurring via tunneling, should then not be considered in terms of a nonrelativistic quantum theory calling into question quantum dynamics computations on tunneling reactions. To answer these questions, we define a new experimentally measurable paradigm, the tunneling flight time, and show that it vanishes for scattering through an Eckart or a square barrier, irrespective of barrier length or height, generalizing the Hartman effect. We explain why this result does not lead to experimental measurement of speeds greater than the speed of light. We show that this tunneling is an incoherent process by comparing a classical Wigner theory with exact quantum mechanical computations.

  10. Clinical study on treatment of Carpal tunnel syndrome using Scolopendrid herbal acupuncture

    Directory of Open Access Journals (Sweden)

    Lim Jeong a

    2005-02-01

    Full Text Available Objective : This study is performed for the purpose of examining into the efficacy of the scolopendrid herbal acupucture which has been used among the Korean people for the Carpal tunnel syndrome. Methods : 40 carpal tunnel syndrome patients who visited Won-kwang University Hospital during the period from January 1998 to December 2004 were analysed for clinical manifestations. After we divided patients into two classes at random, we treated them with scolopendrid herbal acupucture or not. Treatment efficiency was monitored through VAS(Visual Analog Scale and clinical symptom. Conclusion : We brought to the conclusion that the scolopendrid herbal acupucture has possibility to be efficient to cure the carpal tunnel syndrome patients. So we suggest the possibility to use this new remedy for the carpal tunnel syndrome.

  11. Dynamic Response Analysis of Cable of Submerged Floating Tunnel under Hydrodynamic Force and Earthquake

    Directory of Open Access Journals (Sweden)

    Zhiwen Wu

    2017-01-01

    Full Text Available A simplified analysis model of cable for submerged floating tunnel subjected to parametrically excited vibrations in the ocean environment is proposed in this investigation. The equation of motion of the cable is obtained by a mathematical method utilizing the Euler beam theory and the Galerkin method. The hydrodynamic force induced by earthquake excitations is formulated to simulate real seaquake conditions. The random earthquake excitation in the time domain is formulated by the stochastic phase spectrum method. An analytical model for analyzing the cable for submerged floating tunnel subjected to combined hydrodynamic forces and earthquake excitations is then developed. The sensitivity of key parameters including the hydrodynamic, earthquake, and structural parameters on the dynamic response of the cable is investigated and discussed. The present model enables a preliminary examination of the hydrodynamic and seismic behavior of cable for submerged floating tunnel and can provide valuable recommendations for use in design and operation of anchor systems for submerged floating tunnel.

  12. Contribution of static and dynamic ultrasound in cubital tunnel syndrome.

    Science.gov (United States)

    Babusiaux, D; Laulan, J; Bouilleau, L; Martin, A; Adrien, C; Aubertin, A; Rabarin, F

    2014-06-01

    Electroneuromyography (ENMG) is the gold standard examination in cubital tunnel syndrome (CuTS), but sheds no light on etiology. High-resolution ultrasound (HRU) analyzes the anatomic abnormalities and physical properties of the ulnar nerve (UN) and enables dynamic study. The present non-randomized prospective study compared HRU with clinical, ENMG and intraoperative findings. Sixty patients were included. The McGowan clinical classification as modified by Goldberg was employed, and ENMG lesions were ranked for severity. HRU screened for morphologic abnormalities of the ulnar nerve and cubital tunnel, measuring UN cross-sectional area (UNCSA) and flattening index (FI) in the cubital tunnel, in extension and flexion. UN stability was assessed. Ultrasound found 2 stenoses, 29 pseudoneuromas 25 dedifferentiations. There were 16 morphologic abnormalities. Mean cubital tunnel UNCSA (in cm(2)) and FI were respectively 0.112 and 1.549 in extension and 0.117 and 1.827 in flexion. Nineteen cases of UN instability were found on HRU, versus 17 intraoperatively. Only 8 patients showed no abnormality on HRU. Pseudoneuroma or dedifferentiation on HRU correlated with clinical stage (P=0.2579 and 0.2615, respectively). Dedifferentiation was associated with severe abnormality on ENMG (PCubital tunnel UNCSA was elevated in case of CuTS, with cut-off at 0.112 cm(2). FI was elevated in flexion (P=0.0063). The rate of UN instability was 32%, compared to 21-60% in the literature. HRU findings matched the clinical and ENMG classifications. HRU proved to be an effective diagnostic tool for CuTS and its etiologies. IV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Carpal and cubital tunnel and other, rarer nerve compression syndromes.

    Science.gov (United States)

    Assmus, Hans; Antoniadis, Gregor; Bischoff, Christian

    2015-01-05

    Carpal tunnel syndrome is by far the most common peripheral nerve compression syndrome, affecting approximately one in every six adults to a greater or lesser extent. Splitting the flexor retinaculum to treat carpal tunnel syndrome is the second most common specialized surgical procedure in Germany. Cubital tunnel syndrome is rarer by a factor of 13, and the other compression syndromes are rarer still. This review is based on publications retrieved by a selective literature search of PubMed and the Cochrane Library, along with current guidelines and the authors' clinical and scientific experience. Randomized controlled trials have shown, with a high level of evidence, that the surgical treatment of carpal tunnel syndrome yields very good results regardless of the particular technique used, as long as the diagnosis and the indication for surgery are well established by the electrophysiologic and radiological findings and the operation is properly performed. The success rates of open surgery, and the single-portal and dual-portal endoscopic methods are 91.6%, 93.4% and 92.5%, respectively. When performed by experienced hands, all these procedures have complication rates below 1%. The surgical treatment of cubital tunnel syndrome has a comparably low complication rate, but worse results overall. Neuro-ultrasonography and magnetic resonance imaging (neuro-MRI) are increasingly being used to complement the diagnostic findings of electrophysiologic studies. Evidence-based diagnostic methods and treatment recommendations are now available for the two most common peripheral nerve compression syndromes. Further controlled trials are needed for most of the rarer syndromes, especially the controversial ones.

  14. A Lightweight Radio Propagation Model for Vehicular Communication in Road Tunnels.

    Science.gov (United States)

    Qureshi, Muhammad Ahsan; Noor, Rafidah Md; Shamim, Azra; Shamshirband, Shahaboddin; Raymond Choo, Kim-Kwang

    2016-01-01

    Radio propagation models (RPMs) are generally employed in Vehicular Ad Hoc Networks (VANETs) to predict path loss in multiple operating environments (e.g. modern road infrastructure such as flyovers, underpasses and road tunnels). For example, different RPMs have been developed to predict propagation behaviour in road tunnels. However, most existing RPMs for road tunnels are computationally complex and are based on field measurements in frequency band not suitable for VANET deployment. Furthermore, in tunnel applications, consequences of moving radio obstacles, such as large buses and delivery trucks, are generally not considered in existing RPMs. This paper proposes a computationally inexpensive RPM with minimal set of parameters to predict path loss in an acceptable range for road tunnels. The proposed RPM utilizes geometric properties of the tunnel, such as height and width along with the distance between sender and receiver, to predict the path loss. The proposed RPM also considers the additional attenuation caused by the moving radio obstacles in road tunnels, while requiring a negligible overhead in terms of computational complexity. To demonstrate the utility of our proposed RPM, we conduct a comparative summary and evaluate its performance. Specifically, an extensive data gathering campaign is carried out in order to evaluate the proposed RPM. The field measurements use the 5 GHz frequency band, which is suitable for vehicular communication. The results demonstrate that a close match exists between the predicted values and measured values of path loss. In particular, an average accuracy of 94% is found with R2 = 0.86.

  15. Conformational diversity and ligand tunnels of mammalian cytochrome P450s.

    Science.gov (United States)

    Yu, Xiaofeng; Cojocaru, Vlad; Wade, Rebecca C

    2013-01-01

    The mammalian cytochrome P450 (CYP) enzymes play important roles in drug metabolism, steroid biosynthesis, and xenobiotic degradation. The active site of CYPs is buried in the protein and thus the ligands have to enter and exit the active site via ligand tunnels. Conformational changes of flexible parts of the protein usually accompany the entrance and exit of ligands. Comparison of the crystal structures of mammalian CYPs in closed, open, and partially open states reveals that the greatest conformational diversity associated with ligand tunnel opening is in the regions of the B-C and F-G loops. Some CYPs have been observed to adopt different open and closed conformations when bound to different ligands, suggesting that the ligand entrance and exit routes might differ according to the ligand properties. Mammalian CYPs are mostly membrane-bound enzymes, making them difficult to characterize structurally and dynamically. A range of molecular dynamics simulation techniques has been applied to investigate the dynamics and the ligand tunnels of these proteins both in the aqueous environment, and more recently, in lipid bilayers. These simulations not only reveal multiple tunnels through which ligands can pass but also show that different tunnels are preferred by different ligands and that the lipid bilayer can influence the protein dynamics and tunnel opening. The results indicate that not only the active site but also the ligand tunnels can contribute to the different substrate specificity profiles of the mammalian CYPs. © 2013 International Union of Biochemistry and Molecular Biology, Inc.

  16. Resonant tunnel magnetoresistance in a double magnetic tunnel junction

    KAUST Repository

    Useinov, Arthur

    2011-08-09

    We present quasi-classical approach to calculate a spin-dependent current and tunnel magnetoresistance (TMR) in double magnetic tunnel junctions (DMTJ) FML/I/FMW/I/FMR, where the magnetization of the middle ferromagnetic metal layer FMW can be aligned parallel or antiparallel with respect to the fixed magnetizations of the left FML and right FMR ferromagnetic electrodes. The transmission coefficients for components of the spin-dependent current, and TMR are calculated as a function of the applied voltage. As a result, we found a high resonant TMR. Thus, DMTJ can serve as highly effective magnetic nanosensor for biological applications, or as magnetic memory cells by switching the magnetization of the inner ferromagnetic layer FMW.© Springer Science+Business Media, LLC 2011.

  17. MANAGEMENT OF TUNNELS ON THE ZAGREB – MACELJ MOTORWAY IN THE COURSE OF TUNNELS EXPLOITATION

    Directory of Open Access Journals (Sweden)

    Zvonimir Deković

    2012-12-01

    Full Text Available he paper focuses on the features of management of tunnels on the Zagreb-Macelj motorway. Management of tunnels is represented trough public-private partnership model that is applied on the Zagreb-Macelj motorway. In the course of tunnel operation and maintenance in the first five years of tunnels exploitation, the emphasis is put on the maintenance of the tunnel equipment systems. Tunnels as part of the motorway alignment are the most demanding facilities for maintaining appropriate safety and operational level in order to rich continuous availability providing safe and quality of service to the motorway users. The goal of the tunnel operation and maintenance is to ensure undisturbed and safe traffic flow through the tunnels by keeping the tunnel at the normal functional conditions.

  18. Rehabilitation following carpal tunnel release.

    Science.gov (United States)

    Peters, Susan; Page, Matthew J; Coppieters, Michel W; Ross, Mark; Johnston, Venerina

    2016-02-17

    Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. This is the first update of a review first published in 2013. To review the effectiveness and safety of rehabilitation interventions following CTS surgery compared with no treatment, placebo, or another intervention. On 29 September 2015, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, AMED, LILACS, and PsycINFO. We also searched PEDro (3 December 2015) and clinical trials registers (3 December 2015). Randomised or quasi-randomised clinical trials that compared any postoperative rehabilitation intervention with either no intervention, placebo, or another postoperative rehabilitation intervention in individuals who had undergone CTS surgery. Two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and assessed the quality of the body of evidence for primary outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach according to standard Cochrane methodology. In this review we included 22 trials with a total of 1521 participants. Two of the trials were newly identified at this update. We studied different rehabilitation treatments including immobilisation using a wrist orthosis, dressings, exercise, controlled cold therapy, ice therapy, multi-modal hand rehabilitation, laser therapy, electrical modalities, scar desensitisation, and arnica. Three trials compared a rehabilitation treatment to a placebo, four compared rehabilitation to a no treatment control, three compared rehabilitation to standard care, and 15 compared various rehabilitation treatments to one another.Overall, the included studies were very low in quality. Thirteen trials explicitly reported random sequence generation; of these, five adequately concealed the

  19. The Third Quantization: To Tunnel or Not to Tunnel?

    Directory of Open Access Journals (Sweden)

    Mariam Bouhmadi-López

    2018-02-01

    Full Text Available Within the framework of the third quantization, we consider the possibility that an initially recollapsing baby universe can enter a stage of near de Sitter inflation by tunnelling through a Euclidean wormhole that connects the recollapsing and inflationary geometries. We present the solutions for the evolution of the scale factor in the Lorentzian and Euclidean regions as well as the probability that the baby universe indeed crosses the wormhole when it reaches its maximum size.

  20. Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction: anteromedial tunnel first or posterolateral tunnel first?

    Science.gov (United States)

    Taketomi, Shuji; Nakagawa, Takumi; Takeda, Hideki; Nakajima, Kohei; Nakayama, Shuichi; Fukai, Atsushi; Hirota, Jinso; Kachi, Yoshinori; Kawano, Hirotaka; Miura, Toshiki; Fukui, Naoshi; Nakamura, Kozo

    2011-03-01

    The purpose of this study was to know which tunnel--the anteromedial (AM) bundle or the posterolateral (PL) bundle--should be prepared first to create the 2 femoral tunnels accurately in anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. Thirty-four patients were divided into 2 groups of 17 depending on the sequence of preparation of the 2 femoral tunnels. In group A, the AM tunnel was prepared first, whereas the PL tunnel was prepared first in group P. ACL reconstruction was performed using a three-dimensional (3-D) fluoroscopy-based navigation system to place the double femoral tunnels through an accessory medial portal. The double femoral socket positioning was evaluated by 3-D computed tomography (CT) scan image. The non-anatomical placement of the femoral sockets occurred in 5 patients (29%) in group A, whereas the 2 sockets were placed anatomically in all patients in group P (P tunnels through accessory medial portal affected the resultant location of the sockets and the rate of the complications. When femoral tunnels are prepared with a transportal technique, PL tunnel first technique seems to be superior to AM first technique regarding anatomic placement. However, PL tunnel first technique accompanies the risk of socket communication.

  1. Practice network-based care management for patients with type 2 diabetes and multiple comorbidities (GEDIMAplus): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bozorgmehr, Kayvan; Szecsenyi, Joachim; Ose, Dominik; Besier, Werner; Mayer, Manfred; Krisam, Johannes; Jacke, Christian O; Salize, Hans-Joachim; Brandner, Ralf; Schmitt, Sandra; Kiel, Marion; Kamradt, Martina; Freund, Tobias

    2014-06-21

    Care management interventions in the German health-care system have been evaluated with promising results, but further research is necessary to explore their full potential in the context of multi-morbidity. Our aim in this trial is to assess the efficacy of a primary care practice network-based care management intervention in improving self-care behaviour among patients with type 2 diabetes mellitus and multiple co-occurring chronic conditions. The study is designed as a prospective, 18-month, multicentre, investigator-blinded, two-arm, open-label, individual-level, randomized parallel-group superiority trial. We will enrol 582 patients with type 2 diabetes mellitus and at least two severe chronic conditions and one informal caregiver per patient. Data will be collected at baseline (T0), at the primary endpoint after 9 months (T1) and at follow-up after 18 months (T2). The primary outcome will be the differences between the intervention and control groups in changes of diabetes-related self-care behaviours from baseline to T1 using a German version of the revised Summary of Diabetes Self-Care Activities (SDSCA-G). The secondary outcomes will be the differences between the intervention and control groups in: changes in scores on the SDSCA-G subscales, glycosylated haemoglobin A level, health-related quality of life, self-efficacy, differences in (severe) symptomatic hypoglycaemia, cost-effectiveness and financial family burden. The intervention will be delivered by trained health-care assistants as an add-on to usual care and will consist of three main elements: (1) three home visits, including structured assessment of medical and social needs; (2) 24 structured telephone monitoring contacts; and (3) self-monitoring of blood glucose levels after T1 in 3-month intervals. The control group will receive usual care. The confirmatory primary analysis will be performed following the intention-to-treat (ITT) principle. The efficacy of the intervention will be quantified

  2. Mapping of Multiple Sclerosis Walking Scale (MSWS-12 to five-dimension EuroQol (EQ-5D health outcomes: an independent validation in a randomized control cohort

    Directory of Open Access Journals (Sweden)

    Sidovar MF

    2016-02-01

    Full Text Available Matthew F Sidovar,1 Brendan L Limone,2 Craig I Coleman2 1Clinical Development and Medical Affairs, Acorda Therapeutics, Ardsley, NY, 2Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA Background: Mapping of patient-reported outcomes to the five-dimension EuroQol (EQ-5D health index is increasingly being used for understanding the relationship of outcomes to health states and for predicting utilities that have application in economic evaluations. The 12-item Multiple Sclerosis Walking Scale (MSWS-12 is a patient-reported outcome that assesses the impact of walking impairment in people with MS. An equation for mapping the MSWS-12 to the EQ-5D was previously developed and validated using a North American Research Committee on MS (NARCOMS registry cohort. Materials and methods: This analysis retested the validity of the equation mapping the MSWS-12 to the three-level EQ-5D (EQ-5D-3L by using an independent cohort of patients with MS enrolled in a randomized controlled trial. Mapping was evaluated at two separate time points (baseline and week 4 during the clinical trial. The mapping equation’s performance was subsequently assessed with mean absolute error (MAE and root-mean-square error (RMSE by comparing equation-based estimates to values elicited in the trial using the actual EQ-5D-3L questionnaire. Results: The mapping equation predicted EQ-5D-3L values in this external cohort with reasonable precision at both time points (MAE 0.116 and RMSE 0.155 at baseline; MAE 0.105 and RMSE 0.138 at week 4, and was similar to that reported in the original NARCOMS cohort (MAE 0.109 and RMSE 0.145. Also as observed in the original NARCOMS cohort, the mapping equation performed best in patients with EQ-5D-3L values between 0.50 and 0.75, and poorly in patients with values <0.50.Conclusion: The mapping equation performed similarly in this external cohort as in the original derivation cohort, including a poorer

  3. Correlations of Platooning Track Test and Wind Tunnel Data

    Energy Technology Data Exchange (ETDEWEB)

    Lammert, Michael P [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kelly, Kenneth J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Yanowitz, Janet [Ecoengineering

    2018-02-02

    In this report, the National Renewable Energy Laboratory analyzed results from multiple, independent truck platooning projects to compare and contrast track test results with wind tunnel test results conducted by Lawrence Livermore National Laboratory (LLNL). Some highlights from the report include compiled data, and results from four independent SAE J1321 full-size track test campaigns that were compared to LLNL wind tunnel testing results. All platooning scenarios tested demonstrated significant fuel savings with good correlation relative to following distances, but there are still unanswered questions and clear opportunities for system optimization. NOx emissions showed improvements from NREL tests in 2014 to Auburn tests in 2015 with respect to J1321 platooning track testing of Peloton system. NREL evaluated data from Volpe's Naturalistic Study of Truck Following Behavior, which showed minimal impact of naturalistic background platooning. We found significant correlation between multiple track studies, wind tunnel tests, and computational fluid dynamics, but also showed that there is more to learn regarding close formation and longer-distance effects. We also identified potential areas for further research and development, including development of advanced aerodynamic designs optimized for platooning, measurement of platoon system performance in traffic conditions, impact of vehicle lateral offsets on platooning performance, and characterization of the national potential for platooning based on fleet operational characteristics.

  4. Seismic scanning tunneling macroscope - Theory

    KAUST Repository

    Schuster, Gerard T.

    2012-09-01

    We propose a seismic scanning tunneling macroscope (SSTM) that can detect the presence of sub-wavelength scatterers in the near-field of either the source or the receivers. Analytic formulas for the time reverse mirror (TRM) profile associated with a single scatterer model show that the spatial resolution limit to be, unlike the Abbe limit of λ/2, independent of wavelength and linearly proportional to the source-scatterer separation as long as the point scatterer is in the near-field region; if the sub-wavelength scatterer is a spherical impedance discontinuity then the resolution will also be limited by the radius of the sphere. Therefore, superresolution imaging can be achieved as the scatterer approaches the source. This is analogous to an optical scanning tunneling microscope that has sub-wavelength resolution. Scaled to seismic frequencies, it is theoretically possible to extract 100 Hz information from 20 Hz data by imaging of near-field seismic energy.

  5. Tunneling magnetoresistance in Si nanowires

    KAUST Repository

    Montes Muñoz, Enrique

    2016-11-09

    We investigate the tunneling magnetoresistance of small diameter semiconducting Si nanowires attached to ferromagnetic Fe electrodes, using first principles density functional theory combined with the non-equilibrium Green\\'s functions method for quantum transport. Silicon nanowires represent an interesting platform for spin devices. They are compatible with mature silicon technology and their intrinsic electronic properties can be controlled by modifying the diameter and length. Here we systematically study the spin transport properties for neutral nanowires and both n and p doping conditions. We find a substantial low bias magnetoresistance for the neutral case, which halves for an applied voltage of about 0.35 V and persists up to 1 V. Doping in general decreases the magnetoresistance, as soon as the conductance is no longer dominated by tunneling.

  6. Wildlife Tunnel Enhances Population Viability

    Directory of Open Access Journals (Sweden)

    Rodney van der Ree

    2009-12-01

    Full Text Available Roads and traffic are pervasive components of landscapes throughout the world: they cause wildlife mortality, disrupt animal movements, and increase the risk of extinction. Expensive engineering solutions, such as overpasses and tunnels, are increasingly being adopted to mitigate these effects. Although some species readily use such structures, their success in preventing population extinction remains unknown. Here, we use population viability modeling to assess the effectiveness of tunnels for the endangered Mountain Pygmy-possum (Burramys parvus in Australia. The underpasses reduced, but did not completely remove, the negative effects of a road. The expected minimum population size of a "reconnected" population remained 15% lower than that of a comparable "undivided" population. We propose that the extent to which the risk of extinction decreases should be adopted as a measure of effectiveness of mitigation measures and that the use of population modeling become routine in these evaluations.

  7. Dissipative Effect and Tunneling Time

    Directory of Open Access Journals (Sweden)

    Samyadeb Bhattacharya

    2011-01-01

    Full Text Available The quantum Langevin equation has been studied for dissipative system using the approach of Ford et al. Here, we have considered the inverted harmonic oscillator potential and calculated the effect of dissipation on tunneling time, group delay, and the self-interference term. A critical value of the friction coefficient has been determined for which the self-interference term vanishes. This approach sheds new light on understanding the ion transport at nanoscale.

  8. Digging the CNGS decay tunnel

    CERN Multimedia

    Patrice Loiez

    2002-01-01

    Products of the collision between a proton beam and a graphite target will pass through a horn containing an electric field that will produce a focused beam. These particles will decay into muon neutrinos within the tunnel that is being constructed in these images. The neutrinos will then travel 730 km to Gran Sasso in Italy where huge detectors will observe the beam to study a process called neutrino oscillation.

  9. Diagnosis of Carpal Tunnel Syndrome

    OpenAIRE

    Keith, Michael Warren; Masear, Victoria; Chung, Kevin; Maupin, Kent; Andary, Michael; Amadio, Peter C.; Barth, Richard W.; Watters, William C.; Goldberg, Michael J.; Haralson, Robert H.; Turkelson, Charles M.; Wies, Janet L.

    2009-01-01

    This clinical practice guideline was created to improve patient care by outlining the appropriate information-gathering and decision-making processes involved in managing the diagnosis of carpal tunnel syndrome. The methods used to develop this clinical practice guideline were designed to combat bias, enhance transparency, and promote reproducibility. The guideline’s recommendations are as follows: The physician should obtain an accurate patient history. The physician should perform a physica...

  10. Bidirectional resonant tunneling spin pump

    OpenAIRE

    Ting, David Z. -Y.; Cartoixà Soler, Xavier

    2003-01-01

    We propose a mechanism for achieving bidirectional spin pumping in conventional nonmagnetic semiconductorresonant tunnelingheterostructures under zero magnetic field. The device is designed specifically to take advantage of the special spin configuration described by the Rashba effect in asymmetric quantum wells. It induces the simultaneous flow of oppositely spin-polarized current components in opposite directions through spin-dependent resonant tunneling, and can thus generate significant l...

  11. Variable density turbulence tunnel facility

    Science.gov (United States)

    Bodenschatz, E.; Bewley, G. P.; Nobach, H.; Sinhuber, M.; Xu, H.

    2014-09-01

    The Variable Density Turbulence Tunnel at the Max Planck Institute for Dynamics and Self-Organization in Göttingen, Germany, produces very high turbulence levels at moderate flow velocities, low power consumption, and adjustable kinematic viscosity between 10-4 m2/s and 10-7 m2/s. The Reynolds number can be varied by changing the pressure or flow rate of the gas or by using different non-flammable gases including air. The highest kinematic viscosities, and hence lowest Reynolds numbers, are reached with air or nitrogen at 0.1 bar. To reach the highest Reynolds numbers the tunnel is pressurized to 15 bars with the dense gas sulfur hexafluoride (SF6). Turbulence is generated at the upstream ends of two measurement sections with grids, and the evolution of this turbulence is observed as it moves down the length of the sections. We describe the instrumentation presently in operation, which consists of the tunnel itself, classical grid turbulence generators, and state-of-the-art nano-fabricated hot-wire anemometers provided by Princeton University [M. Vallikivi, M. Hultmark, S. C. C. Bailey, and A. J. Smits, Exp. Fluids 51, 1521 (2011)]. We report measurements of the characteristic scales of the flow and of turbulent spectra up to Taylor Reynolds number Rλ ≈ 1600, higher than any other grid-turbulence experiment. We also describe instrumentation under development, which includes an active grid and a Lagrangian particle tracking system that moves down the length of the tunnel with the mean flow. In this configuration, the properties of the turbulence are adjustable and its structure is resolvable up to Rλ ≈ 8000.

  12. Variable density turbulence tunnel facility.

    Science.gov (United States)

    Bodenschatz, E; Bewley, G P; Nobach, H; Sinhuber, M; Xu, H

    2014-09-01

    The Variable Density Turbulence Tunnel at the Max Planck Institute for Dynamics and Self-Organization in Göttingen, Germany, produces very high turbulence levels at moderate flow velocities, low power consumption, and adjustable kinematic viscosity between 10(-4) m(2)/s and 10(-7) m(2)/s. The Reynolds number can be varied by changing the pressure or flow rate of the gas or by using different non-flammable gases including air. The highest kinematic viscosities, and hence lowest Reynolds numbers, are reached with air or nitrogen at 0.1 bar. To reach the highest Reynolds numbers the tunnel is pressurized to 15 bars with the dense gas sulfur hexafluoride (SF6). Turbulence is generated at the upstream ends of two measurement sections with grids, and the evolution of this turbulence is observed as it moves down the length of the sections. We describe the instrumentation presently in operation, which consists of the tunnel itself, classical grid turbulence generators, and state-of-the-art nano-fabricated hot-wire anemometers provided by Princeton University [M. Vallikivi, M. Hultmark, S. C. C. Bailey, and A. J. Smits, Exp. Fluids 51, 1521 (2011)]. We report measurements of the characteristic scales of the flow and of turbulent spectra up to Taylor Reynolds number R(λ) ≈ 1600, higher than any other grid-turbulence experiment. We also describe instrumentation under development, which includes an active grid and a Lagrangian particle tracking system that moves down the length of the tunnel with the mean flow. In this configuration, the properties of the turbulence are adjustable and its structure is resolvable up to R(λ) ≈ 8000.

  13. Autonomous Robotic Inspection in Tunnels

    Science.gov (United States)

    Protopapadakis, E.; Stentoumis, C.; Doulamis, N.; Doulamis, A.; Loupos, K.; Makantasis, K.; Kopsiaftis, G.; Amditis, A.

    2016-06-01

    In this paper, an automatic robotic inspector for tunnel assessment is presented. The proposed platform is able to autonomously navigate within the civil infrastructures, grab stereo images and process/analyse them, in order to identify defect types. At first, there is the crack detection via deep learning approaches. Then, a detailed 3D model of the cracked area is created, utilizing photogrammetric methods. Finally, a laser profiling of the tunnel's lining, for a narrow region close to detected crack is performed; allowing for the deduction of potential deformations. The robotic platform consists of an autonomous mobile vehicle; a crane arm, guided by the computer vision-based crack detector, carrying ultrasound sensors, the stereo cameras and the laser scanner. Visual inspection is based on convolutional neural networks, which support the creation of high-level discriminative features for complex non-linear pattern classification. Then, real-time 3D information is accurately calculated and the crack position and orientation is passed to the robotic platform. The entire system has been evaluated in railway and road tunnels, i.e. in Egnatia Highway and London underground infrastructure.

  14. Diagnosis of Carpal Tunnel Syndrome

    Science.gov (United States)

    Keith, Michael Warren; Masear, Victoria; Chung, Kevin; Maupin, Kent; Andary, Michael; Amadio, Peter C.; Barth, Richard W.; Watters, William C.; Goldberg, Michael J.; Haralson, Robert H.; Turkelson, Charles M.; Wies, Janet L.

    2016-01-01

    This clinical practice guideline was created to improve patient care by outlining the appropriate information-gathering and decision-making processes involved in managing the diagnosis of carpal tunnel syndrome. The methods used to develop this clinical practice guideline were designed to combat bias, enhance transparency, and promote reproducibility. The guideline’s recommendations are as follows: The physician should obtain an accurate patient history. The physician should perform a physical examination of the patient that may include personal characteristics as well as performing a sensory examination, manual muscle testing of the upper extremity, and provocative and/or discriminatory tests for alternative diagnoses. The physician may obtain electrodiagnostic tests to differentiate among diagnoses. This may be done in the presence of thenar atrophy and/or persistent numbness. The physician should obtain electrodiagnostic tests when clinical and/or provocative tests are positive and surgical management is being considered. If the physician orders electrodiagnostic tests, the testing protocol should follow the American Academy of Neurology/American Association of Neuromuscular and Electrodiagnostic Medicine/American Academy of Physical Medicine and Rehabilitation guidelines for diagnosis of carpal tunnel syndrome. In addition, the physician should not routinely evaluate patients suspected of having carpal tunnel syndrome with new technology, such as magnetic resonance imaging, computed tomography, and pressure-specified sensorimotor devices in the wrist and hand. This decision was based on an additional nonsystematic literature review following the face-to-face meeting of the work group. PMID:19474448

  15. Quantum Tunneling Affects Engine Performance.

    Science.gov (United States)

    Som, Sibendu; Liu, Wei; Zhou, Dingyu D Y; Magnotti, Gina M; Sivaramakrishnan, Raghu; Longman, Douglas E; Skodje, Rex T; Davis, Michael J

    2013-06-20

    We study the role of individual reaction rates on engine performance, with an emphasis on the contribution of quantum tunneling. It is demonstrated that the effect of quantum tunneling corrections for the reaction HO2 + HO2 = H2O2 + O2 can have a noticeable impact on the performance of a high-fidelity model of a compression-ignition (e.g., diesel) engine, and that an accurate prediction of ignition delay time for the engine model requires an accurate estimation of the tunneling correction for this reaction. The three-dimensional model includes detailed descriptions of the chemistry of a surrogate for a biodiesel fuel, as well as all the features of the engine, such as the liquid fuel spray and turbulence. This study is part of a larger investigation of how the features of the dynamics and potential energy surfaces of key reactions, as well as their reaction rate uncertainties, affect engine performance, and results in these directions are also presented here.

  16. A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue.

    Science.gov (United States)

    van Kessel, Kirsten; Wouldes, Trecia; Moss-Morris, Rona

    2016-05-01

    To pilot and compare the efficacy of an internet-based cognitive behavioural therapy self-management programme with (MSInvigor8-Plus) and without (MSInvigor8-Only) the use of email support in reducing fatigue severity and impact (primary outcomes), and depressed and anxious mood (secondary outcomes). Randomized controlled trial using an independent randomization system built into the website and intention-to-treat analysis. Participants were recruited through the local Multiple Sclerosis Society and hospital neurological services in New Zealand. A total of 39 people (aged 31-63 years), experiencing multiple sclerosis fatigue, able to walk with and without walking aids, were randomized to MSInvigor8-Only (n = 20) or to MSInvigor8-Plus (n = 19). MSInvigor8 is an eight-session programme based on cognitive behaviour therapy principles including psycho-education, self-monitoring, and changing unhelpful activity and thought patterns. Outcome measures included fatigue severity (Chalder Fatigue Scale) and impact (Modified Fatigue Impact Scale), and anxiety and depression (Hospital Anxiety and Depression Scale). Assessments were performed at baseline and at 10 weeks. The MSInvigor8-Plus condition resulted in significantly greater reductions in fatigue severity (F [1,36] = 9.09, p email-based support is a potentially promising, acceptable, and cost-effective approach to treating fatigue in people with multiple sclerosis in New Zealand. © The Author(s) 2015.

  17. New drainage tunnel of the tunnel Višňové - design and excavation

    Science.gov (United States)

    Jurík, Igor; Grega, Ladislav; Valko, Jozef; Janega, Peter

    2017-09-01

    The actual pilot tunnel dated to the period of geological and hydrogeological survey, is designed as a part of the tunnel Višňové, which is located at the section of the D1 motorway Lietavská Lúčka - Višňové - Dubná Skala in Slovakia. Drainage tunnel will be used for the drainage of the main tunnel tubes, where the maximum inflow from the eastern portal is greater than 250 l.s-1. Overlapping of the initial pilot tunnel with the profile of the southern tunnel tube led to the demolition of the portal sections of the pilot tunnel during the excavation of main tunnel tubes. These sections were replaced by new drainage tunnels, with the lengths of 288.0 meters from west portal and 538.0 meters from eastern portal, to ensure access from both portals. The new drainage tunnel is excavated under the level of the two main tunnel tubes. Drainage pipes with a diameter of 250 mm will be installed from cleaning niches in the main tunnel tubes to the new drainage tunnel.

  18. Tunnel junction 850-nm VCSEL for aperture uniformity and reliability

    Science.gov (United States)

    Wong, P. S.; Yan, J.; Wu, T. C.; Kyi, W.; Pao, J.; Riaziat, M.

    2017-02-01

    We are reporting the first successful fabrication of 850-nm buried tunnel junction (BTJ) VCSELs. Multiple parameters were considered for the design. First, n-type dopants other than silicon had to be considered for an abrupt junction. Second, proper layer thickness had to be chosen. Finally, compatibility with regrowth and processing had to be ensured. In this paper the successful fabrication and performance of 850-nm BTJ VCSELs with tunnel junctions comprised of GaAs and AlGaAs materials is demonstrated. Key achieved parameters include a significant improvement in the slope efficiency from approximately 0.45 W/A in an oxide-aperture VCSEL to over 0.6 W/A.

  19. Low Temperature Scanning Tunneling Spectroscopy

    Science.gov (United States)

    Kirk, Michael Dominic

    A scanning tunneling microscope (STM) was designed and built to operate at liquid helium temperature and was used to measure highly localized electron tunneling spectroscopy. Several instruments were built, all capable of operating in many different environments: air, vacuum, liquid helium and in a transfer gas. An adaptation of one particular design was made into an atomic force microscope capable of operating at low temperatures. Using a low temperature STM, three adsorbed molecular species (liquid crystals, sorbic acid, and carbon monoxide), deposited on a graphite substrate, have been imaged at 4.2K. The inelastic tunneling spectra of these adsorbates show strong peaks in dI/dV vs V curves at energies that correspond to known vibrational modes. The increase in conductance at the onset of inelastic tunneling was measured to be as high as 100 times. The spatial variation of the spectra was measured and was seen to change dramatically on the scale of angstroms, suggesting that individual molecular bonds could be measured. A theoretical model is presented to explain the contrast seen in the STM images of adsorbed molecules, thereby explaining why adsorbed molecules appear to be more conductive than the background. The microscope proved very useful for measuring the energy gap of high temperature superconductors. These materials often have submicron grain sizes. For LaSrCuO, YBaCuO, and BiCaSrCuO, the conductance curves showed a large energy gap suggesting a strongly coupled superconductor. The conductance curves also indicated that intergrain tunneling may occur and that the background conductance varied linearly with the applied voltage. The crystalline structure of rm Bi_2 Sr_2 CaCu_2 O_ {8 + delta} was imaged by an STM operating in air and in ultra-high vacuum. From the STM images the bulk crystal structure model for this material was refined. Finally, the STM was used to make holes reproducibly on a graphite surface with diameters less than 40A. Because the

  20. Structural analysis for shallow tunnels in soft soils

    NARCIS (Netherlands)

    Vu Minh, N.; Broere, W.; Bosch, J.W.

    2017-01-01

    Generally, studies on structural design for bored tunnels focus on moderate to deep tunnels (cover-to-diameter ratio C/D ≥ 2). Such tunnel design methods cannot be used for shallow-situated bored tunnels because the influence of buoyancy is discounted, and actual loads on the tunnel lining are

  1. Tunnel design considering stress release effect

    Directory of Open Access Journals (Sweden)

    Van-hung Dao

    2009-09-01

    Full Text Available In tunnel design, the determination of installation time and the stiffness of supporting structures is very important to the tunnel stability. This study used the convergence-confinement method to determine the stress and displacement of the tunnel while considering the counter-pressure curve of the ground base, the stress release effect, and the interaction between the tunnel lining and the rock surrounding the tunnel chamber. The results allowed for the determination of the installation time, distribution and strength of supporting structures. This method was applied to the intake tunnel in the Ban Ve Hydroelectric Power Plant, in Nghe An Province, Vietnam. The results show that when a suitable displacement µ0 ranging from 0.0865 m to 0.0919 m occurrs, we can install supporting structures that satisfy the stability and economical requirements.

  2. Investigation into scanning tunnelling luminescence microscopy

    CERN Document Server

    Manson-Smith, S K

    2001-01-01

    This work reports on the development of a scanning tunnelling luminescence (STL) microscope and its application to the study of Ill-nitride semiconductor materials used in the production of light emitting devices. STL microscopy is a technique which uses the high resolution topographic imaging capabilities of the scanning tunnelling microscope (STM) to generate high resolution luminescence images. The STM tunnelling current acts as a highly localised source of electrons (or holes) which generates luminescence in certain materials. Light generated at the STM tunnelling junction is collected concurrently with the height variation of the tunnelling probe as it is scanned across a sample surface, producing simultaneous topographic and luminescence images. Due to the very localised excitation source, high resolution luminescence images can be obtained. Spectroscopic resolution can be obtained by using filters. Additionally, the variation of luminescence intensity with tunnel current and with bias voltage can provi...

  3. Tunneling anisotropic magnetoresistance in Co/AIOx/Al tunnel junctions with fcc Co (111) electrodes

    NARCIS (Netherlands)

    Wang, Kai; Tran, T. Lan Ahn; Brinks, Peter; Brinks, P.; Sanderink, Johannes G.M.; Bolhuis, Thijs; van der Wiel, Wilfred Gerard; de Jong, Machiel Pieter

    2013-01-01

    Tunneling anisotropic magnetoresistance (TAMR) has been characterized in junctions comprised of face-centered cubic (fcc) Co (111) ferromagnetic electrodes grown epitaxially on sapphire substrates, amorphous AlOx tunnel barriers, and nonmagnetic Al counterelectrodes. Large TAMR ratios have been

  4. New thermoelectric effect in tunnel junctions

    Energy Technology Data Exchange (ETDEWEB)

    Smith, A.D.; Tinkham, M.; Skocpol, W.J.

    1980-11-01

    A new type of thermoelectric current effect is derived for tunneling through oxide barriers between metals at different temperatures, for both superconducting and normal tunnel junctions. This effect was observed in both current and voltage measurements on Al-PbVb tunnel junctions in which one electrode was heated by laser irradiation. The existence of this thermoelectric effect may resolve long-standing discrepencies between experimental results and theoretical predictions for a series of point-contact experiments.

  5. The Management of Cubital Tunnel Syndrome.

    Science.gov (United States)

    Boone, Sean; Gelberman, Richard H; Calfee, Ryan P

    2015-09-01

    Symptomatic cubital tunnel syndrome is a condition that frequently prompts patients to seek hand surgical care. Although cubital tunnel syndrome is readily diagnosed, achieving complete symptom resolution remains challenging. This article reviews related anatomy, clinical presentation, and current management options for cubital tunnel syndrome with an emphasis on contemporary outcomes research. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Electromyographic diagnosis of the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    K. Toyonaga

    1978-06-01

    Full Text Available Sensory conduction velocities of the median nerVe were studied from digit to palm and from palm to wrist in normal subjects and in patients with the carpal tunnel syndrome. Definite slowing was noted in the palm to wrist segment, even in the early carpal tunnel syndrome. It was noted that 37% of normal women over 40 years of age had electrophysiological evidence of the carpal tunnel syndrome.

  7. Quantum tunneling and field electron emission theories

    CERN Document Server

    Liang, Shi-Dong

    2013-01-01

    Quantum tunneling is an essential issue in quantum physics. Especially, the rapid development of nanotechnology in recent years promises a lot of applications in condensed matter physics, surface science and nanodevices, which are growing interests in fundamental issues, computational techniques and potential applications of quantum tunneling. The book involves two relevant topics. One is quantum tunneling theory in condensed matter physics, including the basic concepts and methods, especially for recent developments in mesoscopic physics and computational formulation. The second part is the f

  8. Femtosecond tunneling response of surface plasmon polaritons

    DEFF Research Database (Denmark)

    Keil, Ulrich Dieter Felix; Ha, Taekjip; Jensen, Jacob Riis

    1998-01-01

    and suggests that nanometer spatial resolution can be obtained together with femtosecond temporal resolution. This fast response, in contrast to the picosecond decay time of SPPs revealed by differential reflectivity measurements, can be attributed to a coherent superposition of SPPs rectified at the tunneling......We obtain femtosecond (200 fs) time resolution using a scanning tunneling microscope on surface plasmon polaritons (SPPs) generated by two 100 fs laser beams in total internal reflection geometry. The tunneling gap dependence of the signal clearly indicates the tunneling origin of the signal...

  9. Experimental investigation on tunnel sonic boom

    Science.gov (United States)

    Takayama, K.; Sasoh, A.; Onodera, O.; Kaneko, R.; Matsui, Y.

    1995-10-01

    Upon the entrance of a high-speed train into a relatively long train tunnel, compression waves are generated in front of the train. These compression waves subsequently coalesce into a weak shock wave so that a unpleasant sonic boom is emitted from the tunnel exit. In order to investigate the generation of the weak shock wave in train tunnels and the emission of the resulting sonic boom from the train tunnel exit and to search for methods for the reduction of these sonic booms, a 1∶300 scaled train tunnel simulator was constructed and simulation experiments were carried out using this facility. In the train tunnel simulator, an 18 mm dia. and 200 mm long plastic piston moves along a 40 mm dia. and 25 m long test section with speed ranging from 60 to 100 m/s. The tunnel simulator was tilted 8° to the floor so that the attenuation of the piston speed was not more than 10 % of its entrance speed. Pressure measurements along the tunnel simulator and holographic interferometric optical flow visualization of weak shock waves in the tunnel simulator clearly showed that compression waves, with propagation, coalesced into a weak shock wave. Although, for reduction of the sonic boom in prototype train tunnels, the installation of a hood at the entrance of the tunnels was known to be useful for their suppression, this effect was confirmed in the present experiment and found to be effective particularly for low piston speeds. The installation of a partially perforated wall at the exit of the tunnel simulator was found to smear pressure gradients at the shock. This effect is significant for higher piston speeds. Throughout the series of train tunnel simulator experiments, the combination of both the entrance hood and the perforated wall significantly reduces shock overpressures for piston speeds of u p ranging from 60 to 100 m/s. These experimental findings were then applied to a real train tunnel and good agreement was obtained between the tunnel simulator result and the

  10. Thermal transient analysis of TI8 tunnel

    CERN Document Server

    Pimenta dos Santos, M A

    2000-01-01

    The TI8 tunnel will house a proton beam transfer line of 450 GeV from the SPS to the LHC collider. This line will comprise 340 classical compact design magnets which are expected to dissipate about 120 W/m to the air along the tunnel. As the ventilation injection and extraction points are separated by approximately 2.5 Km (the length of the tunnel), a significant increase in the air bulk temperature is expected along the distance. This report presents an estimation of the air temperature evolution with time at the end of the tunnel.

  11. Seismic Response of Building Structure Near Tunnel

    Directory of Open Access Journals (Sweden)

    Zhou Zhanxue

    2017-01-01

    Full Text Available To research the influence of seismic response of building by the underground tunnel, a high-rise frame structure on the uniform field was analysed by using finite element method (FEM.The results showed that when the tunnel was located below the building the biggest influence on structural seismic response will been emerged, and made the structural displacement and natural vibration period increase and bending moment decrease. Tunnel located elsewhere on the influence of the structure response was not simply decreases with increasing of the distance, but to show some volatility. The tunnel will have little impact on seismic response of the underground part of the structure.

  12. Polyphenon E, non-futile at neuroprotection in multiple sclerosis but unpredictably hepatotoxic: Phase I single group and phase II randomized placebo-controlled studies.

    Science.gov (United States)

    Lovera, Jesus; Ramos, Alexander; Devier, Deidre; Garrison, Virginia; Kovner, Blake; Reza, Tara; Koop, Dennis; Rooney, William; Foundas, Anne; Bourdette, Dennis

    2015-11-15

    Phase I (PhI): assess the safety of Polyphenon E in people with multiple sclerosis (MS) and determine the futility of Polyphenon E as a neuroprotective agent. Correlate plasma levels of EGCG with neuroprotective effects. Phase II (PhII): Further assess safety and confirm the neuroprotective effects of Polyphenon E. PhI: single group futility study. PhII: parallel group randomized double-blind placebo-controlled study. Recruitment area (both studies): LSU MS Center, New Orleans, LA and general public from surrounding areas. Inclusion criteria (both studies): 1) MS per 2005 McDonald criteria; 2) relapsing remitting or secondary progressive MS; 3) stable for six months prior to enrollment on either no therapy or glatiramer acetate (GA) for the PhI study and on either on GA or Interferon β for the PhII study. Exclusion criteria (both studies): 1) complete bone marrow ablation or alentuzumab use at any time; 2) mitoxantrone, cyclophosphamide, natalizumab or fingolimod use in the prior nine months; 3) liver problems or significant medical problems. PhI: Polyphenon E, a green tea extract containing 50% of the antioxidant Epigallocatechin-gallate (EGCG), two capsules twice daily (200mg of EGCG per capsule; total daily dose 800mg) for six months. PhII: Polyphenon E or matching placebo capsules, same dose for one year. Only the research pharmacist knew treatment assignment and she randomized participants (one-to-one, stratified by GA or Interferon β, blocks of 4 or 6). Outcome evaluators did not discuss side effects with participants. PhI: 1) adverse events (AE); 2) futility: decrease in N-acetyl aspartate (NAA) from baseline to six months of 10% or more; 3) association between EGCG plasma levels and change in NAA. PhII: 1) AEs; 2) difference in the rate of change of NAA-levels over twelve months.We measured NAA using a point resolved magnetic resonance spectroscopic imaging sequence (TE30/TR2000) on a 10cm×10cm×1cm volume of interest (VOI) located just superior to the

  13. On the flow of groundwater in closed tunnels. Generic hydrogeological modelling of nuclear waste repository, SFL 3-5

    Energy Technology Data Exchange (ETDEWEB)

    Holmen, J.G. [Uppsala Univ. (Sweden). Inst. of Earth Sciences]|[Golder Associates AB (Sweden)

    1997-06-01

    The purpose is to study the flow of groundwater in closed tunnels by use of mathematical models. The calculations were based on three dimensional models, presuming steady state conditions. The stochastic continuum approach was used for representation of a heterogeneous rock mass. The size of the calculated flow is given as a multiple of an unknown regional groundwater flow. The size of the flow in a tunnel has been studied, as regards: Direction of the regional groundwater flow, Tunnel length, width and conductivity; Heterogeneity of the surrounding rock mass; Flow barriers and encapsulation inside a tunnel. The study includes a model of the planned repository for nuclear waste (SFL 3-5). The flow through the tunnels is estimated for different scenarios. The stochastic continuum approach has been investigated, as regards the representation of a scale dependent heterogeneous conductivity. An analytical method is proposed for the scaling of measured conductivity values, the method is consistent with the stochastic continuum approach. Some general conclusions from the work are: The larger the amount of heterogeneity, the larger the expected flow; The effects of the heterogeneity will decrease with increased tunnel length; If the conductivity of the tunnel is smaller than a threshold value, the tunnel conductivity is the most important parameter; If the tunnel conductivity is large and the tunnel is long, the most important parameter is the direction of the regional flow; Given a heterogeneous rock mass, if the tunnel length is shorter than about 500 m, the heterogeneity will be an important parameter, for lengths shorter than about 250 m, probably the most important; The flow through an encapsulation surrounded by a flow barrier is mainly dependent on the conductivity of the barrier. 70 refs, 110 figs, 10 tabs.

  14. Probing spin-polarized tunneling at high bias and temperature with a magnetic tunnel transistor

    NARCIS (Netherlands)

    Park, B.G.; Banerjee, T.; Min, B.C.; Sanderink, Johannes G.M.; Lodder, J.C.; Jansen, R.

    2005-01-01

    The magnetic tunnel transistor (MTT) is a three terminal hybrid device that consists of a tunnel emitter, a ferromagnetic (FM) base, and a semiconductor collector. In the MTT with a FM emitter and a single FM base, spin-polarized hot electrons are injected into the base by tunneling. After

  15. Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study.

    Science.gov (United States)

    Kopf, Sebastian; Forsythe, Brian; Wong, Andrew K; Tashman, Scott; Irrgang, James J; Fu, Freddie H

    2012-11-01

    The purpose of this study was to visualize and quantify the positions of femoral and tibial tunnels in patients who underwent traditional transtibial single-bundle ACL reconstruction, as performed by multiple surgeons, utilizing 3D CT models, and to compare these positions to our previously reported anatomical tunnel positions. Fifty-eight knee computed tomography (CT) scans were performed on patients who underwent primary or revision transtibial single-bundle ACL reconstruction, and three-dimensional reconstructions of the CT scans were aligned within an anatomical coordinate system. The position of femoral tunnel aperture centers was measured with (1) the quadrant method and (2) in the anatomic posterior-to-anterior and proximal-to-distal directions. The position of tibia tunnel aperture centers were measured similarly, in the anterior-to-posterior and medial-to-lateral dimensions on the tibial plateau. Comparisons were made to previously established anatomical tunnel positions, and data were presented as "mean value ± standard deviation (range)." The location of tibial tunnels was at 48.0 ± 5.4% (35.6-59.5%) of the anterior-to-posterior plateau depth and at 47.9 ± 2.9% (42.2-57.4%) of the medial-to-lateral plateau width. The location of femoral tunnels was at 55.8 ± 8.0% (41.5-79.5%) in the anatomic posterior-to-anterior direction and at 41.2 ± 10.4% (15.1-67.4%) in the proximal-to-distal directions. Utilizing a quadrant method, femoral tunnels were positioned at 37.4 ± 5.1% (24.9-50.6%) from the proximal condylar surface, parallel to Blumensaat line, and at 11.0 ± 7.3% (-6.0-28.7%) from the notch roof, perpendicular to Blumensaat line. In summary, tibial tunnels were positioned medial to the anatomic PL position (p tunnels were positioned anterior to both AM and PL anatomic tunnel locations (p tunnels within the native ACL insertion site. To achieve anatomical graft placement, other surgical techniques should be considered. IV.

  16. Thermoelectricity and disorder of FeCo/MgO/FeCo magnetic tunnel junctions

    NARCIS (Netherlands)

    Wang, S.Z.; Xia, K.; Bauer, G.E.W.

    2014-01-01

    We compute the thermoelectric transport parameterized by the Seebeck coefficient and thermal/electric conductance of random-alloy FeCo/MgO/FeCo(001) magnetic tunnel junctions (MTJs) from first principles using a generalized Landauer-Büttiker formalism. The thermopower is found to be typically

  17. Reliability analysis of shallow tunnels using the response surface methodology

    Directory of Open Access Journals (Sweden)

    Adam Hamrouni

    2017-12-01

    Full Text Available A probabilistic study of a circular tunnel excavated in a soil mass using the response surface methodology (RSM is presented. A deterministic model based on two-dimensional numerical simulations in a transversal section is used, and the serviceability limit state (SLS is considered in the analysis. The model permits the surface settlement curve and the bending moment on the tunnel lining to be obtained. Only the soil parameters are considered as random variables. The first-order reliability method (FORM and the response surface methodology (RSM are utilized for the assessment of the Hasofer-Lind reliability index (βHL optimized by the use of a genetic algorithm (GA. Two assumptions (normal and non-normal distribution were used for the random variables. The comparison analysis considering a correlation between the friction angle and the cohesion indicates that the results are conservative if a negative correlation among strength parameters is not taken into account. The assumption of a non-normal distribution for the random variables has an important effect on the reliability index for the practical range of values of surface settlements.

  18. CARPAL TUNNEL SYNDROME PADA PEKERJA GARMEN DI JAKARTA

    Directory of Open Access Journals (Sweden)

    Lusianawaty Tana

    2012-10-01

    Full Text Available Carpal tunnel syndrome (CTS is a disorder caused by medianus nerve entrapment in carpal tunnel in the wrist and gives many symptoms as painfully, numbness, hyperesthesia at nerve medianus area. The objective of this study was to asses CTS in garment factory workers and determine the prevalence of CTS, CTS relation to age, sex, workhour, and repeated biomechanical pressure in hand/wrist. A cross sectional design was used in the study conducted in Jakarta in 2002, to 814 person sample with simple random sampling method. Data collection was done through interviews, inspections, and examinations. The study found that prevalence of CTS was 20.3% (n= 814 in work unit. Workers who worked with high repeated biomechanical pressure in right hand/wrist was 74.1%, in left hand/wrist were 65.5%. Carpal tunnel syndrome in female higher than CTS in male (p=0.04. There was 110 significant correlation between increased of age, workhour, repeated biomechanical pressure in hand/wrist and increased of CTS. For confirmation 10% cases CTS were examined by electroneurography and electromyography, and found that CTS was 35,3%.

  19. Mars Surface Tunnel Element Concept

    Science.gov (United States)

    Rucker, Michelle A.

    2016-01-01

    How crews get into or out of their ascent vehicle has profound implications for Mars surface architecture. Extravehicular Activity (EVA) hatches and Airlocks have the benefit of relatively low mass and high Technology Readiness Level (TRL), but waste consumables with a volume depressurization for every ingress/egress. Perhaps the biggest drawback to EVA hatches or Airlocks is that they make it difficult to keep Martian dust from being tracked back into the ascent vehicle, in violation of planetary protection protocols. Suit ports offer the promise of dust mitigation by keeping dusty suits outside the cabin, but require significant cabin real estate, are relatively high mass, and current operational concepts still require an EVA hatch to get the suits outside for the first EVA, and back inside after the final EVA. This is primarily because current designs don't provide enough structural support to protect the suits from ascent/descent loads or potential thruster plume impingement. For architectures involving more than one surface element-such as an ascent vehicle and a rover or surface habitat-a retractable tunnel is an attractive option. By pushing spacesuit don/doff and EVA operations to an element that remains on the surface, ascended vehicle mass and dust can be minimized. What's more, retractable tunnels provide operational flexibility by allowing surface assets to be re-configured or built up over time. Retractable tunnel functional requirements and design concepts being developed as part of the National Aeronautics and Space Administration's (NASA) Evolvable Mars Campaign (EMC) work will add a new ingress/egress option to the surface architecture trade space.

  20. More about tunnelling times and superluminal tunnelling (Hartmann effect)

    Energy Technology Data Exchange (ETDEWEB)

    Olkhovsky, V.S. [Ukrainian Akademy of Sciences, Kiev (Ukraine). Inst. for Nuclear Research]|[INFN-Sezione di Catania (Italy); Recami, E. [Bergamo Univ. (Italy). Facolta` di Ingegneria]|[State Univ. at Campinas, Campinas (Brazil); Raciti, F. [Catania Univ. (Italy); Zaichenko, A. [Ukrainian Akademy of Sciences, Kiev (Ukraine). Inst. for Nuclear Reserch

    1995-05-01

    Aims of the present paper are: (i) presenting and analysing the results of various numerical calculations on the penetration and return times <{tau}{sub Pen}>, <{tau}{sub Ret}>, during tunnelling inside a rectangular potential barrier, for various penetration depths x{sub f}; (ii) putting forth and discussing suitable definitions, besides of the mean values, also of the variances (or dispersions) D{sub {tau}T} and D{sub {tau}R} for the time durations of transmission and reflection processes; (iii) mentioning, moreover, that our definition <{tau}{sub T}> for the average transmission time results to constitute an improvement of the ordinary dwell- time formula; (iv) commenting, at last, on the basis of the new numerical results, upon some recent criticism by C.R. Leavens. The paper stresses that numerical evaluations confirm that the approach implied, and implies, the existence of the Hartmann effect: an effect that in these days (due to the theoretical connections between tunnelling and evanescent-wave propagation) is receiving - at Cologne, Berkeley, Florence and Vienna - indirect, but quite interesting, experimental verification.