Sample records for randomization study doors

  1. Is Door-to-Door Canvassing Effective in Europe? Evidence from a Meta-study across Six European Countries

    Bhatti, Yosef; Dahlgaard, Jens Olav; Hansen, Jonas Hedegaard


    A vast amount of experimental evidence suggests that get-out-the-vote encouragements delivered through door-to-door canvassing have large effects on turnout. Most of the existing studies have been conducted in the United States, and are inspiring European mobilization campaigns. This article expl...

  2. Confounding adjustment through front-door blocking in longitudinal studies

    Arvid Sjölander


    Full Text Available A common aim of epidemiological research is to estimate the causal effect of a particular exposure on a particular outcome. Towards this end, observed associations are often ‘adjusted’ for potential confounding variables. When the potential confounders are unmeasured, explicit adjustment becomes unfeasible. It has been demonstrated that causal effects can be estimated even in the presence of umeasured confounding, utilizing a method called ‘front-door blocking’. In this paper we generalize this method to longitudinal studies. We demonstrate that the method of front-door blocking poses a number of challenging statistical problems, analogous to the famous problems associ- ated with the method of ‘back-door blocking’.

  3. Mobilizing citizen effort to enhance environmental outcomes: a randomized controlled trial of a door-to-door recycling campaign.

    Cotterill, Sarah; John, Peter; Liu, Hanhua; Nomura, Hisako


    This paper uses a randomized controlled trial to test whether doorstep canvassing can raise participation in kerbside recycling. Existing research shows that canvassing can confront negative attitudes, increase understanding and resolve structural obstacles, but there is less known about the longitudinal effects of such interventions, which may fall away over time. 194 streets in Trafford, in the North West of England, UK were randomly assigned into a treatment and a control group. All households in the treatment group were visited by canvassers who were trained to promote and encourage recycling. Recycling participation rates for all households were measured by observing bin set out rates over a three-week period. Measurement was done before and after the canvassing campaign and then again three months later to see if the intervention had been effective in raising participation rates. Random-effects multilevel regression models, controlling for baseline recycling, street size, deprivation and size of ethnic minority population, show that the canvassing raised recycling participation rates for the treatment group compared to the control group, but there was a decline in the impact of the intervention over time. The intervention was more effective on streets with low levels of recycling at baseline.

  4. The prevalence and clinical features of restless legs syndrome: a door to door population study in Orhangazi, Bursa in Turkey.

    Erer, Sevda; Karli, Necdet; Zarifoglu, Mehmet; Ozcakir, Alis; Yildiz, Demet


    Restless leg syndrome (RLS) has negative effects on the quality of life of the patients. Epidemiological studies on RLS are limited. To determine the prevalence of RLS among people aged 40 years and above in Orhangazi district of Bursa, Turkey. The study was carried out between 2004 and 2005. This population-based study was conducted in two phases. In the phase 1, residents conducted door-to-door interviews using a short questionnaire to determine the possible cases of RLS. In the phase 2, physicians ascertained the suspected cases of RLS. Diagnosis of RLS was made using the criteria proposed by the International Restless Legs Syndrome Study Group (IRLSSG) and also the rating scale for RLS. Out of 1, 256 subjects screened in phase 1, 1,124 (89.6%) were included in the study. Also, 161 cases with suspected symptoms of RLS were detected in phase 1, 49 of the suspected cases could not be evaluated in phase 2. A diagnosis of RLS was also made in 60 cases during phase 2. We defined the prevalence of RLS as 9.71% among 40 years of age and older population. The prevalence of RLS did not differ by age and was 2.6 times more in women. None of the patients were diagnosed as RLS sought medical care for the symptoms, possibly due to lack of knowledge of patients and physicians about RLS. Prevalence studies help to provide knowledge on morbidity, which is essential for diagnosis and early treatment.

  5. Medium-to-high prevalence of screening-detected parkinsonism in the urban area of Tehran, Iran: data from a community-based door-to-door study

    Fereshtehnejad SM


    Full Text Available Seyed-Mohammad Fereshtehnejad,1,2 Mahdiyeh Shafieesabet,3 Arash Rahmani,4 Ahmad Delbari,1,5 Johan Lökk1,6 1Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS, Karolinska Institutet, Stockholm, Sweden; 2Firoozgar Clinical Research Development Center (FCRDC, Firoozgar Hospital, 3Medical Student Research Committee (MSRC, Faculty of Medicine, 4Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran; 5Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran; 6Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden Introduction: Parkinsonism occurs in all ethnic groups worldwide; however, there are wide variations in the prevalence rates reported from different countries, even for neighboring regions. The huge socioeconomic burden of parkinsonism necessitates the need for prevalence studies in each country. So far, there is neither data registry nor prevalence information on parkinsonism in the Iranian population. The aim of our study was to estimate the prevalence rate of probable parkinsonism in a huge urban area in Iran, Tehran using a community-based door-to-door survey.Materials and methods: We used a random multistage sampling of the households within the network of health centers consisting of 374 subunits in all 22 districts throughout the entire urban area of Tehran. Overall, 20,621 individuals answered the baseline checklist and screening questionnaire and data from 19,500 persons aged ≥30 years were entered in the final analysis. Health care professionals used a new six-item screening questionnaire for parkinsonism, which has been previously shown to have a high validity and diagnostic value in the same population.Results: A total of 157 cases were screened for parkinsonism using the validated six-item questionnaire. After

  6. A transpersonal approach to care: a qualitative study of performers' experiences with DooR to DooR, a hospital-based arts program.

    Hurdle, Caitlin E; Quinlan, Margaret M


    The arts have a history of relaxing and calming patients in the hospital setting, yet research is limited on how arts may aid in the healing process. DooR to DooR was established to bring comfort, respite, and healing to hospitalized patients, family members, and health care staff. DooR to DooR is located in the University of North Carolina Hospitals at Chapel Hill, North Carolina; professional performing artists visit there, spending 5 to 10 minutes with each patient, family member, and health care staff. The purpose of this qualitative study is to understand performers' experiences and of how arts-based programs can facilitate improved patient outcomes in the hospitalized setting to help nurses better use the arts in their care of patients and families. Three overarching themes were identified: (a) the arts are therapeutic for all involved, (b) the arts transform the hospital environment, and (c) nurses and the other medical staff play an important role. The significance of this study for nursing practice is that the arts are a plausible intervention for the hospital because they may help improve patient outcomes by reducing pain and depression and by relieving stress among staff and family members. More research is needed to determine the level of arts-as-an-intervention knowledge among nurses.

  7. The genetic basis of DOORS syndrome: an exome-sequencing study

    Campeau, Philippe M; Kasperaviciute, Dalia; Lu, James T; Burrage, Lindsay C; Kim, Choel; Hori, Mutsuki; Powell, Berkley R; Stewart, Fiona; Félix, Têmis Maria; van den Ende, Jenneke; Wisniewska, Marzena; Kayserili, Hülya; Rump, Patrick; Nampoothiri, Sheela; Aftimos, Salim; Mey, Antje; Nair, Lal D V; Begleiter, Michael L; De Bie, Isabelle; Meenakshi, Girish; Murray, Mitzi L; Repetto, Gabriela M; Golabi, Mahin; Blair, Edward; Male, Alison; Giuliano, Fabienne; Kariminejad, Ariana; Newman, William G; Bhaskar, Sanjeev S; Dickerson, Jonathan E; Kerr, Bronwyn; Banka, Siddharth; Giltay, Jacques C; Wieczorek, Dagmar; Tostevin, Anna; Wiszniewska, Joanna; Cheung, Sau Wai; Hennekam, Raoul C; Gibbs, Richard A; Lee, Brendan H; Sisodiya, Sanjay M


    Summary Background Deafness, onychodystrophy, osteodystrophy, mental retardation, and seizures (DOORS) syndrome is a rare autosomal recessive disorder of unknown cause. We aimed to identify the genetic basis of this syndrome by sequencing most coding exons in affected individuals. Methods Through a search of available case studies and communication with collaborators, we identified families that included at least one individual with at least three of the five main features of the DOORS syndrome: deafness, onychodystrophy, osteodystrophy, intellectual disability, and seizures. Participants were recruited from 26 centres in 17 countries. Families described in this study were enrolled between Dec 1, 2010, and March 1, 2013. Collaborating physicians enrolling participants obtained clinical information and DNA samples from the affected child and both parents if possible. We did whole-exome sequencing in affected individuals as they were enrolled, until we identified a candidate gene, and Sanger sequencing to confirm mutations. We did expression studies in human fibroblasts from one individual by real-time PCR and western blot analysis, and in mouse tissues by immunohistochemistry and real-time PCR. Findings 26 families were included in the study. We did exome sequencing in the first 17 enrolled families; we screened for TBC1D24 by Sanger sequencing in subsequent families. We identified TBC1D24 mutations in 11 individuals from nine families (by exome sequencing in seven families, and Sanger sequencing in two families). 18 families had individuals with all five main features of DOORS syndrome, and TBC1D24 mutations were identified in half of these families. The seizure types in individuals with TBC1D24 mutations included generalised tonic-clonic, complex partial, focal clonic, and infantile spasms. Of the 18 individuals with DOORS syndrome from 17 families without TBC1D24 mutations, eight did not have seizures and three did not have deafness. In expression studies, some

  8. CT and MRI-based door-needle-times for acute stroke patients a quasi-randomized clinical trial

    Hansen, Christine Krarup; Christensen, Anders; Rodgers, Helen


    OBJECTIVES: Door-Needle-times (DNT) of 20min are feasible when Computer Tomography (CT) is used for first-line brain-imaging to assess stroke-patients' eligibility for intravenous-tissue-Plasminogen-Activator (iv-tPA), but the more time-consuming Magnetic Resonance Imaging (MRI)-based-evaluation ......OBJECTIVES: Door-Needle-times (DNT) of 20min are feasible when Computer Tomography (CT) is used for first-line brain-imaging to assess stroke-patients' eligibility for intravenous-tissue-Plasminogen-Activator (iv-tPA), but the more time-consuming Magnetic Resonance Imaging (MRI...

  9. Hand sanitizer-dispensing door handles increase hand hygiene compliance: a pilot study.

    Babiarz, Lukasz S; Savoie, Brent; McGuire, Mark; McConnell, Lauren; Nagy, Paul


    Improving rates of hand hygiene compliance (HHC) has been shown to reduce nosocomial disease. We compared the HHC for a traditional wall-mounted unit and a novel sanitizer-dispensing door handle device in a hospital inpatient ultrasound area. HHC increased 24.5%-77.1% (P sanitizer-dispensing door handle, whereas it remained unchanged for the other rooms. Technical improvements like a sanitizer-dispensing door handle can improve hospital HHC.

  10. A nondestructive stratigraphic and radiographic neutron study of Lorenzo Ghiberti's reliefs from paradise and north doors of Florence baptistery

    Festa, G.; Andreani, C.; de Pascale, M. P.; Senesi, R.; Vitali, G.; Porcinai, S.; Giusti, A. M.; Schulze, R.; Canella, L.; Kudejova, P.; Mühlbauer, M.; Schillinger, B.; Ancient Charm Collaboration


    A neutron study on two gilded bronze reliefs by Lorenzo Ghiberti is presented. The two reliefs, representing heads of prophets, come from the north and east doors of the Baptistery of Florence. The east door will be permanently located at the Museo dell'Opera di Santa Maria del Fiore museum at the end of its restoration, which is still in progress at the Metals Conservation Department of the Opificio delle Pietre Dure in Florence. The north door is kept in the original site, on the north facade of the Florentine Baptistery. Both reliefs exhibit critical aspects regarding their state of conservation in particular the stability of the gold layer on the bronze surface. Moreover the east head presents a remelting of which extension and composition are still unknown. The present work describes a non-destructive study of the subgilding area and bulk. The two main objectives of such analyses are: (1) to study the manufacturing technique and state of conservation of the reliefs; and (2) to assess the two cleaning techniques (laser cleaning and Rochelle salts chemical cleaning) used by the conservators during the restoration process of the east door. The experiment was carried out using prompt gamma-ray activation imaging combined with neutron radiography and conventional neutron radiography. The former method was applied to map the elemental composition of the two reliefs, while neutron radiography was used to investigate the bulk. The results provide significant information about subsuperficial areas, elemental composition of the objects from the surface down to a depth of 1 mm below gilding, and bulk structure of the remelting. Such information will guide the curators in the selection of the most suitable microclimatic conditions for the exhibition of the east door and for future conservation work on the north door.

  11. The genetic basis of DOORS syndrome : an exome-sequencing study

    Campeau, Philippe M.; Kasperaviciute, Dalia; Lu, James T.; Burrage, Lindsay C.; Kim, Choel; Hori, Mutsuki; Powell, Berkley R.; Stewart, Fiona; Felix, Temis Maria; van den Ende, Jenneke; Wisniewska, Marzena; Kayserili, Huelya; Rump, Patrick; Nampoothiri, Sheela; Aftimos, Salim; Mey, Antje; Nair, Lal D. V.; Begleiter, Michael L.; De Bie, Isabelle; Meenakshi, Girish; Murray, Mitzi L.; Repetto, Gabriela M.; Golabi, Mahin; Blair, Edward; Male, Alison; Giuliano, Fabienne; Kariminejad, Ariana; Newman, William G.; Bhaskar, Sanjeev S.; Dickerson, Jonathan E.; Kerr, Bronwyn; Banka, Siddharth; Giltay, Jacques C.; Wieczorek, Dagmar; Tostevin, Anna; Wiszniewska, Joanna; Cheung, Sau Wai; Hennekam, Raoul C.; Gibbs, Richard A.; Lee, Brendan H.; Sisodiya, Sanjay M.


    Background Deafness, onychodystrophy, osteodystrophy, mental retardation, and seizures (DOORS) syndrome is a rare autosomal recessive disorder of unknown cause. We aimed to identify the genetic basis of this syndrome by sequencing most coding exons in affected individuals. Methods Through a search o

  12. Door Grond Horizontaal Belaste Palen: Analyse case study "Brienenoord Corridor Rotterdam"

    Breedeveld, J.


    In onderliggend rapport wordt onderzocht in welke mate de verschillende rekenmodellen, die in de dagelijkse praktijk worden toegepast om de mate van de omgevingsbeïnvloeding door een ophoging te voorspellen, het werkelijke grondgedrag dat tijdens en na de uitvoering van de BRICOR-ophoging is gemeten

  13. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study

    Rathore, Saif S.; Curtis, Jeptha P.; Chen, Jersey; Wang, Yongfei; Nallamothu, Brahmajee K.; Epstein, Andrew J; Krumholz, Harlan M.; ,


    Objective To evaluate the association between door-to-balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in door-to-balloon times of less than 90 minutes. Design Prospective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6. Setting Acute care hospitals. Participants 43 801 pat...

  14. Analytical study of the main door of Santiago church, Guadix, Granada

    Espinosa Gaitán, Jesús


    Full Text Available The analytical study described on this paper has been made due to the request formulated by the priest of Santiago church, D. José Mª Ballesteros, through the Provincial Delegation of Culture of Granada. In view of the degradation of the main door front, the Instituto Andaluz del Patrimonio Histórico has been asked for technical advice on the possible treatment to be carried out to resolve the problems of this front. As a part of the technical study we have carried out the analysis required to determine the characteristics of the stone used, the possible causes of weathering and to evaluate the most adequate treatment products, in case that it is convenient to apply any one as a part of the conservation restoration works. As a first step we have carried out a visual inspection of the door front and the inside of the church, and then samples have been taken. These samples have been analyzed by means of: chemical analysis of main components, X Ray diffraction, mineralogic petrographic study and SEM observation. From all these determinations it has been deduced the possible causes and mechanisms of alteration. As previous phase to the evaluation of treatments, due to the high quantity of stone needed to make all the tests, we have proceeded to identify and find the quarry of origin of this stone; it is located in Bácor, a little village on the municipal term of Guadix, at 40 Km from it. Once the identification has been made with certainty, enough material has been extracted to prepare the samples used. It is very interesting to study this stone because it has been employed also on the Cathedral of Guadix and it will be able to extend the results obtained on the tests to this building.

    El estudio analítico recogido en el presente artículo se realiza como respuesta a la petición formulada por el párroco de la iglesia de Santiago, D. José Mª Ballesteros, a través de la Delegación Provincial de Cultura de Granada. Ante el estado de

  15. Some case studies of random walks in dynamic random environments

    Soares dos Santos, Renato


    This thesis is dedicated to the study of random walks in dynamic random environments. These are models for the motion of a tracer particle in a disordered medium, which is called a static random environment if it stays constant in time, or dynamic otherwise. The evolution of the random walk is defi

  16. Effect of door-to-antibiotic time on mortality of patients with sepsis in emergency department: a prospective cohort study.

    Mohammad Jalili


    Full Text Available Sepsis constitutes an important cause of hospital admission with a high mortality rate. Appropriate antibiotic therapy is the cornerstone of therapy in patients with sepsis. Although numerous studies have recommended early antibiotic initiation in severe sepsis or septic shock stages of sepsis syndrome, its role in treatment of patients with sepsis who have not entered these stages remains to be investigated. The purpose of this study is to investigate the effect of door-to-antibiotic time in sepsis patients with various degrees of severity. This is a longitudinal prospective cohort study on adult patients admitted with sepsis to the emergency department. Sepsis was defined as presence of at least two criteria of systemic inflammatory response syndrome and procalcitonin levels ≥ 2μg/l. Severity of sepsis was determined using the APACHE II (Acute Physiology and Chronic Health Evaluation II scoring system. Time to antibiotic administration was recorded and its relationship with mortality was assessed. A total of 145 patients were eligible for enrollment. The mean age was 60.4 years and the mean APACHE score was 13.7. The overall in-hospital mortality was 21.4%, and the mean length of stay in hospital was 211.9 hours. The mean door-to-antibiotic time for our patients was 104.4 minutes. Antibiotic administration time and mortality in patients with APACHE scores of 21 or higher (P=0.05 were significantly related; whereas such a relationship was not observed for patients with APACHE scores of 11- 20 (P=0.46. We observed early antibiotic initiation for patients in sepsis phase with higher severity scores was associated with significant improvement in survival rate.

  17. Vee ziek door eikenprocessierups

    Spijker, J.H.


    In 2006 zijn er incidenteel ernstige problemen geweest met vee dat ingeschaard was langs eiken die zwaar waren aangetast door eikenprocessierups. Tot vele tientallen meters langs deze lanen bleek het gras niet geschikt voor dierlijke consumptie door de aanwezigheid van verwaaide nesten van deze rups

  18. A Study on the Improvement and Development Plan for Express Delivery Door to Door Services%浅析快递服务的制度改善方向及发展方案



    快递服务(express service;courier service)是快速收寄、运输、投递单独封装的、有名址的快件或其他不需储存的物品,按承诺时限递送到收件人或指定地点、并获得签收的寄递服务。运输产业是高速发展的新动力产业,从实际意义角度来看,实现交通运输服务活性化,需要对交通运输服务的制度进行改善及对未来的发展做出规划方案。研究通过快递市场的实态及问题来找到快递服务业制度改善方向及发展方案。以管理学的角度进行实证性的研究。%The express deliver services is business delivered in the form of transportation with assembling,sorting under the responsibility of the transport operators.There is necessary to clarify the nature and extent of government support to build the institutional framework In order to develop with new growth engine industry The purpose of study is to research the institutional framework and to improve plan of express deliver door to door services for the activation of the courier service sector.This study was based on literature survey with a questionnaire.This study was empirically based on requirements,development plan,approval criteria by literature survey with a questionnaire.

  19. Ballistic Missile Silo Door Monitoring Analysis



    This paper compares the cost and effectiveness of several potential options that may be used to monitor silo-based ballistic missiles. Silo door monitoring can be used to verify that warheads removed to deactivate or download silo-based ballistic missiles have not been replaced. A precedent for monitoring warhead replacement using reentry vehicle on site inspections (RV-OSIs) and using satellites has been established by START-I and START-II. However, other monitoring options have the potential to be less expensive and more effective. Three options are the most promising if high verification confidence is desired: random monitoring using door sensors; random monitoring using manned or unmanned aircraft; and continuous remote monitoring using unattended door sensors.

  20. Stop Sagging Doors.

    Cronk, Bob


    Explains how continuous geared hinges can help prevent doors from pulling away from their frames and can last as long as 20 years with little maintenance. Descriptions of three main applications for continuous geared hinges are described. (GR)

  1. Electronic doors to education: study of high school website accessibility in Iowa.

    Klein, David; Myhill, William; Hansen, Linda; Asby, Gary; Michaelson, Susan; Blanck, Peter


    The Americans with Disabilities Act (ADA), and Sections 504 and 508 of the Rehabilitation Act, prohibit discrimination against people with disabilities in all aspects of daily life, including education, work, and access to places of public accommodations. Increasingly, these antidiscrimination laws are used by persons with disabilities to ensure equal access to e-commerce, and to private and public Internet websites. To help assess the impact of the anti-discrimination mandate for educational communities, this study examined 157 website home pages of Iowa public high schools (52% of high schools in Iowa) in terms of their electronic accessibility for persons with disabilities. We predicted that accessibility problems would limit students and others in obtaining information from the web pages as well as limiting ability to navigate to other web pages. Findings show that although many web pages examined included information in accessible formats, none of the home pages met World Wide Web Consortium (W3C) standards for accessibility. The most frequent accessibility problem was lack of alternative text (ALT tags) for graphics. Technical sophistication built into pages was found to reduce accessibility. Implications are discussed for schools and educational institutions, and for laws, policies, and procedures on website accessibility. Copyright 2003 John Wiley & Sons, Ltd.

  2. Developments in sanitary techniques 2011-2012. Important progress through studies in 2011; Ontwikkelingen sanitaire technieken 2011-2012. Belangrijke vorderingen door studies in 2011

    Scheffer, W.


    In 2011, new laws and regulations were the main theme in sanitary techniques (ST). Libraries have been updated in the areas of tap water installations and sewer systems of buildings. Some important progress was made in the framework of several ST preliminary studies conducted by TVVL and Uneto-VNI. Still, the start-up of new ST studies and projects in 2012 is lagging behind compared to previous years. [Dutch] Het vakgebied van sanitaire technieken (ST) stond in 2011 vooral in het teken van nieuwe wet- en regelgeving. Zowel op het gebied van leidingwaterinstallaties als riolering van bouwwerken zijn de bibliotheken geactualiseerd. In het kader van enkele ST-voorstudies, uitgevoerd door TVVL en Uneto-VNI zijn belangrijke vorderingen gemaakt. De opstart van nieuwe ST-studies en -projecten in 2012 blijft echter achter ten opzichte van voorgaande jaren.

  3. From "Closing Doors" to "Opening Doors": Exploring gender and subject choice in UK schools

    Marks, Ann


    Two reports drawing on the National (English) Pupil Database are discussed: the It's Different for Girls and the Closing Doors reports (2012 and 2013, respectively), both of which examine the experience of girls studying physics in England. The UK government has responded to these studies by launching the "Opening Doors" project (June 2014), which will focus on a whole-school approach to addressing gender imbalance in progression to post-16 studies.

  4. Study on Objective Sound Quality Evaluation of Automotive Door Closing Sound%汽车车门关闭声声品质客观评价

    邓江华; 夏洪兵


    目前汽车声品质的研究多针对稳态声,非稳态声声品质评价方法欠缺,且噪声信号处理多采用FFT等传统方法,未充分考虑其非稳态特性.汽车车门关闭声为一种瞬态的非稳态噪声,关门声声品质的好坏常常能反映出整车的品质.以多款汽车关门声为研究对象,采用常用的声品质评价参数对其进行声品质分析.另外,采用小波变换方法,对关门声声信号进行时频分析,并对多款车的车门关闭声进行声品质评价,提出仅仅用响度、尖锐度等传统评价参量并不能很好反映非稳态噪声声品质特性,而通过时频分析则能对其进行很好的补充,但评价参量的确定还有待进一步研究,最后,提出下一步的研究方向和内容.%Currently, research of sound quality of automobiles is mainly focused on the steady sound, and there are very few methods for transient sound quality evaluation. In addition, traditional FFT method is often adopted in sound signal processing, while the transient property of the acoustic signal has not been considered adequately. Automotive door closing sound is a transient impulse sound, and the quality of door closing sound can reflect the quality of vehicles. In this paper, first of all, the quality of door closing sound of some types of vehicles is evaluated using traditional evaluation parameters. Then, the wavelet transform method is used to analyze the sound signal of the door closing sound in time frequency domain. It is indicated that the traditional parameters such as loudness, sharpness, roughness, and so on can not sufficiently reflect the sound quality characteristics of transient sound, while the time-frequency analysis is a good complement for the sound quality evaluation. However, selection of the evaluation parameters remains a problem for further study.

  5. A Door-to-Door Combined Transport Planner

    Aastrup, Jesper; Jespersen, Per Homann; Pedersen, Michael B.


    Establishing a web-based portal functioning as a one-stop-shop for transport buyers is a radical idea of a consumer oriented intermodal freight system. This utopian vision will be materialized in a system description and a prototype of a Door-to-Door Combined Trans-port Planner (COTRAP), developed...

  6. Study on the Quality of Fuel Filler Door%油箱门质量问题研究

    麻桂艳; 闫禄平


    Rust,sagging and matching is the most importment quality problem of metallic fuel filler door,do reasearch on quality prob-lem,compare to benchmark car and CAE result,and what should be pay attention to describe in this paper.This reasearch solve the quali-ty problem,and very useful to the subsequent design.Because of the ability of author is limit,the method can not avoid the quality prob-lem completely,should do more effort in the future.%生锈、下沉和匹配是汽车金属类油箱门生产中较为常见的三大质量问题。本文通过对这三大质量问题进行研究,并与精品车进行对比及CAE分析,阐述了油箱门设计过程中应该注意的问题。研究有效地解决了质量问题,并对后续项目起到了一定的指导作用。由于作者能力有限,本文所阐述的设计方法并不能完全消除质量问题,更好的方法还有待进一步研究。

  7. Development and Validation of Project Management Constructs of Security Door Access Control Systems: A Pilot Study in Macau

    Chan Brenda Wing Han


    Full Text Available A Security Door Access Control System (SDACS project involves a number of teams from different organizations with diverse project goals. One of the main challenges of such projects is the lack of a standard approach or common understanding to achieve a common goal among project parties. This research examines various management concerns for SDACS projects, highlights the expected common understanding for project participants, develops the project management constructs, and emphasizes on the resulting value of the project to all participants. A two-stage process of scale development and validation was conducted. First, six generic constructs were identified based on the Security Access Control System Framework. Next, a multi-item scale for each construct was developed with reference to the Result-Oriented Management Framework. Expert judges were invited to conduct manual sorting of the items iteratively until reliability and validity was reached. In the next stage, further refinement and validation were carried out with a synthesized survey instrument and a series of statistical testing followed. The finalized SDACS project management constructs and the related findings help reinforce the importance of a standardized management practice for SDACS projects. The value of this research not only benefits SDACS project managers but everyone who works on the project.

  8. Bidding to give in the field: door-to-door fundraisers had it right from the start

    Onderstal, S.; Schram, A.J.H.C.; Soetevent, A.R.


    In a door-to-door fundraising field experiment, we study the impact of fundraising mechanisms on charitable giving. We approached about 4500 households, each participating in either an all-pay auction, a lottery, a non-anonymous voluntary contribution mechanism (VCM), or an anonymous VCM. In contras

  9. 汽车门内饰板间隙面差研究%Study on Gap and Flush of Automotive Door trim



    门内饰板是汽车内饰中重要组成部分,对舒适性有很高的要求。门内饰板间隙和面差对门内饰板外部美观和感知质量起着至关重要的作用,反映了门内饰板的设计和工艺水平。文章主要论述门内饰板的间隙面差研究方法,分析门内饰板内部以及门内饰板和周围环境件的间隙面差,总结了门内饰板间隙面差设置方法和要点,用于设置合理的间隙面差,提高了门内饰板的感知质量和舒适性。%Door trim is an important part of the automotive interior, have very high requirement for comfort prope- rty. The gap and flush of door trim play a vital role for door trim appearance and perceived quality,reflecting the d- esign and process level of door trim. This article mainly discusses research methods of gap and flush of automotive door trim,analyze the gap and flush of door trim internal parts and gap between door trim with the surrounding environmental parts,summarizes gap and flush of door trim setting methods and key points, can be used for setting reasonable gap and flush, improve perceived quality and comfort property of door trim.

  10. Door locking and exit security measures on acute psychiatric admission wards

    Nijman, H.L.I.; Bowers, L.; Haglund, K.; Muir-Cochrane, E.; Simpson, A.; Merwe, M. van der


    Locking the exit doors of psychiatric wards is believed to reduce the risk of patients absconding. The aims of the study were to investigate both the prevalence of door locking and other exit security measures on UK admission wards, as well as whether door locking appears to be effective in keeping

  11. China opens the door

    Starke, K.


    The door to China`s vast market for power generation was opened a bit further for foreign firms in November. That is when power ministry head Shi Dazhen said the country would rely on overseas investors for 20 percent of the funding needed to boost output--double the amount foreigners were previously allowed to contribute. Through 1995, foreigners invested $12.2 billion in China`s electricity industry, accounting for 10 percent of total investment. According to Shi, foreign investors will be asked to provide about $17 billion of the $84 billion China plans to invest in the sector over the next five years. Under China`s Ninth Five-Year Plan (1996-2000), the government aims to boost the country`s power generation capacity at the rate of 15,000 MW to 20,000 MW annually by the year 2000. Since China`s public external debt balance already exceeds $80 billion, however, the government would seem to have little choice but to allow foreigners a greater role. Shi also said that foreigners would be allowed 100 percent ownership of PRC power projects. This is discouraged under China`s current industry guidelines. It is, however, expected to be permitted under China`s first build-operate-transfer (BOT) law, which was anticipated by the end of 1996, says Susan Urkevich, director of project finance at HSBC Investment Bank Asia in Hong Kong. Indeed, China`s first BOT is already happening.

  12. Genetics Home Reference: DOORS syndrome

    ... do not have all of these features. Most people with DOORS syndrome have profound hearing loss caused by changes in the inner ears (sensorineural deafness). Developmental delay and intellectual disability are also often severe in this disorder. The ...

  13. 14 CFR 23.783 - Doors.


    ... may be crowded against the door on the inside of the airplane. (2) If inward opening doors are used, there must be a means to prevent occupants from crowding against the door to the extent that would... the external door, for which the initial opening movement is not inward, is fully closed and...

  14. Numerical Study on Effects of Door-Opening on Airflow Patterns and Dynamic Cross-Contamination in an ISO Class 5 Operating Room

    DONG Shuyun; TU Guangbei; CAO Rongguang; YU Zhenfeng


    The contamination diffusion to the operating room when the door is open was simulated with a computational fluid dynamic (CFD) method,to give the extent of the contamination diffusion.The influence of the door-opening procedure was ignored since the door of the operating room is normally a sliding one.The flow field in the case of the 16 s course of opening the door was simulated.The simulated and the experimental results demonstrate that the extent of the contamination diffusion is around 1.5 m when there is no temperature difference between indoor and outdoor,and there is hardly any contamination diffusion when the temperature difference is 1 ℃.It can be concluded that the positive pressure difference in the operating room lost its function in preventing the contamination when the door is open.That the temperature of corridor is lower than that of operating room contributes to contamination control.Keeping 1 ℃ temperature difference between corridor and operating room and increasing positive pressure and air flow are suggested.It is more secure to set up an anteroom if persons come in or out of the operation room at the course of surgery.

  15. A benchmark study for different numerical parameters and their impact on the calculated strain levels for a model part door outer

    Berger, E.; Brenne, T.; Heath, A.; Hochholdinger, B.; Kassem-Manthey, K.; Keßler, L.; Koch, N.; Kortmann, G.; Kröff, A.; Otto, T.; Steinbeck, G.; Till, E.; Verhoeven, H.; Vu, T.-C.; Wiegand, K.


    To increase the accuracy of finite element simulations in daily practice the local German and Austrian Deep Drawing Research Groups of IDDRG founded a special Working Group in year 2000. The main objective of this group was the continuously ongoing study and discussion of numerical / material effects in simulation jobs and to work out possible solutions. As a first theme of this group the intensive study of small die radii and the possibility of detecting material failure in these critical forming positions was selected. The part itself is a fictional body panel outside in which the original door handle of the VW Golf A4 has been constructed, a typical position of possible material necking or rupture in the press shop. All conditions to do a successful simulation have been taken care of in advance, material data, boundary conditions, friction, FLC and others where determined for the two materials in investigation — a mild steel and a dual phase steel HXT500X. The results of the experiments have been used to design the descriptions of two different benchmark runs for the simulation. The simulations with different programs as well as with different parameters showed on one hand negligible and on the other hand parameters with strong impact on the result — thereby having a different impact on a possible material failure prediction.

  16. Bodemverontreiniging en de opname van lood door moestuingewassen : risico’s van lood door bodemverontreiniging

    Otte, P.F.; Römkens, P.F.A.M.; Rietra, R.P.J.J.; Lijzen, J.P.A.


    Lood uit bodemverontreinigingen wordt opgenomen door moestuingewassen die daarop worden geteeld. Deze gewassen kunnen een gezondheidsrisico vormen als zij worden geconsumeerd. Uit deze studie van het RIVM en Alterra blijkt dat bij hoge concentraties lood in de bodem de opname minder wordt. Hierdoor

  17. A Door-to-Door Combined Transport Planner

    Aastrup, Jesper; Jespersen, Per Homann; Pedersen, Michael B.


    Establishing a web-based portal functioning as a one-stop-shop for transport buyers is a radical idea of a consumer oriented intermodal freight system. This utopian vision will be materialized in a system description and a prototype of a Door-to-Door Combined Trans-port Planner (COTRAP), develope......- and inter-organizational barriers to the establishment of a competitive and effective combined transport system with rail freight operators as the intermodal integrator. In this paper we describes the ideas and methodology behind the project, as well as some preliminary results....

  18. Ontkenning vaderschap door bijzondere curator namens minderjarige

    A.J.M. Nuytinck (André)


    textabstractOntkenning vaderschap door minderjarig kind, vertegenwoordigd door een daartoe benoemde bijzondere curator; niet vereist dat kind in staat is tot redelijke waardering belangen; belang van zeer jeugdig kind kan anders meebrengen

  19. Ontkenning vaderschap door bijzondere curator namens minderjarige

    A.J.M. Nuytinck (André)


    textabstractOntkenning vaderschap door minderjarig kind, vertegenwoordigd door een daartoe benoemde bijzondere curator; niet vereist dat kind in staat is tot redelijke waardering belangen; belang van zeer jeugdig kind kan anders meebrengen

  20. De andere ‘anderen’ : Een exploratieve studie naar processen van labelling van, door en tussen hackers

    van der Wagen, Wytske; Althoff, Martina; van Swaaningen, René


    While in the sixties hackers were the heroes of cyberspace, they are nowadays often perceived as the archetype cybercriminal. From the perspective of labelling theory, this empirical study examines how hackers feel perceived by society at large, how they perceive themselves as ‘others’ and how they

  1. Smediger kaas door juiste voer

    Hettinga, K.A.; Dijkstra, J.


    Veel kaasmakers willen smedige (zachte, smeuïge) kaas maken, want de gemiddelde consument vindt die kaas het lekkerst. Kasper Hettinga en Jan Dijkstra van Wageningen Universiteit vertellen hoe de smedigheid van kaas kan worden beïnvloed door de samenstelling van het veevoer.

  2. Project Open Door. Final Report.

    Verheyden-Hilliard, Mary Ellen

    The major purpose of Project Open Door was to design, develop, test, and disseminate a portable module for vocational educators and others to use with junior high school students in pre-vocational exploration free of sex stereotyping. The module produced contained a slide presentation with accompanying cassette tape and a leader's guide. An…

  3. Koperemissies door drinkwaterleidingen (herziene editie)

    Verweij W; Mons MN; Aalbers JEM; Cruchten RGH van; LWD


    Ge-inventariseerd werd wat er bekend is over de fluxen van koper door (corrosie van) waterleidingen naar rioolwaterzuiveringsinstallaties (rwzi's), rwzi-slib en het oppervlaktewater. Gebleken is dat in 1993 (landelijk gemiddeld) 57% van de koperbelasting van rwzi's afkomstig is van cor

  4. Empirical power and sample size calculations for cluster-randomized and cluster-randomized crossover studies.

    Reich, Nicholas G; Myers, Jessica A; Obeng, Daniel; Milstone, Aaron M; Perl, Trish M


    In recent years, the number of studies using a cluster-randomized design has grown dramatically. In addition, the cluster-randomized crossover design has been touted as a methodological advance that can increase efficiency of cluster-randomized studies in certain situations. While the cluster-randomized crossover trial has become a popular tool, standards of design, analysis, reporting and implementation have not been established for this emergent design. We address one particular aspect of cluster-randomized and cluster-randomized crossover trial design: estimating statistical power. We present a general framework for estimating power via simulation in cluster-randomized studies with or without one or more crossover periods. We have implemented this framework in the clusterPower software package for R, freely available online from the Comprehensive R Archive Network. Our simulation framework is easy to implement and users may customize the methods used for data analysis. We give four examples of using the software in practice. The clusterPower package could play an important role in the design of future cluster-randomized and cluster-randomized crossover studies. This work is the first to establish a universal method for calculating power for both cluster-randomized and cluster-randomized clinical trials. More research is needed to develop standardized and recommended methodology for cluster-randomized crossover studies.

  5. Pneumatic vs. door-to-door waste collection systems in existing urban areas: a comparison of economic performance.

    Teerioja, Nea; Moliis, Katja; Kuvaja, Eveliina; Ollikainen, Markku; Punkkinen, Henna; Merta, Elina


    Pneumatic waste collection systems are becoming increasingly popular in new urban residential areas, and an attractive alternative to conventional vehicle-operated municipal solid waste (MSW) collection also in ready-built urban areas. How well pneumatic systems perform in ready-built areas is, however, an unexplored topic. In this paper, we analyze how a hypothetical stationary pneumatic waste collection system compares economically to a traditional vehicle-operated door-to-door collection system in an existing, densely populated urban area. Both pneumatic and door-to-door collection systems face disadvantages in such areas. While buildings and fixed city infrastructure increase the installation costs of a pneumatic system in existing residential areas, the limited space for waste transportation vehicles and containers cause problems for vehicle-operated waste collection systems. The method used for analyzing the cost effects of the compared waste collection systems in our case study takes into account also monetized environmental effects of both waste collection systems. As a result, we find that the door-to-door collection system is economically almost six times more superior. The dominant cost factor in the analysis is the large investment cost of the pneumatic system. The economic value of land is an important variable, as it is able to reverse the results, if the value of land saved with a pneumatic system is sufficiently high. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Antiknock Performance of Interlayered High-Damping-Rubber Blast Door under Thermobaric Shock Wave

    Xiudi Li


    Full Text Available The long duration and high impulse shock wave of thermobaric bomb threatens the security of underground structures. To obtain high resistance blast door against thermobaric shock wave, firstly, the dynamic mechanic property of high damping rubber was studied by split Hopkinson pressure bar (SHPB equipment and the stress-strain relationship of high damping rubber under average strain rate of 5200/s was obtained. Secondly, the numerical model of interlayered high-damping-rubber blast door was established with ANSYS/LS-DYNA code based on test results, and the antiknock performance of interlayered high-damping-rubber blast door under thermobaric shock wave was analyzed by contrast with ordinary blast door. The results showed that the midspan displacement of the blast door decreased firstly and then increased with the increase of thickness of the high-damping-rubber interlayer, and the optimal thickness of the high-damping-rubber interlayer for energy consuming was 150 mm in the calculation condition of this paper. With the increase of the distance between the interlayer and the front surface of the door, the midspan displacement of the blast door decreased continually. The midspan maximum displacement of interlayered high-damping-rubber blast door decreased 74.5% in comparison to ordinary blast door. It showed that the high-damping-rubber structure can effectively improve the antiknock performance of blast door under thermobaric shock wave.

  7. A Door-to-Door Combined Transport Planner

    Aastrup, Jesper; Jespersen, Per Homann; Pedersen, Michael B.


    - and inter-organizational barriers to the establishment of a competitive and effective combined transport system with rail freight operators as the intermodal integrator. In this paper we describes the ideas and methodology behind the project, as well as some preliminary results.......Establishing a web-based portal functioning as a one-stop-shop for transport buyers is a radical idea of a consumer oriented intermodal freight system. This utopian vision will be materialized in a system description and a prototype of a Door-to-Door Combined Trans-port Planner (COTRAP), developed...... to fulfill the requirements of potential customers and in interaction with customers, shippers, rail and road freight operators, rail infrastructure owners and other actors in the intermodal freight system. Conversely, successive versions of the COTRAP will be used as an instrument to identify intra...

  8. Theory, Methods and Tools for Statistical Testing of Pseudo and Quantum Random Number Generators

    Jakobsson, Krister Sune


    Statistical random number testing is a well studied field focusing on pseudo-random number generators, that is to say algorithms that produce random-looking sequences of numbers. These generators tend to have certain kinds of flaws, which have been exploited through rigorous testing. Such testing has led to advancements, and today pseudo random number generators are both very high-speed and produce seemingly random numbers. Recent advancements in quantum physics have opened up new doors, wher...

  9. Mendelian randomization studies in coronary artery disease.

    Jansen, Henning; Samani, Nilesh J; Schunkert, Heribert


    Epidemiological research over the last 50 years has discovered a plethora of biomarkers (including molecules, traits or other diseases) that associate with coronary artery disease (CAD) risk. Even the strongest association detected in such observational research precludes drawing conclusions about the causality underlying the relationship between biomarker and disease. Mendelian randomization (MR) studies can shed light on the causality of associations, i.e whether, on the one hand, the biomarker contributes to the development of disease or, on the other hand, the observed association is confounded by unrecognized exogenous factors or due to reverse causation, i.e. due to the fact that prevalent disease affects the level of the biomarker. However, conclusions from a MR study are based on a number of important assumptions. A prerequisite for such studies is that the genetic variant employed affects significantly the biomarker under investigation but has no effect on other phenotypes that might confound the association between the biomarker and disease. If this biomarker is a true causal risk factor for CAD, genotypes of the variant should associate with CAD risk in the direction predicted by the association of the biomarker with CAD. Given a random distribution of exogenous factors in individuals carrying respective genotypes, groups represented by the genotypes are highly similar except for the biomarker of interest. Thus, the genetic variant converts into an unconfounded surrogate of the respective biomarker. This scenario is nicely exemplified for LDL cholesterol. Almost every genotype found to increase LDL cholesterol level by a sufficient amount has also been found to increase CAD risk. Pending a number of conditions that needed to be fulfilled by the genetic variant under investigation (e.g. no pleiotropic effects) and the experimental set-up of the study, LDL cholesterol can be assumed to act as the functional component that links genotypes and CAD risk and

  10. Slim door Gym

    Van Dijk, Martin; De Groot, Renate; Kirschner, Paul A.


    In deze interactieve presentatie werd de huidige wetenschappelijke stand van zaken omtrent de associatie tussen lichamelijke activiteit en cognitieve prestaties en schoolprestaties besproken. Daarnaast werden de eerste resultaten van De GOALS Studie, ons eigen onderzoek uitgevoerd onder 440 adolesce

  11. Koperemissies door drinkwaterleidingen

    Verweij W; Mons MN; Aalbers JEM; Cruchten RGH van; LWD


    This study was carried out to assess the amounts of copper released by copper pipes used for drinking-water distribution into wastewater treatment plants, sewage sludge and surface water in the Netherlands. For the Netherlands as a whole, 57% of the copper load in wastewater treatment plants is att

  12. Optimaliseren geneesmiddelengebruik door ouderen

    Kwint, Henk Frans|info:eu-repo/dai/nl/308480783; Faber, Adrianne; Gussekloo, Jacobijn; Bouvy, Marcel|info:eu-repo/dai/nl/153182210


    Kwint H-F, Faber A, Gussekloo J, Bouvy ML. Optimizing medication use for elderly patients. Huisarts Wet 2015;58(3):134-8. In conclusion, the studies presented in the thesis show the importance of the different steps of the medication review process when prescribing for elderly patients and the

  13. Experimental percolation studies of random networks

    Feinerman, A.; Weddell, J.


    This report establishes an experimental method of studying electrically percolating networks at a higher resolution than previously implemented. This method measures the current across a conductive sheet as a function of time as elliptical pores are cut into the sheet. This is done utilizing a Universal Laser System X2-600 100 W CO2 laser system with a 76 × 46 cm2 field and 394 dpc (dots/cm) resolution. This laser can cut a random system of elliptical pores into a conductive sheet with a potential voltage applied across it and measures the current versus time. This allows for experimental verification of a percolation threshold as a function of the ellipse's aspect ratio (minor/major diameter). We show that as an ellipse's aspect ratio approaches zero, the percolation threshold approaches one. The benefit of this method is that it can experimentally measure the effect of removing small pores, as well as pores with complex geometries, such as an asterisk from a conductive sheet.

  14. The doors have been removed… for YOUR safety

    Abildgaard, Mette Simonsen

    A sociomaterial case study of how bombs (and their users), doors and politics instigated the destabilization and dismantling of the public telephone booth in Denmark, and the subsequent re-assembling process, through design contests and political struggle, to establish a new appropriate design...... Paper Long Abstract: This sociomaterial case study deals with the destabilization and dismantling of the public telephone booth in Denmark, which began in 1977-1978 when an unforeseen use - a series of bomb attacks - struck the booths in Copenhagen. As a safety measure, police removed the doors...... on the classic box-shaped telephone booths, which had been a part of Danish communication infrastructure since 1932. But the doors were never reinstalled after the capture of the user, who became known as The Telephone Bomber, and a competition for a new open design was commissioned in 1980. The winning design...

  15. Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study

    QIU Jian-ping; ZHANG Qi; LU Ji-de; WANG Hai-rong; LIN Jie; GE Zhi-ru; ZHANG Rui-yan; SHEN Wei-feng


    Background Primary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.Methods The study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group).Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time,and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.Results Baseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P=0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54±18) minutes and (112±55) minutes, P <0.0001)and the percentage of patients with D2B <90 minutes was increased in the DIRECT group (96.9% and 27.0%, P<0.0001).The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P=0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P=0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis

  16. Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients

    Coyne, Christopher J.


    Full Text Available Introduction: The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG times for patients with ST-segment elevation myocardial infarction (STEMI. Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times. Methods: We conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based “cardiac triage” designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time. Results: We enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01, ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01, and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03. Conclusion: By creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time. [West J Emerg Med. 2015;16(1:184–189.

  17. The doors have been removed… for YOUR safety

    Abildgaard, Mette Simonsen

    A sociomaterial case study of how bombs (and their users), doors and politics instigated the destabilization and dismantling of the public telephone booth in Denmark, and the subsequent re-assembling process, through design contests and political struggle, to establish a new appropriate design...... Paper Long Abstract: This sociomaterial case study deals with the destabilization and dismantling of the public telephone booth in Denmark, which began in 1977-1978 when an unforeseen use - a series of bomb attacks - struck the booths in Copenhagen. As a safety measure, police removed the doors...

  18. A modified unilateral open-door miniscrew-plate fixation:a biomechanical study%新型改良单开门微型钛钉-钛板内固定的生物力学研究

    刘帅; 雷伟; 吴子祥; 樊勇; 严亚波; 石磊; 刘达; 张扬


    Objective To evaluate the biomechanical performance of a modified miniscrew-plate fixation in the unilateral open-door cervical laminoplasty.Methods Eight specimens of cervical spine (C3-C7) were made from intact adult cadavers.After randomization into 2 groups, with 4 specimens and 20 vertebral segments in each group, the unilateral open-door cervical laminoplasty was performed in each cervical vertebra in both groups.In group A the modified miniscrew-plates were used while in group B the traditional miniscrew-plates were implanted.A MTS880 machine was used to test the maximal load of the reclosed open-door miniscrew-plate at each cervical vertebra, and the maximal load and energy of the completely closed open-door miniscrew-plate.Results In the reclosing process, the mean maximal load was 873.61 ±154.40 N in group A and 297.17 ± 133.41 N in group B.In the complete closing state, the mean maximal load was 812.98 ± 141.79 N in group A and 145.77 ±59.21 N in group B; the mean energy was 5.95 ±0.83 J in group A and 1.65 ± 0.70 J in group B.There were significant differences between the 2 groups ( P < 0.05 ) .Conclusion The modified miniscrew-plate can have better biomechanical performance than the traditional miniscrew-plate in simulated unilateral open-door cervical laminoplasty.%目的 探讨改良单开门微型钛钉-钛板内固定的生物力学特性.方法 选取8具无损伤的新鲜人尸体颈椎标本(C3-7),经分次处理后随机分为两组,每组4具标本20个节段:A组:于每个节段颈椎标本模拟单开门颈椎管扩大成形术,术中使用改良单开门微型钛钉-钛板固定;B组:每节段颈椎标本模拟同样手术操作,使用传统单开门钛钉-钛板(Centerpiece钉板)固定.应用MTS880生物材料实验机测试每个颈椎节段标本开门后再关门的最大负荷、完全关门时的负荷及功耗,并对两组结果进行比较.结果 再关门过程中A组和B组的最大负荷平均分别为(873.61±154.40)

  19. Investment in sustainable electricity production by Dutch banks. A case study for the Fair Bank Guide; Investeringen in duurzame elektriciteitsopwekking door Nederlandse banken. Een onderzoeksrapport voor de Eerlijke Bankwijzer

    Van Gelder, J.W.; Kouwenhoven, D.


    This report contains the results of the second case study commissioned by the Fair Bank Guide on the financing practices of twelve investigated banks in the Netherlands. It has been examined which part of the investments in electricity generation by Dutch banks involves electricity generation from sustainable sources (sustainable electricity generation) [Dutch] Dit rapport bevat de resultaten van het tweede onderzoek in opdracht van de Eerlijke Bankwijzer naar de financieringspraktijk van twaalf onderzochte banken in Nederland. Hiermee is in kaart gebracht welk deel van de investeringen in elektriciteitsopwekking door de Nederlandse banken, betrekking heeft op elektriciteitsopwekking met behulp van duurzame energiebronnen ('duurzame elektriciteitsopwekking')

  20. Holiday Door Decorating Contest Brings Cheer | Poster

    By Carolynne Keenan, Contributing Writer Other than the time of year, what do the following have in common: the leg lamp from the movie “A Christmas Story,” a compilation of silly holiday jokes, a gingerbread house, and Santa on a motorcycle? All four were among the individual door winners for the Holiday Door Decorating Contest, held at NCI at Frederick in December. Employees dressed up their office doors, hallways, and even stairwells to participate. Entries for the contest included individual office doors as well as groups. Some employees even “decked the halls” of whole office buildings to participate.

  1. Literature Survey on Door Lock Security Systems

    Pradnya R Nehete; J P Chaudhari; S R Pachpande; K P Rane


    .... Due to the advancement in recent techniques, some door lock security systems are based on microcontroller, GSM, GPS, many sensors, software like MATLAB, PROTEUS, biometrics like face recognition...

  2. 33 CFR 100.905 - Door County Triathlon; Door County, WI.


    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Door County Triathlon; Door County, WI. 100.905 Section 100.905 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY REGATTAS AND MARINE PARADES SAFETY OF LIFE ON NAVIGABLE WATERS § 100.905 Door County...

  3. Randomized studies of PSA screening: an opinion

    Oliver Sartor


    @@ The issue of prostate cancer screening with prostate-specific antigen (PSA) has been contentious for nearly two decades due to lack of data from randomized trials, but that has now changed.A brief review of the available data is warranted as there is finally some clarity on this critically important topic.Knowing what to ignore, as well as what to focus on, is critical for understanding the current data.

  4. Studies in the theory of random processes

    Skhorokhod, A V


    This text is devoted to the development of certain probabilistic methods in the specific field of stochastic differential equations and limit theorems for Markov processes. Specialists, researchers, and students in the field of probability will find it a source of important theorems as well as a remarkable amount of advanced material in compact form.The treatment begins by introducing the basic facts of the theory of random processes and constructing the auxiliary apparatus of stochastic integrals. All proofs are presented in full. Succeeding chapters explore the theory of stochastic different

  5. Experimental Study on Sealing Performance of Protective Sealing Door for Mine Refuge Chamber%避难硐室防护密闭门密封性能试验研究

    朱先国; 张广勋; 井婷婷; 蒋德献


    A new protective sealing door for mine refuge chamber was designed;the theoretical analysis and experimental study on variety of rubber strips showed that the optimum compression rate of the rectangular silicone rubber sealing strip with the hardness of 20-25 degree is 15%-25% under the static sealing condition. On this basis, a sealing structure was designed according to the optimum compression amount and in consideration of some factors such as the machining error;experimental study was made on the air tightness of the protective sealing door.%  设计了一种新型矿井避难硐室防护密闭门,通过对各种密封胶条的理论分析和实验研究表明:硬度为20~25度的矩形硅橡胶密封胶条,在静密封工况下,最佳压缩率为15%~25%。根据最佳压缩量范围并考虑机械加工误差等主要因素,设计了密封结构;通过密封试验,对防护密闭门的关键指标气密性进行了研究,验证了密封结构设计的合理性和可靠性。

  6. 29 CFR 1917.114 - Cargo doors.


    ... 29 Labor 7 2010-07-01 2010-07-01 false Cargo doors. 1917.114 Section 1917.114 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) MARINE TERMINALS Terminal Facilities § 1917.114 Cargo doors. (a) Mechanically operated. (1) Cargo...

  7. Goedkopere weefselkweekplantjes door kweek in het donker

    Klerk, de G.J.M.


    Weefselkweek is duur. Daardoor zijn voordelen van weefselvermeerdering maar bij een klein aantal gewassen te benutten. Tot nu toe zijn de kosten teruggbracht door stoomlijnen van de productie en door overbrengen van de bulkproductie naar lagelonenlanden. Er zijn pogingen geweest het weefselkweekproc

  8. Outsourcing van het ICT door overheidsinstellingen

    Kok, L.; Theeuwes, J.J.M.; Janssens, L.


    Het IWI heeft onlangs gewezen op de risico’s van outsourcing van ICT door het UWV. Ook het uitbesteden van ICT door gemeenten is niet zonder risico. Om outsourcingsbeslissingen van gemeenten en UWV te kunnen beoordelen wil het ministerie meer inzicht in de effecten van outsourcing. De directie

  9. Novel Door-opening Method for Six-legged Robots Based on Only Force Sensing

    Chen, Zhi-Jun; Gao, Feng; Pan, Yang


    Current door-opening methods are mainly developed on tracked, wheeled and biped robots by applying multi-DOF manipulators and vision systems. However, door-opening methods for six-legged robots are seldom studied, especially using 0-DOF tools to operate and only force sensing to detect. A novel door-opening method for six-legged robots is developed and implemented to the six-parallel-legged robot. The kinematic model of the six-parallel-legged robot is established and the model of measuring the positional relationship between the robot and the door is proposed. The measurement model is completely based on only force sensing. The real-time trajectory planning method and the control strategy are designed. The trajectory planning method allows the maximum angle between the sagittal axis of the robot body and the normal line of the door plane to be 45º. A 0-DOF tool mounted to the robot body is applied to operate. By integrating with the body, the tool has 6 DOFs and enough workspace to operate. The loose grasp achieved by the tool helps release the inner force in the tool. Experiments are carried out to validate the method. The results show that the method is effective and robust in opening doors wider than 1 m. This paper proposes a novel door-opening method for six-legged robots, which notably uses a 0-DOF tool and only force sensing to detect and open the door.

  10. A numerical study of self-averaging in adsorption of random copolymers and random surfaces

    Moghaddam, M S


    Numerical studies involving random copolymers and random surfaces assume self-averaging of thermodynamic and metric properties of the systems to calculate different properties. For the problem of adsorption of a random copolymer, rigorous proofs regarding self-averaging of some properties such as free energy in the thermodynamic limit (n-> infinity) exist. This says little about the extent of self-averaging for finite size systems used in numerical studies. For the problem of adsorption of a homopolymer on a random surface, no analytical proofs regarding self-averaging exist. In this work assumptions of self-averaging of thermodynamic and metric properties of a self-avoiding walk model of random copolymer adsorption are tested via multiple Markov chain Monte Carlo method. Numerical evidence is provided in support of self-averaging of energy, heat capacity and the z-component of the self-avoiding walk in different temperature intervals. Self-averaging in energy of a homopolymer interacting with a random surfac...

  11. Optimization of Circular Side Door Beam for Crashworthiness Analysis

    Raja Sharmi Raja Husin


    Full Text Available Structural optimization related to crashworthiness and energy absorption capability is particularly importance to the automotive industry. The optimization involves highly nonlinear computational analysis and design with many material and structure parameters. This paper presents a crashworthiness design of the circular side door beam which attach to the side door structures. The response surface method (RSM is utilized to formulate the complex crashworthiness design problem in the case of optimization. In this study, side door beam will be optimized. The beams in circular shape were studied and compared. The focus is on finding an optimum cross-section shape of the beam in order to improve the energy absorption character.  An optimization problem is formulated to find the maximum energy absorbed with the maximum peak load as a constraint, the shape of the beam cross section and the thickness as variable. The structure optimum design and simulation analysis of automobile side-door beam was carried out by using Finite Element (FE method.

  12. Celiac Patients: A Randomized, Controlled Clinical Study

    Giuseppe Mazzarella


    Full Text Available A lifelong gluten-free diet (GFD is mandatory for celiac disease (CD but has poor compliance, justifying novel strategies. We found that wheat flour transamidation inhibited IFN-γ secretion by intestinal T cells from CD patients. Herein, the primary endpoint was to evaluate the ability of transamidated gluten to maintain GFD CD patients in clinical remission. Secondary endpoints were efficacy in prevention of the inflammatory response and safety at the kidney level, where reaction products are metabolized. In a randomized single blinded, controlled 90-day trial, 47 GFD CD patients received 3.7 g/day of gluten from nontransamidated (12 or transamidated (35 flour. On day 15, 75% and 37% of patients in the control and experimental groups, respectively, showed clinical relapse (=0.04 whereas intestinal permeability was mainly altered in the control group (50% versus 20%, =0.06. On day 90, 0 controls and 14 patients in the experimental group completed the challenge with no variation of antitransglutaminase IgA (=0.63, Marsh-Oberhuber grading (=0.08, or intestinal IFN-γ mRNA (>0.05. Creatinine clearance did not vary after 90 days of treatment (=0.46. In conclusion, transamidated gluten reduced the number of clinical relapses in challenged patients with no changes of baseline values for serological/mucosal CD markers and an unaltered kidney function.

  13. An unexpected knock on Corrigan's secret door.

    Woywodt, Alexander


    Corrigan's secret door describes a metaphorical escape route for busy physicians. The term was derived from the successful and exceptionally busy professional life of Irish physician Dominic John Corrigan (1802-80). It is claimed that Corrigan's outpatient clinic was so busy that he required a secret door in his consulting rooms to escape from the ever-growing queue of eager patients. The origins of this charming story are unknown, and the door may have never existed. However, at present, Corrigan's secret door is often quoted when busy physicians have their own little ways in surviving a stressful professional life. Generations of British-trained doctors have grown up with Corrigan's secret door, as it was featured in the introduction of the Oxford Handbook of Clinical Medicine. Accordingly, trainees as well as more senior doctors are often reminded that having a 'secret door' is vital in surviving in the medical profession. My own escape is through classical music and the violoncello, in particular. As the name implies, my own secret door is normally invisible to colleagues and patients. This little article is about a patient who found me out, and a reflection on the role of classical music and the cello in my professional life.

  14. Environmental sustainability comparison of a hypothetical pneumatic waste collection system and a door-to-door system.

    Punkkinen, Henna; Merta, Elina; Teerioja, Nea; Moliis, Katja; Kuvaja, Eveliina


    Waste collection is one of the life cycle phases that influence the environmental sustainability of waste management. Pneumatic waste collection systems represent a new way of arranging waste collection in densely populated urban areas. However, limited information is available on the environmental impacts of this system. In this study, we compare the environmental sustainability of conventional door-to-door waste collection with its hypothetical pneumatic alternative. Furthermore, we analyse whether the size of the hypothetical pneumatic system, or the number of waste fractions included, have an impact on the results. Environmental loads are calculated for a hypothetical pneumatic waste collection system modelled on an existing dense urban area in Helsinki, Finland, and the results are compared to those of the prevailing, container-based, door-to-door waste collection system. The evaluation method used is the life-cycle inventory (LCI). In this study, we report the atmospheric emissions of greenhouse gases (GHG), SO(2) and NO(x). The results indicate that replacing the prevailing system with stationary pneumatic waste collection in an existing urban infrastructure would increase total air emissions. Locally, in the waste collection area, emissions would nonetheless diminish, as collection traffic decreases. While the electricity consumption of the hypothetical pneumatic system and the origin of electricity have a significant bearing on the results, emissions due to manufacturing the system's components prove decisive. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. A case of possessive state with onset influenced by 'door-to-door' sales.

    Satoh, S; Obata, S; Seno, E; Okada, T; Morita, N; Saito, T; Yoshikawa, M; Yamagami, A


    Recently in Japan, 'door-to-door sales' has become of concern because it has created numerous legal and social problems. In this paper, a 47 year old dissociative trance disorder case who presented with possession by God is discussed. Specific types of door-to-door sales is known to use superstition and folk beliefs as tools to lure customers. In this particular case, these religious factors seemed to have played an important role in the precipitation of the disorder and its presentation. In addition, the brain-washing environment observed in video lectures used in door-to-door sales seemed to play an important role in the development of the possessive state. We also performed social psychiatric analysis of the occurrence of the possessive state in a city area, which has been considered to develop within traditional culture. Phenomenological classification by one of the authors was useful for diagnosing underlying disorders in the possessive state.

  16. September 2013: the doors open

    Antonella Del Rosso


    Three special days and one public open day: at the end of September our Laboratory will open its doors to visitors from CERN, the local region and all over the world. With over 150,000 visitors expected in total, the organisation of the OpenDays is a challenge that a core team of eleven people have taken up with enthusiasm.   They come from several departments but share one goal: making the last four days of September an unforgettable experience for all the visitors who will come to discover the Laboratory and its scientists. The core team in charge of the organisation of the events is co-ordinated by Hermann Schmickler. “The events are an opportunity for us to celebrate  the discoveries, the excellent performance of the technical installations and the vital contribution of all the CERN personnel, the thousands of users and those working under support contracts,” says Hermann Schmickler. The four-day programme will start on Friday 27 September with an “...

  17. The Globe reopens its doors

    CERN Bulletin


    After a year of work, the newly renovated Globe of Science and Innovation will open its doors again at 10 a.m. on Tuesday, 19 April. The “Universe of Particles” exhibition has been updated and will be open to the public, free of charge, from 10 a.m. to 5 p.m., Monday to Saturday (except during official CERN closures). The Globe’s programme of lectures and events for the general public will restart at the end of April. What’s on at the Globe in April and May: - 28 April at 6.30 p.m.: Theatre – “Curie_Meitner_Lamarr_indivisible”, a play that pays tribute to the lives of three exceptional women in the field of science and technology (in English). Reservations: - 10 May at 8.30 p.m.: Lecture – “Le modèle du CERN et les grands défis mondiaux” (“The CERN model and the key global challenges”) by Michel Spiro (in French with simultaneous ...

  18. A prospective, randomized multicenter study comparing APD and CAPD treatment

    Bro, S; Bjorner, J B; Tofte-Jensen, P


    OBJECTIVE: The goals for maintenance dialysis treatment are to improve patient survival, reduce patient morbidity, and improve patient quality of life. This is the first randomized prospective study comparing automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD)...

  19. Vraaggericht werken door narratief onderzoek

    Joos Meesters


    Full Text Available Narrative research as a means for demand-driven policy and interventions This article reports on the advantages of performing narrative research discovering need patterns of families, children, local residents regarding quality of the pedagogical climate in their neighbourhood. A need pattern is a constructed set of related questions and needs that people express in response to life events, concrete experiences or within their current habitat. A method for narrative analysis was developed for two applications: use as a research tool and use as a change management tool. In this method professionals assume the role of narrative researchers and simultaneously learn to listen to the demands and needs of their potential clients from a more objective perspective. The method has been developed while performing transdisciplinary narrative research in the town-area of Hatert in Nijmegen, which will be presented as an example case throughout the text. Vraaggericht werken door narratief onderzoek Dit artikel gaat in op de mogelijkheden van narratief onderzoek in het opsporen van vraagpatronen van gezinnen, kinderen, wijkbewoners met betrekking tot de kwaliteit van het opgroeiklimaat in hun wijk. Een vraagpatroon is een set van samenhangende vragen en behoeften die burgers uiten naar aanleiding van een levensgebeurtenis, een concrete ervaring of binnen de actuele context waar zij in leven. Voor deze vorm van onderzoek is een vraaganalyse-instrument ontwikkeld om deze vraagpatronen te identificeren. Dit instrument heeft een dubbel perspectief. Het is een onderzoeksinstrument en een veranderkundig instrument. De professional kruipt in de rol van onderzoeker en leert hiermee te luisteren naar de vragen en behoeften van burgers. Het instrument is ontwikkeld in en voor een transdisciplinair, narratief onderzoek in de wijk Hatert in Nijmegen, dat we als casus zullen presenteren.

  20. Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards.

    Muir-Cochrane, Eimear; van der Merwe, Marie; Nijman, Henk; Haglund, Kristina; Simpson, Alan; Bowers, Len


    There is disagreement among psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. This study explored patient, staff, and visitor perceptions about the acceptability of locking the ward door on acute psychiatric inpatient wards. Interviews were conducted with 14 registered nurses, 15 patients, and six visitors from three different acute wards. Findings revealed commonalities across all groups, with general agreement that locking the door reduced absconding. Staff expressed feelings of guilt, embarrassment, and fear of being blamed when a patient absconded. Staff also reported that open wards created anxious vigilance to prevent an abscond and increased workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door, expressing depression, a sense of stigma, and low self-esteem when the door was locked. The issue of balancing safety and security on acute psychiatric wards against the autonomy of patients is not easily resolved, and requires focused research to develop innovative nursing practices. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  1. Improving Balance in Subacute Stroke Patients: A Randomized Controlled Study

    Goljar, Nika; Burger, Helena; Rudolf, Marko; Stanonik, Irena


    The aim of the study was to compare the efficacy of balance training in a balance trainer, a newly developed mechanical device for training balance, with conventional balance training in subacute stroke patients. This was a randomized controlled study. Fifty participants met the inclusion criteria and 39 finished the study. The participants were…

  2. 49 CFR 571.206 - Standard No. 206; Door locks and door retention components.


    ... can be loaded or unloaded. It does not include: (a) A trunk lid; or (b) A door or window composed... the door in the fully latched or secondary latched position. Trunk Lid is a movable body panel that... minimum displacement of 300 mm. (c) Two load cells of sufficient capacity to measure the applied loads...

  3. Electric two wheelers, zero emission solution for urban door to door transportation

    Fasil, Muhammed; Jensen, Bogi Bech

    The noise and exhaust pollution coupled with increasing congestion faced by urban centres demands new personal mobility solution for faster door to door connectivity. The advancement in electric power train and lowering cost of Li-ion battery is made it possible to develop light weight fully...

  4. Empirical evidence of study design biases in randomized trials

    Page, Matthew J.; Higgins, Julian P. T.; Clayton, Gemma


    Objective: To synthesise evidence on the average bias and heterogeneity associated with reported methodological features of randomized trials. Design: Systematic review of meta-epidemiological studies. Methods: We retrieved eligible studies included in a recent AHRQ-EPC review on this topic (late...

  5. Will patients accept randomization to psychoanalysis? A feasibility study.

    Caligor, Eve; Hilsenroth, Mark J; Devlin, Michael; Rutherford, Bret R; Terry, Madeleine; Roose, Steven P


    The feasibility of using a randomized design in a psychoanalytic outcome study was evaluated. Our hypothesis was that it would be feasible to randomize patients to psychoanalysis three or four times weekly on the couch for five years, supportive expressive therapy once or twice weekly for up to forty sessions, and cognitive behavior therapy once or twice weekly for up to forty sessions. Successful randomization was defined as a 30% recruitment rate among eligible patients. Recruitment began in September 2009 and closed in April 2010. A total of 132 subjects responded to study advertisements, 107 of whom (81%) were triaged out. The remaining 25 were scheduled for the first of two clinical interviews, and 21 of 25 (88%) completed the interview. Eleven of the 25 (44%) were determined to be eligible based on inclusion and exclusion criteria. Eight of the 11 accepted the idea of randomization and completed the diagnostic assessment phase. Calculated on the basis of 8 of 11 eligible patients accepting randomization, the 95% confidence interval was that 39% to 92% of eligible subjects would participate in a larger study of this design. Our findings support the feasibility of implementing an RCT comparing psychoanalysis as defined by the American Psychoanalytic Association (three or four times weekly on the couch for approximately five years) with shorter-term dynamic or cognitive behavioral therapy once or twice a week. Pre-treatment characteristics of these eight patients are presented, as are initial reliability data for the treatment adherence scales used in this trial.

  6. A Monte Carlo study of adsorption of random copolymers on random surfaces

    Moghaddam, M S


    We study the adsorption problem of a random copolymer on a random surface in which a self-avoiding walk in three dimensions interacts with a plane defining a half-space to which the walk is confined. Each vertex of the walk is randomly labelled A with probability p sub p or B with probability 1 - p sub p , and only vertices labelled A are attracted to the surface plane. Each lattice site on the plane is also labelled either A with probability p sub s or B with probability 1 - p sub s , and only lattice sites labelled A interact with the walk. We study two variations of this model: in the first case the A-vertices of the walk interact only with the A-sites on the surface. In the second case the constraint of selective binding is removed; that is, any contact between the walk and the surface that involves an A-labelling, either from the surface or from the walk, is counted as a visit to the surface. The system is quenched in both cases, i.e. the labellings of the walk and of the surface are fixed as thermodynam...


    Muhammet ARSLAN


    Full Text Available Woodworking which is in the most important Turk art branches have been used especially in Anatolia land readily. Wooden material that is seen on architectural units such as mimbar, ambo, wings of door and window, lectern has an important particularly with its ornamental figures. Wooden composition on the north and east doors of Adıyaman Great Mosque was built by Dulkadir Principality but regulated again in the last period of Ottoman Empire, is a theme which is exemined detailedly in Turk art. In this article, it is tried to determined ornamentel and tecnical characteristics of wooden door wings of Adıyaman Great Mosque belongs to early XX. century and the place of them in Turk art.

  8. Improving Emergency Department Door to Doctor Time and Process Reliability

    El Sayed, Mazen J.; El-Eid, Ghada R.; Saliba, Miriam; Jabbour, Rima; Hitti, Eveline A.


    Abstract The aim of this study is to determine the effectiveness of using lean management methods on improving emergency department door to doctor times at a tertiary care hospital. We performed a before and after study at an academic urban emergency department with 49,000 annual visits after implementing a series of lean driven interventions over a 20 month period. The primary outcome was mean door to doctor time and the secondary outcome was length of stay of both admitted and discharged patients. A convenience sample from the preintervention phase (February 2012) was compared to another from the postintervention phase (mid-October to mid-November 2013). Individual control charts were used to assess process stability. Postintervention there was a statistically significant decrease in the mean door to doctor time measure (40.0 minutes ± 53.44 vs 25.3 minutes ± 15.93 P < 0.001). The postintervention process was more statistically in control with a drop in the upper control limits from 148.8 to 72.9 minutes. Length of stay of both admitted and discharged patients dropped from 2.6 to 2.0 hours and 9.0 to 5.5 hours, respectively. All other variables including emergency department visit daily volumes, hospital occupancy, and left without being seen rates were comparable. Using lean change management techniques can be effective in reducing door to doctor time in the Emergency Department and improving process reliability. PMID:26496278

  9. Use of risk assessment analysis by failure mode, effects, and criticality to reduce door-to-balloon time.

    Khare, Rahul K; Nannicelli, Anna P; Powell, Emilie S; Seivert, Nicholas P; Adams, James G; Holl, Jane L


    The Centers for Medicare & Medicaid Services currently endorses a door-to-balloon time of 90 minutes or less for patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction. Recent evidence shows that a door-to-balloon time of 60 minutes significantly decreases inhospital mortality. We seek to use a proactive risk assessment method of failure mode, effects, and criticality analysis (FMECA) to evaluate door-to-balloon time process, to investigate how each component failure may affect the performance of a system, and to evaluate the frequency and the potential severity of harm of each failure. We conducted a 2-part study: FMECA of the door-to-balloon time system and process of care, and evaluation of a single institution's door-to-balloon time operational data using a retrospective observational cohort design. A multidisciplinary group of FMECA participants described the door-to-balloon time process to then create a comprehensive map and table listing all process steps and identified process failures, including their frequency, consequence, and causes. Door-to-balloon time operational data were assessed by "on" versus "off" hours. Fifty-one failure points were identified across 4 door-to-balloon time phases. Of the 12 high-risk failures, 58% occurred between ECG and catheterization laboratory activation. Total door-to-balloon time during on hours had a median time of 55 minutes (95% confidence interval 46 to 60 minutes) compared with 77 minutes (95% confidence interval 68 to 83 minutes) during off hours. The FMECA revealed clear areas of potential delay and vulnerability that can be addressed to decrease door-to-balloon time from 90 to 60 minutes. FMECAs can provide a robust assessment of potential risks and can serve as the platform for significant process improvement and system redesign for door-to-balloon time. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  10. Randomized controlled study of CBT in bronchial asthma

    Grover Naveen


    Full Text Available The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random-ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured interview schedule, Asthma Symptom Checklist, Asthma di-ary, Asthma Bother Profile, Hospital Anxiety & Depression Scale, AQLQ and Peak Expiratory Flow Rate. Within group comparison showed significant improvement in both groups at the post assessment. Between group comparisons showed that CBT group reported significantly greater change than that of SM group. Cognitive behavior therapy helps in improving the managment of asthma.

  11. Thromboembolism and mechanical heart valves : A randomized study revisited

    Kuntze, CEE; Blackstone, EH; Ebels, T


    Background. This study was designed to revise and substantiate previous inferences, based on short-term follow-up, about differences in the incidence of anticoagulant-related events after heart valve replacement among patients who had been randomly assigned to receive either a Bjork-Shiley, Edwards-

  12. Cognitive Behavioral Principles within Group Mentoring: A Randomized Pilot Study

    Jent, Jason F.; Niec, Larissa N.


    This study evaluated the effectiveness of a group mentoring program that included components of empirically supported mentoring and cognitive behavioral techniques for children served at a community mental health center. Eighty-six 8- to 12-year-old children were randomly assigned to either group mentoring or a wait-list control group. Group…

  13. A Systematic Review of Randomized Controlled Studies of Art Therapy

    Maujean, Annick; Pepping, Christopher A.; Kendall, Elizabeth


    This review article examines current knowledge about the efficacy of art therapy based on the findings of 8 randomized controlled trials (RCTs) conducted with adult populations from 2008-2013 that met a high standard of rigor. Of these studies, all but one reported beneficial effects of art therapy. Review findings suggest that art therapy may…

  14. A Systematic Review of Randomized Controlled Studies of Art Therapy

    Maujean, Annick; Pepping, Christopher A.; Kendall, Elizabeth


    This review article examines current knowledge about the efficacy of art therapy based on the findings of 8 randomized controlled trials (RCTs) conducted with adult populations from 2008-2013 that met a high standard of rigor. Of these studies, all but one reported beneficial effects of art therapy. Review findings suggest that art therapy may…

  15. Thromboembolism and mechanical heart valves : A randomized study revisited

    Kuntze, CEE; Blackstone, EH; Ebels, T


    Background. This study was designed to revise and substantiate previous inferences, based on short-term follow-up, about differences in the incidence of anticoagulant-related events after heart valve replacement among patients who had been randomly assigned to receive either a Bjork-Shiley, Edwards-

  16. Maillard-reactie door model beheersbaar

    Roost, van M.


    Gewenste en ongewenste bruinkleuring van levensmiddelen door een Maillard-reactie is vaak lastig te beheersen. Wageningse onderzoekers ontwikkelden een simulatiemodel, waarmee producentenmeer inzicht krijgen in de Maillard-reactie, en zo ook de kleur van het eindproduct beter kunnen beheersen tijden

  17. Opnieuw sterfte van jonge bomen door woelmuizen

    Moraal, L.G.


    In het begin van de jaren negentig trad er behoorlijk veel schade op bij bosaanleg in het kader van de Randstadgroenstructuur en de set-aside regelingen in Groningen en Drenthe. De boompjes waren geplant op voormalige landbouwgrond. Door snelle verruiging van de vegetatie, ontstaat er voor woelmuize

  18. Schade door overstroming: Ervaringen uit New Orleans

    Kok, M.; Theunissen, R.; Jonkman, S.N.; Vrijling, J.K.


    Korte samenvatting van de overstromingen door hurricane Katrina in augustus 2005 in New Orleans en omgeving. Beschrijving van de effecten op het gebied en de bewoners, kwantitatieve inschatting van de gevolgend, en wat we hieruit voor Nederland kunnen leren. Uitgave met ondersteuning van het

  19. Zuivel en soep gezonder door logo

    Temme, E.H.M.


    Gezondheidslogo’s verspreiden zich door de schappen van de supermarkt. Het blauwe vinkje van de stichting Ik kies bewust en het klavertje vier van supermarkt Albert Heijn moeten zorgen voor een gezonder aanbod van voedingsmiddelen. Liesbeth Temme van RIKILT – Instituut voor voedselveiligheid onderzo

  20. Verspreiding van komkommerbontvirus (CGMMV) door vogels

    Stijger, I.; Hamelink, R.; Ludeking, D.J.W.


    Het komkommerbontvirus is een zeer persistent virus. De afgelopen jaren heeft het zich uitgebreid naar meerdere bedrijven. Door komkommertelers worden veel verschillende maatregelen op het gebied van hygiëne doorgevoerd om het virus uit de kas te houden of om verspreiding te voorkomen. Ondanks deze

  1. Pixel masks for screen-door transparency

    Mulder, J.D.; Groen, F.C.A.; Wijk, J.J. van


    Rendering objects transparently gives additional insight in complex and overlapping structures. However, traditional techniques for the rendering of transparent objects such as alpha blending are not very well suited for the rendering of multiple transparent objects in dynamic scenes. Screen-door tr

  2. Door grond horizontaal belaste palen: Bestaande ontwerpmodellen

    Hoefsloot, F.J.M.


    In het algemeen is een door grond horizontaal belaste paal een 3-D situatie, die in 1 fase direct met een 3-D EEM-model (zoals PLAXIS 3D Foundation) kan worden gemodelleerd. Deze modellen zijn echter gecompliceerd en pas de laatste jaren eenvoudiger toepasbaar in de adviespraktijk. Een directe berek

  3. How does the effort spent to hold a door affect verbal thanks and reciprocal help?

    Glenn Ryan Fox


    Full Text Available When someone holds a door for us we often respond with a verbal ``thanks.'' But given such a trivial favor, our feelings can vary considerably depending on how the door is held. Studies have shown that verbal thanking increases in relation to door-holding effort. However, it is unclear how such a favor can lead to verbal thanks in addition to reciprocal help. We examined how holding a door in an effortful or non-effortful manner relates to verbal thanking and reciprocal helping. We measured: (1 whether participants verbally thanked the experimenter, (2 whether they agreed to help another person by taking a survey, and (3 whether they helped pick up objects (pens that the door-holder subsequently dropped. Participants in the effortful condition were more likely to offer verbal thanks, to help pick up the pens, and to walk a greater distance to pick them up. Participants who thanked the door-holder, however, were not more likely to provide help.

  4. How Does the Effort Spent to Hold a Door Affect Verbal Thanks and Reciprocal Help?

    Fox, Glenn R.; Araujo, Helder Filipe; Metke, Michael J.; Shafer, Chris; Damasio, Antonio


    When someone holds a door for us we often respond with a verbal “thanks.” But given such a trivial favor, our feelings can vary considerably depending on how the door is held. Studies have shown that verbal thanking increases in relation to door-holding effort. However, it is unclear how such a favor can lead to verbal thanks in addition to reciprocal help. We examined how holding a door in an effortful or non-effortful manner relates to verbal thanking and reciprocal helping. We measured: (1) whether participants verbally thanked the experimenter, (2) whether they agreed to help another person by taking a survey, and (3) whether they helped pick up objects (pens) that the door-holder subsequently dropped. Participants in the effortful condition were more likely to offer verbal thanks, to help pick up the pens, and to walk a greater distance to pick them up. Participants who thanked the door-holder, however, were not more likely to provide help. PMID:26617559

  5. The Move from Accuracy Studies to Randomized Trials in PET

    Siepe, Bettina; Hoilund-Carlsen, Poul Flemming; Gerke, Oke


    Since the influential study by van Tinteren et al. published in The Lancet in 2002, there have been an increasing number of diagnostic randomized controlled trials (RCTs) investigating the benefit of PET. If they provide valid and useful information on the benefit, these studies can play an impor......Since the influential study by van Tinteren et al. published in The Lancet in 2002, there have been an increasing number of diagnostic randomized controlled trials (RCTs) investigating the benefit of PET. If they provide valid and useful information on the benefit, these studies can play...... of diagnostic randomized trials, in which PET was applied in only one arm. We covered published studies as well as registered unpublished and planned studies. We considered 3 quality indicators related to the usefulness of a trial to generate evidence for a clinical benefit: use of patient-important outcome...... only under the assumption of a substantial reduction in the event rate. Comparators typically reflected the current standard. CONCLUSION: If we consider the traditional areas of primary diagnosis, staging, and follow-up, then the number and quality of RCTs on PET is currently not sufficient to provide...

  6. Computational analysis of aircraft pressure relief doors

    Schott, Tyler

    Modern trends in commercial aircraft design have sought to improve fuel efficiency while reducing emissions by operating at higher pressures and temperatures than ever before. Consequently, greater demands are placed on the auxiliary bleed air systems used for a multitude of aircraft operations. The increased role of bleed air systems poses significant challenges for the pressure relief system to ensure the safe and reliable operation of the aircraft. The core compartment pressure relief door (PRD) is an essential component of the pressure relief system which functions to relieve internal pressure in the core casing of a high-bypass turbofan engine during a burst duct over-pressurization event. The successful modeling and analysis of a burst duct event are imperative to the design and development of PRD's to ensure that they will meet the increased demands placed on the pressure relief system. Leveraging high-performance computing coupled with advances in computational analysis, this thesis focuses on a comprehensive computational fluid dynamics (CFD) study to characterize turbulent flow dynamics and quantify the performance of a core compartment PRD across a range of operating conditions and geometric configurations. The CFD analysis was based on a compressible, steady-state, three-dimensional, Reynolds-averaged Navier-Stokes approach. Simulations were analyzed, and results show that variations in freestream conditions, plenum environment, and geometric configurations have a non-linear impact on the discharge, moment, thrust, and surface temperature characteristics. The CFD study revealed that the underlying physics for this behavior is explained by the interaction of vortices, jets, and shockwaves. This thesis research is innovative and provides a comprehensive and detailed analysis of existing and novel PRD geometries over a range of realistic operating conditions representative of a burst duct over-pressurization event. Further, the study provides aircraft

  7. Accuracy of the blower door measurement; Genauigkeit der Blower Door-Messung. Der Einfluss von Aussenklimaparametern

    Weier, H. [Hochschule fuer Technik, Wirtschaft und Sozialwesen Zittau/Goerlitz (FH), Zittau (Germany)


    The blower door is a simple to use measuring device for determing the seal of the external surfaces of buildings. The accuracy of the measurement is dependent to a considerable extent on the external climatic conditions that prevail at the time of taking the measurement. (orig.) [German] Die Blower Door ist ein einfach anzuwendendes Messgeraet zum Bestimmen der Dichtheit von Gebaeudeaussenflaechen. Die Genauigkeit der Messung ist in starkem Masse von den zum Messzeitpunkt herrschenden Aussenklimabedingungen abhaengig. (orig.)

  8. Study on the Air Flow Field of Screen Doors and Safety Doors in Underground Station of the Intercity Rail%城际铁路地下站台屏蔽门与安全门对站台内气流组织的影响研究

    喻容; 冯炼; 易小楠


      以长株潭城际快铁地下车站为研究对象,结合当地的气象条件,采用数值分析方法,通过CFD三维计算模拟软件对车站内无车进站和两车进站两种工况进行模拟,分析了屏蔽门与安全门对站台内气流组织的影响。%Taking the Changzhutan intercity rail station as the research object, concerning the local weather conditions, using the numerical analysis method, it is available to simulate the temperature and airflow distribution in two different situation of no car and two cars stops in the station through the CFD three-dimensional software. The paper analyzed the influence of screen doors and the safety doors to airflow distribution in the station.

  9. 46 CFR 32.56-35 - Doors-T/ALL.


    ... 46 Shipping 1 2010-10-01 2010-10-01 false Doors-T/ALL. 32.56-35 Section 32.56-35 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS... Doors—T/ALL. (a) Casing doors in category A machinery spaces and all elevator doors must be self-closing...

  10. Blower door measurements - extended measuring methods; Blower Door-Messungen - erweiterte Messmethoden

    Geissler, A.; Bolender, T.; Hauser, G. [Kassel Univ. (Germany). Fachgebiet Bauphysik


    To determine the air tightness of the external envelope, blower door measurements are normally carried out. The thus determined integral figure for the complete structure is an insufficient basis for carrying out specific insulation procedures in existing buildings. Within the scope of the air tightness measurements with the blower door, additional measuring methods permit the determination of additional information on the leakage distribution and the leakage routes. The expanded measuring methods that are known from the bibliography `opening a door` and `adding a hole` as well as the new method of `adding a hole plus` are explained, compared by means of exemplary measurements, and are considered for their suitability during field trials. (orig.) [Deutsch] Zur Bestimmung der Luftdichtheit der Gebaeudehuelle werden im allgemeinen Blower Door-Messungen durchgefuehrt. Der hierbei bestimmte integrale Wert fuer das gesamte Gebaeude stellt fuer das Ergreifen von gezielten Abdichtungsmassnahmen im Gebaeudebestand eine zu geringe Basis dar. Weiterfuehrende Messmethoden erlauben, im Rahmen von Luftdichtheitsmessungen mit der Blower Door zusaetzliche Informationen ueber die Leckageverteilung und ueber Leckagewege zu bestimmen. Die aus der Literatur bekannten erweiterten Messmethoden `Opening A Door` und `Adding A Hole` sowie die neue Methode `Adding A Hole Plus` werden erlaeutert, anhand von exemplarischen Messungen verglichen und im Feldeinsatz auf ihre Anwendbarkeit hin betrachtet. (orig.)

  11. Concepts for a theoretical and experimental study of lifting rotor random loads and vibrations, Phase 1

    Hohenemser, K. H.; Gaonkar, G. H.


    A number of lifting rotor conditions with random inputs are discussed. The present state of random process theory, applicable to lifting rotor problems is sketched. Possible theories of random blade flapping and random blade flap-bending are outlined and their limitations discussed. A plan for preliminary experiments to study random flapping motions of a see-saw rotor is developed.

  12. Quantum Monte Carlo Study of Random Antiferromagnetic Heisenberg Chain

    Todo, Synge; Kato, Kiyoshi; Takayama, Hajime


    Effects of randomness on the spin-1/2 and 1 antiferromagnetic Heisenberg chains are studied using the quantum Monte Carlo method with the continuous-time loop algorithm. We precisely calculated the uniform susceptibility, string order parameter, spatial and temporal correlation length, and the dynamical exponent, and obtained a phase diagram. The generalization of the continuous-time loop algorithm for the systems with higher-S spins is also presented.

  13. Contact angle hysteresis on randomly rough surfaces: a computational study.

    David, Robert; Neumann, A Wilhelm


    Wetting is important in many applications, and the solid surfaces being wet invariably feature some amount of surface roughness. A free energy-based computational simulation is used to study the effect of roughness on wetting and especially contact angle hysteresis. On randomly rough, self-affine surfaces, it is found that hysteresis depends primarily on the value of the Wenzel roughness parameter r, increasing in proportion with r - 1. Micrometer-level roughness causes hysteresis of a few degrees.

  14. Missing data methods in Mendelian randomization studies with multiple instruments.

    Burgess, Stephen; Seaman, Shaun; Lawlor, Debbie A; Casas, Juan P; Thompson, Simon G


    Mendelian randomization studies typically have low power. Where there are several valid candidate genetic instruments, precision can be gained by using all the instruments available. However, sporadically missing genetic data can offset this gain. The authors describe 4 Bayesian methods for imputing the missing data based on a missing-at-random assumption: multiple imputations, single nucleotide polymorphism (SNP) imputation, latent variables, and haplotype imputation. These methods are demonstrated in a simulation study and then applied to estimate the causal relation between C-reactive protein and each of fibrinogen and coronary heart disease, based on 3 SNPs in British Women's Heart and Health Study participants assessed at baseline between May 1999 and June 2000. A complete-case analysis based on all 3 SNPs was found to be more precise than analyses using any 1 SNP alone. Precision is further improved by using any of the 4 proposed missing data methods; the improvement is equivalent to about a 25% increase in sample size. All methods gave similar results, which were apparently not overly sensitive to violation of the missing-at-random assumption. Programming code for the analyses presented is available online.

  15. Effectiveness of adenotonsillectomy in PFAPA syndrome: a randomized study.

    Garavello, Werner; Romagnoli, Marco; Gaini, Renato Maria


    To evaluate whether adenotonsillectomy leads to complete resolution in children with PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome. Thirty-nine children with PFAPA syndrome were randomized to either adenotonsillectomy (surgery group; n = 19) or expectant management (control group; n = 20). All patients were then invited prospectively to record all PFAPA episodes, and were evaluated clinically every 3 months for 18 months after randomization. The proportion of patients experiencing complete resolution was 63% in the surgery group and 5% in the control group (P < .001). The mean (+/- standard deviation) number of episodes recorded during the study period was 0.7 +/- 1.2 in the surgery group and 8.1 +/- 3.9 in the control group (P < .001). The episodes were less severe in the surgery group. Adenotonsillectomy is an effective treatment strategy for children with PFAPA syndrome.

  16. The Vaccination of 35,000 Dogs in 20 Working Days Using Combined Static Point and Door-to-Door Methods in Blantyre, Malawi.

    Andrew D Gibson


    Full Text Available An estimated 60,000 people die of rabies annually. The vast majority of cases of human rabies develop following a bite from an infected dog. Rabies can be controlled in both human and canine populations through widespread vaccination of dogs. Rabies is particularly problematic in Malawi, costing the country an estimated 13 million USD and 484 human deaths annually, with an increasing paediatric incidence in Blantyre City. Consequently, the aim of this study was to vaccinate a minimum of 75% of all the dogs within Blantyre city during a one month period. Blantyre's 25 administrative wards were divided into 204 working zones. For initial planning, a mean human:dog ratio from the literature enabled estimation of dog population size and dog surveys were then performed in 29 working zones in order to assess dog distribution by land type. Vaccination was conducted at static point stations at weekends, at a total of 44 sites, with each operating for an average of 1.3 days. On Monday to Wednesday, door-to-door vaccination sessions were undertaken in the areas surrounding the preceding static point stations. 23,442 dogs were vaccinated at static point stations and 11,774 dogs were vaccinated during door-to-door vaccinations. At the end of the 20 day vaccination programme, an assessment of vaccination coverage through door-to-door surveys found that of 10,919 dogs observed, 8,661 were vaccinated resulting in a vaccination coverage of 79.3% (95%CI 78.6-80.1%. The estimated human:dog ratio for Blantyre city was 18.1:1. Mobile technology facilitated the collection of data as well as efficient direction and coordination of vaccination teams in near real time. This study demonstrates the feasibility of vaccinating large numbers of dogs at a high vaccination coverage, over a short time period in a large African city.

  17. WAC: Closing Doors or Opening Doors for Second Language Writers?

    Cox, Michelle


    Written by a WAC program director and second language writing studies scholar, this article raises questions about how second language writers are faring in WAC programs and the extent to which the fields of second language writing and WAC are informed by each other's scholarship. In this article, Cox draws from her review of 26 journal articles…

  18. Coblation tonsillectomy: a double blind randomized controlled study.

    Timms, M S; Temple, R H


    Tonsillectomy has been performed by a number of techniques. This double blind randomized controlled study compares the technique of tissue coblation with bipolar dissection for the removal of tonsils in 10 adult patients with a history of chronic tonsillitis. A significant reduction in post-operative pain and more rapid healing of the tonsillar fossae were found in the side removed by tissue coblation. There were no episodes of primary or secondary haemorrhage on either side. This new technique for tonsil removal warrants further study.

  19. Opening New Doors: Hands-On Participation Brings a New Audience to the Clay Studio. Wallace Studies in Building Arts Audiences

    Harlow, Bob; Heywood, Tricia


    This case study examines how The Clay Studio, a ceramic-arts studio, gallery and shop in Philadelphia, attracted younger audiences to its workshops and exhibits. In 2007, the studio became concerned that its audience was getting older and few newcomers were signing up for classes or making purchases. The studio had to engage younger professionals…

  20. Influence of door handles design in effort perception: accessibility and usability.

    Paschoarelli, Luis Carlos; Santos, Raquel; Bruno, Paula


    The application of ergonomics in product design is essential to its accessibility and usability. The development of manual devices should be based on ergonomic principles. Effort perception analysis is an essential approach to understand the physical and subjective aspects of the interface. The objective of the present study was to analyze the effort perception during a simulated task with different door handles by Portuguese subjects of both genders and different ages. This transversal study agreed with ethical aspects. 180 subjects of both genders pertaining to three age groups have participated. Five door handles with different shapes were evaluated. A subjective numeric rating scale of 5 levels was used to evaluate the effort. For statistical analysis it was applied the Friedman non-parametric test. The results have showed no significant differences of effort perception in door handles "A" and "B"; "A" and "D"; and "D" and "C". Door handle "E" presented the lowest values of all. In general, there's an inverse relationship between the results of biomechanical studies and the effort perception of the same task activity. This shows that door handles design influence directly these two variables and can interfere in the accessibility and usability of these kinds of products.

  1. Randomly and Non-Randomly Missing Renal Function Data in the Strong Heart Study: A Comparison of Imputation Methods.

    Shara, Nawar; Yassin, Sayf A; Valaitis, Eduardas; Wang, Hong; Howard, Barbara V; Wang, Wenyu; Lee, Elisa T; Umans, Jason G


    Kidney and cardiovascular disease are widespread among populations with high prevalence of diabetes, such as American Indians participating in the Strong Heart Study (SHS). Studying these conditions simultaneously in longitudinal studies is challenging, because the morbidity and mortality associated with these diseases result in missing data, and these data are likely not missing at random. When such data are merely excluded, study findings may be compromised. In this article, a subset of 2264 participants with complete renal function data from Strong Heart Exams 1 (1989-1991), 2 (1993-1995), and 3 (1998-1999) was used to examine the performance of five methods used to impute missing data: listwise deletion, mean of serial measures, adjacent value, multiple imputation, and pattern-mixture. Three missing at random models and one non-missing at random model were used to compare the performance of the imputation techniques on randomly and non-randomly missing data. The pattern-mixture method was found to perform best for imputing renal function data that were not missing at random. Determining whether data are missing at random or not can help in choosing the imputation method that will provide the most accurate results.

  2. Randomly and Non-Randomly Missing Renal Function Data in the Strong Heart Study: A Comparison of Imputation Methods.

    Nawar Shara

    Full Text Available Kidney and cardiovascular disease are widespread among populations with high prevalence of diabetes, such as American Indians participating in the Strong Heart Study (SHS. Studying these conditions simultaneously in longitudinal studies is challenging, because the morbidity and mortality associated with these diseases result in missing data, and these data are likely not missing at random. When such data are merely excluded, study findings may be compromised. In this article, a subset of 2264 participants with complete renal function data from Strong Heart Exams 1 (1989-1991, 2 (1993-1995, and 3 (1998-1999 was used to examine the performance of five methods used to impute missing data: listwise deletion, mean of serial measures, adjacent value, multiple imputation, and pattern-mixture. Three missing at random models and one non-missing at random model were used to compare the performance of the imputation techniques on randomly and non-randomly missing data. The pattern-mixture method was found to perform best for imputing renal function data that were not missing at random. Determining whether data are missing at random or not can help in choosing the imputation method that will provide the most accurate results.

  3. Random matrix study for a three-terminal chaotic device

    Martínez-Argüello, A. M.; Castaño, E.; Martínez-Mares, M. [Departamento de Física, Universidad Autónoma Metropolitana-Iztapalapa, Apartado Postal 55-534, 09340 México Distrito Federal (Mexico)


    We perform a study based on a random-matrix theory simulation for a three-terminal device, consisting of chaotic cavities on each terminal. We analyze the voltage drop along one wire with two chaotic mesoscopic cavities, connected by a perfect conductor, or waveguide, with one open mode. This is done by means of a probe, which also consists of a chaotic cavity that measure the voltage in different configurations. Our results show significant differences with respect to the disordered case, previously considered in the literature.

  4. Revolving Doors in International Tax

    Christensen, Rasmus Corlin


    Financial technology, or FinTech, involves the design and delivery of financial products and services through technology. It impacts financial institutions, regulators, customers, and merchants across a wide range of industries. Pervasive digital technologies are challenging the fundamentals...... of the highly regulated financial sector, leading to the emergence of non-traditional payment systems, peer-to-peer money exchanges and increased turbulence in currency markets. This case study explores the development of a FinTech company in China that offers microloans to college students. Five lessons...

  5. Do locked doors in psychiatric hospitals prevent patients from absconding?

    Undine E. Lang

    Full Text Available Background and Objectives: In the acute treatment of acute psychiatric patients coercive measures are often required and therapeutic relationships can be affected by such measures. In this study we assessed whether opening the entrance door of an acute psychiatric ward influences absconding behaviour. Methods: An acute psychiatric ward was primarily closed (91.4% for six months and primarily open (75.6% for six months over the time period of one year. In this one year period, 337 patients were treated (206 male, age: 40 ± 16 years: 60.2% of the patients had schizophrenia, 13.6% had affective disorders, 11.6% suffered from addiction and 14.5% displayed other diagnoses. Results: In terms of age (t = 0.026, df = 335, p = 0.979, gender (chi² = 1.6, df = 1, p = 0.13, diagnoses (chi² = 7.337, df = 1, p = 0.062 and duration of stay (t = -0.90, df = 335, p = 0.928, we found no significant differences between the patients admitted in the closed and those admitted in the open ward period. Absconding (df = 1, chi² = 5.107, p = 0.029, aggressive incidents (chi² = 4.46, df = 1, p = 0.050 and coercive medications (chi² = 4.646, df = 1, p = 0.037 were observed significantly more often in the closed door period. Moreover, the duration up to readmission was reduced in the closed time period (t = 2.314, df = 54, p = 0.025. Conclusions: We hypothesize that open doors reduce patient's discomfort, improve ward atmosphere and aggressive acts and do not appear to increase the risk of absconding.

  6. Traumatic asphyxia--fatal accident in an automatic revolving door.

    Cortis, J; Falk, J; Rothschild, M A


    Due to continuing modernisation, the number of automatic doors in routine use, including powered revolving doors, has increased in recent years. Automatic revolving doors are found mostly in department stores, airports, railway stations and hospitals. Although safety arrangements and guidelines concerning the installation of automatic doors are in existence, their disregard in conjunction with obsolete or incorrect installation can lead to fatal accidents. In this report, a 19-month-old boy is described whose right arm was caught between the elements of an automatic revolving door. As a direct result of rescue attempts, the child's body was drawn further into the narrow gap between elements of the door. To get the boy's body out of the 4-cm-wide gap between the fixed outer wall of the revolving door and the revolving inner, back-up batteries had to be disconnected so as to stop the electrical motor powering the door. Cardiopulmonary resuscitation was begun immediately after the rescue but was unsuccessful; the child was declared dead at the hospital he was taken to. The cause of death was a combination of compression-related skull and brain injury together with thoracic compression. This case shows an outstanding example of the preventive aspect as a special task of forensic medicine. Additionally, it serves as a warning for the correct installation and use of automatic revolving doors. Even so, small children should not use these doors on their own, but only with an alert companion, so as to prevent further fatal accidents of this sort.

  7. Revolving Doors in International Tax

    Christensen, Rasmus Corlin


    learned are presented for organizations to better manage the challenges and to leverage the opportunities amidst the disruption of financial sector. Our findings also shed light on how digital technology 1) offers the strategic capability for a firm to occupy a market niche in financial sector, 2) enables......Financial technology, or FinTech, involves the design and delivery of financial products and services through technology. It impacts financial institutions, regulators, customers, and merchants across a wide range of industries. Pervasive digital technologies are challenging the fundamentals...... of the highly regulated financial sector, leading to the emergence of non-traditional payment systems, peer-to-peer money exchanges and increased turbulence in currency markets. This case study explores the development of a FinTech company in China that offers microloans to college students. Five lessons...

  8. Hypnosis versus diazepam for embryo transfer: a randomized controlled study.

    Catoire, Patrick; Delaunay, Laurent; Dannappel, Thomas; Baracchini, Dominique; Marcadet-Fredet, Sabine; Moreau, Olivier; Pacaud, Luc; Przyrowski, Daniel; Marret, Emmanuel


    Levitas et al. (2006) showed in a cohort study that hypnosis during embryo transfer (ET) increased pregnancy ratio by 76%. In order to evaluate hypnosis during ET in a general population, the authors performed a randomized prospective controlled study comparing diazepam (usual premedication) administered before ET plus muscle relaxation versus hypnosis plus placebo in 94 patients. Additionally, the authors studied anxiety pre and post ET. Anxiety scores were not different in the two groups before and after ET. No difference in pregnancy and birth ratio was found in the two groups. Hypnosis during ET is as effective as diazepam in terms of pregnancy ratio and anxiolytic effects, but with fewer side effects and should be routinely available.

  9. Alcohol consumption and cognitive performance: a Mendelian randomization study.

    Kumari, Meena; Holmes, Michael V; Dale, Caroline E; Hubacek, Jaroslav A; Palmer, Tom M; Pikhart, Hynek; Peasey, Anne; Britton, Annie; Horvat, Pia; Kubinova, Ruzena; Malyutina, Sofia; Pajak, Andrzej; Tamosiunas, Abdonas; Shankar, Aparna; Singh-Manoux, Archana; Voevoda, Mikhail; Kivimaki, Mika; Hingorani, Aroon D; Marmot, Michael G; Casas, Juan P; Bobak, Martin


    To use Mendelian randomization to assess whether alcohol intake was causally associated with cognitive function. Mendelian randomization using a genetic variant related to alcohol intake (ADH1B rs1229984) was used to obtain unbiased estimates of the association between alcohol intake and cognitive performance. Europe. More than 34 000 adults. Any versus no alcohol intake and units of intake in the previous week was measured by questionnaire. Cognitive function was assessed in terms of immediate and delayed word recall, verbal fluency and processing speed. Having consumed any versus no alcohol was associated with higher scores by 0.17 standard deviations (SD) [95% confidence interval (CI) = 0.15, 0.20] for immediate recall, 0.17 SD (95% CI = 0.14, 0.19) for delayed recall, 0.17 SD (95% CI = 0.14, 0.19) for verbal fluency and 0.12 SD (95% CI = 0.09, 0.15) for processing speed. The minor allele of rs1229984 was associated with reduced odds of consuming any alcohol (odds ratio = 0.87; 95% CI = 0.80, 0.95; P = 0.001; R(2)  = 0.1%; F-statistic = 47). In Mendelian randomization analysis, the minor allele was not associated with any cognitive test score, and instrumental variable analysis suggested no causal association between alcohol consumption and cognition: -0.74 SD (95% CI = -1.88, 0.41) for immediate recall, -1.09 SD (95% CI = -2.38, 0.21) for delayed recall, -0.63 SD (95% CI = -1.78, 0.53) for verbal fluency and -0.16 SD (95% CI = -1.29, 0.97) for processing speed. The Mendelian randomization analysis did not provide strong evidence of a causal association between alcohol consumption and cognitive ability. © 2014 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

  10. Mendelian randomization: genetic anchors for causal inference in epidemiological studies

    Davey Smith, George; Hemani, Gibran


    Observational epidemiological studies are prone to confounding, reverse causation and various biases and have generated findings that have proved to be unreliable indicators of the causal effects of modifiable exposures on disease outcomes. Mendelian randomization (MR) is a method that utilizes genetic variants that are robustly associated with such modifiable exposures to generate more reliable evidence regarding which interventions should produce health benefits. The approach is being widely applied, and various ways to strengthen inference given the known potential limitations of MR are now available. Developments of MR, including two-sample MR, bidirectional MR, network MR, two-step MR, factorial MR and multiphenotype MR, are outlined in this review. The integration of genetic information into population-based epidemiological studies presents translational opportunities, which capitalize on the investment in genomic discovery research. PMID:25064373

  11. Randomized study of phentolamine mesylate for reversal of local anesthesia.

    Laviola, M; McGavin, S K; Freer, G A; Plancich, G; Woodbury, S C; Marinkovich, S; Morrison, R; Reader, A; Rutherford, R B; Yagiela, J A


    Local anesthetic solutions frequently contain vasoconstrictors to increase the depth and/or duration of anesthesia. Generally, the duration of soft-tissue anesthesia exceeds that of pulpal anesthesia. Negative consequences of soft-tissue anesthesia include accidental lip and tongue biting as well as difficulty in eating, drinking, speaking, and smiling. A double-blind, randomized, multicenter, Phase 2 study tested the hypothesis that local injection of the vasodilator phentolamine mesylate would shorten the duration of soft-tissue anesthesia following routine dental procedures. Participants (122) received one or two cartridges of local anesthetic/vasoconstrictor prior to dental treatment. Immediately after treatment, 1.8 mL of study drug (containing 0.4 mg phentolamine mesylate or placebo) was injected per cartridge of local anesthetic used. The phentolamine was well-tolerated and reduced the median duration of soft-tissue anesthesia in the lip from 155 to 70 min (p < 0.0001).

  12. Prevention of radioinduced cystitis by orgotein: a randomized study.

    Sanchiz, F; Millá, A; Artola, N; Julià, J C; Moya, L M; Pedro, A; Vila, A


    On the basis of previous experiences indicating that the anti-oxidant agent Cu/Zn superoxide dismutase (SOD) is an effective drug in reducing acute and late radiation-induced tissue injury, in the Center of Radiotherapy and Oncology of Catalonia, Barcelona, Spain in 1990 we implemented a randomized prospective study to analyze the incidence and grade of side effects in a group of bladder cancer patients. After surgery patients were randomly allocated to receive either: Option A: Radiotherapy or Option B: Radiotherapy + SOD 8 mgr/IM/day, after each radiotherapeutic application. Between January 1990 and January 1995 a total of 448 patients were included (226 A/ 222 B). Apart from cutaneous side effects, a highly significant incidence of radioinduced acute cystitis and rectitis was detected in patients not treated by SOD. Which was similar to the delayed side effects. From our data we can conclude that SOD is effective in decreasing acute radioinduced damage, and also in preventing the appearance of more delayed disorders.

  13. A Comparative Study of Randomized Constraint Solvers for Random-Symbolic Testing

    Takaki, Mitsuo; Cavalcanti, Diego; Gheyi, Rohit; Iyoda, Juliano; dAmorim, Marcelo; Prudencio, Ricardo


    The complexity of constraints is a major obstacle for constraint-based software verification. Automatic constraint solvers are fundamentally incomplete: input constraints often build on some undecidable theory or some theory the solver does not support. This paper proposes and evaluates several randomized solvers to address this issue. We compare the effectiveness of a symbolic solver (CVC3), a random solver, three hybrid solvers (i.e., mix of random and symbolic), and two heuristic search solvers. We evaluate the solvers on two benchmarks: one consisting of manually generated constraints and another generated with a concolic execution of 8 subjects. In addition to fully decidable constraints, the benchmarks include constraints with non-linear integer arithmetic, integer modulo and division, bitwise arithmetic, and floating-point arithmetic. As expected symbolic solving (in particular, CVC3) subsumes the other solvers for the concolic execution of subjects that only generate decidable constraints. For the remaining subjects the solvers are complementary.


    Golubev Stanislav Sergeevich


    Full Text Available Results of thermal tests of balcony doors are presented in the article. In the course of the research project, two types of doors were tested. The first type represents a PVC frame door (width 82 mm; it has a triple glazing (4K-16Ar-4-16Ar-K4; its blank part represents a polystyrene sandwich panel (width 40 mm. The second type represents a PVC frame door (width 82 mm, that has a triple glazing (4K-16Ar-4-16Ar-K4 and composite PVC panels. The testing procedure and processing results are described in the article. The test has demonstrated that the thermal resistance value of the balcony door of the first type exceeds the thermal resistance value of the balcony door of the second type.

  15. Design Report for ACP Hot Cell Rear Door

    Ku, J. H.; Kwon, K. C.; Choung, W. M.; Cho, I. J.; Kook, D. H.; Lee, W. K.; You, G. S.; Lee, E. P.; Park, S. W


    A hot-cell facility was constructed at the IMEF building for the demonstrate ACP process. ACP hot-cell consists of process cell and maintenance cell, and each cell has rear door. Since this facility was constructed at basement floor, all process materials, equipment and radioactive materials are take in and out through the rear door. Also, this door can be an access route of workers for the maintenance works. Therefore ACP hot-cell rear doors must maintain the radiation shielding, sealing, mechanical and structural safety. This report presents design criteria, design contents of each part and driving part. It was confirmed that the rear doors sufficiently maintain the safety through the structural analysis and shielding analysis. Also, it was confirmed that the rear doors were constructed as designed by the gamma scanning test after the installation.


    Slobodan Stefanovic


    Full Text Available The paper presents a logic synthesis procedure pneumatic control of the door of the bus for suburban traffic. Minimization of pneumatic control is determined graphically by Weitz – Carnot method. It also shows all pneumatic components belonging to installations used for opening and closing the door of the bus. Finally it is shown the basic maintenance of pneumatic system of the bus door.

  17. Opening the doors: building brand awareness.

    John, Judith; McCartney, Rob


    In search of a credible and cost-effective way to promote Mount Sinai Hospital (Mount Sinai) and educate a broad public, Mount Sinai opened its doors wide to The Globe and Mail (The Globe). The result was a three-part national feature series that told Mount Sinai's compelling story, provided third-party credibility and confirmed the value of proactive media relations. The series engaged our staff, energized our volunteers and reached both stakeholders and the general public on an emotional level. It also generated the more than dollars 6 million worth of equivalent advertising space it would have required for Mount Sinai to reach this national audience.

  18. Patterns of post-cabinet careers: When one door closes another door opens?

    Dörrenbächer, N.


    This article tackles the question to what extent former cabinet members go through the so-called revolving door by starting a second career in the private sector, and what factors make them likely to do so. After a cabinet position, career advancement in the political and public sector is difficult.

  19. Simplified multizone blower door techniques for multifamily buildings. Final report



    This research focused on the applicability of (a) two-blower-door and (b) single-blower-door multi-zone pressurization techniques for estimating the air leakage characteristics of New York State multi-family apartment buildings. The research also investigated the magnitude of external leakage area in multi-family buildings and used computer simulations to estimate the effect of decreasing external and internal leakage areas on air infiltration rates. This research investigates whether two blower doors can be used to determine the ELA of the exterior envelope and the ELA of partitions. Two multi-zone versions of the single-blower-door pressurization method are also examined.

  20. Humans cannot consciously generate random numbers sequences: Polemic study.

    Figurska, Małgorzata; Stańczyk, Maciej; Kulesza, Kamil


    It is widely believed, that randomness exists in Nature. In fact such an assumption underlies many scientific theories and is embedded in the foundations of quantum mechanics. Assuming that this hypothesis is valid one can use natural phenomena, like radioactive decay, to generate random numbers. Today, computers are capable of generating the so-called pseudorandom numbers. Such series of numbers are only seemingly random (bias in the randomness quality can be observed). Question whether people can produce random numbers, has been investigated by many scientists in the recent years. The paper "Humans can consciously generate random numbers sequences..." published recently in Medical Hypotheses made claims that were in many ways contrary to state of art; it also stated far-reaching hypotheses. So, we decided to repeat the experiments reported, with special care being taken of proper laboratory procedures. Here, we present the results and discuss possible implications in computer and other sciences.

  1. Investigating the temperature field on doors, frames and armor plate of large capacity coke ovens

    Shashov, D.V.; Shustorovich, V.M.; Komolov, V.G.; Zhazhin, S.N.


    Experimental studies were carried out at the Altaiskii and Avdeevskii coking plants to determine the temperature field on the frames, doors and armor plating of coking batteries with a capacity of 41.6 m/sup 3/. It was established that for normal operation the temperature on metal parts of the combustion chambers remained stable. However, when gas is burned, the metal is subjected to rapid heating to temperatures exceeding those under normal operation. After the flame is extinguished, cooling is characterized by an accelerated temperature drop along the ribs and the temperature on the door and frame at the upper cross beam is higher than at other levels of the combustion chamber. Several recommendations on eliminating these temperature effects are made, e.g. using material with stable mechanical properties for doors, frames and armor plate. 4 references.

  2. Partner randomized controlled trial: study protocol and coaching intervention

    Garbutt Jane M


    Full Text Available Abstract Background Many children with asthma live with frequent symptoms and activity limitations, and visits for urgent care are common. Many pediatricians do not regularly meet with families to monitor asthma control, identify concerns or problems with management, or provide self-management education. Effective interventions to improve asthma care such as small group training and care redesign have been difficult to disseminate into office practice. Methods and design This paper describes the protocol for a randomized controlled trial (RCT to evaluate a 12-month telephone-coaching program designed to support primary care management of children with persistent asthma and subsequently to improve asthma control and disease-related quality of life and reduce urgent care events for asthma care. Randomization occurred at the practice level with eligible families within a practice having access to the coaching program or to usual care. The coaching intervention was based on the transtheoretical model of behavior change. Targeted behaviors included 1 effective use of controller medications, 2 effective use of rescue medications and 3 monitoring to ensure optimal control. Trained lay coaches provided parents with education and support for asthma care, tailoring the information provided and frequency of contact to the parent's readiness to change their child's day-to-day asthma management. Coaching calls varied in frequency from weekly to monthly. For each participating family, follow-up measurements were obtained at 12- and 24-months after enrollment in the study during a telephone interview. The primary outcomes were the mean change in 1 the child's asthma control score, 2 the parent's quality of life score, and 3 the number of urgent care events assessed at 12 and 24 months. Secondary outcomes reflected adherence to guideline recommendations by the primary care pediatricians and included the proportion of children prescribed controller medications

  3. Ombuds’ corner: Open door and confidentiality

    Vincent Vuillemin


    For the Open Days, CERN will be transparent for all visitors. It's also the occasion to remember that the Ombuds' door is fully open every day of the year for all persons working for or on behalf of CERN.   The door is open, but as soon as it's closed for a discussion, the office becomes a place where total confidentiality is preserved. This may appear as a contradiction, no? The Ombuds is available to help everyone in all circumstances, but his clause of confidentiality prevents him from acting without the consent of his “visitors”. How can he possibly resolve the in-house conflicts in groups, or units, if all the parties do not voluntarily participate in its resolution? The answer is clear: the job of the Ombuds is to help the parties resolve their conflict by themselves. He will provide a few rules of communication, a process of mutual respect, suggest some possibilities that the parties may want to follow, and mediate the dispute so that people...

  4. Golden Jubilee Photos: Doors wide open

    2004-01-01 The reception area and visits desk (formerly PIO - Public Information Office) in 1972. Régine Chareyron (on the right), who has worked for the Visits Service for 35 years, is pictured here with Chantal Montuel and Cora Roth. CERN inaugurated its permanent visitor centre "Microcosm" in 1989. This brand new outreach facility added a crowning touch to CERN's tradition of openness in conducting its research activities. In keeping with Article II of the Convention, which stipulates that "the results of its (...) work shall be published or otherwise made available," CERN was already organising visits for the general public in the late 1950s, with members of the personnel doubling up as voluntary tour guides. By 1959, the Laboratory was opening its doors to almost 2 500 visitors a year. Ten years down the line, that number had risen to 12 700, and today CERN welcomes some 30 000 visitors through its doors every year. In addition, the Visits Service has developed teaching packs for sc...

  5. 颈椎后路单开门与双开门椎管扩大修复多节段脊髓型颈椎病:颈椎活动度对比%Posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy:motion range of cervical vertebrae

    梁和胜; 肖立军; 邓德礼


    BACKGROUND:Previous studies on posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy mainly focus onneurological function and clinical parameters and lack of certain comprehensiveness. OBJECTIVE:To explore the effects of posterior cervical single door and double door laminoplasty for repair of multilevel cervical myelopathy. METHODS:We selected 120 patients with multilevel cervical myelopathy and randomly divided into single door group (n=60) and double door group (n=60). The single door group underwent single door laminoplasty. The double door group underwent double door laminoplasty. The blood loss,length of stay, complication rate, neurological function improvement, motion range of cervical vertebrae and imaging changes were compared between the two groups. RESULTS AND CONCLUSION:(1) Blood loss was significantly less, length of stay was significantly shorter, and the incidence of axial symptom was significantly reduced in the double door group than in the single door group (alP 0.05). The incidence of axial symptoms was significantly less in the double door group than in the single door group (P 0.05). Postoperative Japanese Orthopaedic Association scores were significantly increased as compared with that preoperatively in both groups (P 0.05). Motion range of cervical vertebrae, extension angle, and inflexion angle were smaler after treatment compared with that preoperatively in both groups (P  目的:基于颈椎活动度探究颈椎后路单开门与双开门椎管扩大成形修复多节段脊髓型颈椎病的效果差异。方法:选取120例多节段脊髓型颈椎病患者,采取随机数字表法分为单开门组与双开门组,每组60例。单开门组给予单开门椎管扩大成形治疗,双开门组给予双开门椎管扩大成形治疗,对比两组出血量、术后住院时间、并发症发生率、神经功能改善情况、颈椎活动度及影像学变化。  结果与

  6. Working on asymmetry in Parkinson's disease: randomized, controlled pilot study.

    Ricciardi, Lucia; Ricciardi, Diego; Lena, Francesco; Plotnik, Meir; Petracca, Martina; Barricella, Simona; Bentivoglio, Anna Rita; Modugno, Nicola; Bernabei, Roberto; Fasano, Alfonso


    Posture, gait and balance problems are very disabling symptoms in Parkinson's disease (PD). An increased stride-to-stri de variability, reduction of automaticity and asymmetry of lower limbs function characterize parkinsonian gait. These features predispose to freezing of gait (FOG), which often leads to falls. The aim of this study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and reduce FOG, thus preventing falls. Twenty-eight PD patients entered a double-blind pilot feasibility controlled study and were evaluated at baseline and after 3 months of a rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire, Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire. Patients were randomly assigned to three treatment arms: (1) worst side improvement; (2) best side improvement; (3) standard therapy. All study arms showed a significant improvement of the Tinetti and SPPB scores. BSI led to a greater improvement than ST in terms of UPDRS-III (p = 0.01); Tinetti total score (p = 0.05) and Tinetti gait subscore (p = 0.01). Our study confirms the efficacy of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g., asymmetry of motor condition) might be even more effective than standard rehabilitative programs.

  7. NSAID Use after Bariatric Surgery: a Randomized Controlled Intervention Study.

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N


    Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID use in patients who underwent bariatric surgery, and to determine the use of PPIs in patients who use NSAIDs after bariatric surgery. A randomized controlled intervention study in patients after bariatric surgery. Patients were randomized to an intervention or a control group. The intervention consisted of sending a letter to patients and their general practitioners on the risks of use of NSAIDs after bariatric surgery and the importance of avoiding NSAID use. The control group received care-as-usual. Dispensing data of NSAIDs and PPIs were collected from patients' pharmacies: from a period of 6 months before and from 3 until 9 months after the intervention. Two hundred forty-eight patients were included (intervention group: 124; control group: 124). The number of users of NSAIDs decreased from 22 to 18 % in the intervention group and increased from 20 to 21 % in the control group (NS). The use of a PPI with an NSAID rose from 52 to 55 % in the intervention group, and from 52 to 69 % in the control group (NS). Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery (trial number NTR3665).

  8. People's Intuitions about Randomness and Probability: An Empirical Study

    Lecoutre, Marie-Paule; Rovira, Katia; Lecoutre, Bruno; Poitevineau, Jacques


    What people mean by randomness should be taken into account when teaching statistical inference. This experiment explored subjective beliefs about randomness and probability through two successive tasks. Subjects were asked to categorize 16 familiar items: 8 real items from everyday life experiences, and 8 stochastic items involving a repeatable…

  9. The Study of Randomized Visual Saliency Detection Algorithm

    Yuantao Chen


    Full Text Available Image segmentation process for high quality visual saliency map is very dependent on the existing visual saliency metrics. It is mostly only get sketchy effect of saliency map, and roughly based visual saliency map will affect the image segmentation results. The paper had presented the randomized visual saliency detection algorithm. The randomized visual saliency detection method can quickly generate the same size as the original input image and detailed results of the saliency map. The randomized saliency detection method can be applied to real-time requirements for image content-based scaling saliency results map. The randomization method for fast randomized video saliency area detection, the algorithm only requires a small amount of memory space can be detected detailed oriented visual saliency map, the presented results are shown that the method of visual saliency map used in image after the segmentation process can be an ideal segmentation results.


    L. Díaz-Vilariño


    Full Text Available Updated and detailed indoor models are being increasingly demanded for various applications such as emergency management or navigational assistance. The consolidation of new portable and mobile acquisition systems has led to a higher availability of 3D point cloud data from indoors. In this work, we explore the combined use of point clouds and trajectories from SLAM-based laser scanner to automate the reconstruction of building indoors. The methodology starts by door detection, since doors represent transitions from one indoor space to other, which constitutes an initial approach about the global configuration of the point cloud into building rooms. For this purpose, the trajectory is used to create a vertical point cloud profile in which doors are detected as local minimum of vertical distances. As point cloud and trajectory are related by time stamp, this feature is used to subdivide the point cloud into subspaces according to the location of the doors. The correspondence between subspaces and building rooms is not unambiguous. One subspace always corresponds to one room, but one room is not necessarily depicted by just one subspace, for example, in case of a room containing several doors and in which the acquisition is performed in a discontinue way. The labelling problem is formulated as combinatorial approach solved as a minimum energy optimization. Once the point cloud is subdivided into building rooms, envelop (conformed by walls, ceilings and floors is reconstructed for each space. The connectivity between spaces is included by adding the previously detected doors to the reconstructed model. The methodology is tested in a real case study.

  11. Prospective randomized clinical studies involving reirradiation. Lessons learned

    Nieder, Carsten [Nordland Hospital, Department of Oncology and Palliative Medicine, Bodoe (Norway); University of Tromsoe, Department of Clinical Medicine, Faculty of Health Sciences, Tromsoe (Norway); Langendijk, Johannes A. [University Medical Centre Groningen, Department of Radiation Oncology, Groningen (Netherlands); Guckenberger, Matthias [University Hospital Zuerich, Department of Radiation Oncology, Zuerich (Switzerland); Grosu, Anca L. [University Hospital Freiburg, Department of Radiation Oncology, Freiburg (Germany)


    Reirradiation is a potentially useful option for many patients with recurrent cancer. The purpose of this study was to review all recently published randomized trials in order to identify methodological strengths and weaknesses, comment on the results, clinical implications and open questions, and give advice for the planning of future trials. Systematic review of trials published between 2000 and 2015 (databases searched were PubMed, Scopus and Web of Science). We reviewed 9 trials, most of which addressed reirradiation of head and neck tumours. The median number of patients was 69. Trial design, primary endpoint and statistical hypotheses varied widely. The results contribute mainly to decision making for reirradiation of nasopharynx cancer and bone metastases. The trials with relatively long median follow-up confirm that serious toxicity remains a concern after high cumulative total doses. Multi-institutional collaboration is encouraged to complete sufficiently large trials. Despite a paucity of large randomized studies, reirradiation has been adopted in different clinical scenarios by many institutions. Typically, the patients have been assessed by multidisciplinary tumour boards and advanced technologies are used to create highly conformal dose distributions. (orig.) [German] Eine Rebestrahlung kann fuer viele Patienten mit rezidivierenden Malignomen eine nuetzliche Option bieten. Der Zweck dieser Studie bestand darin, alle in der juengeren Vergangenheit publizierten randomisierten Studien zu beurteilen, da deren methodische Staerken und Schwaechen, Ergebnisse und resultierende Implikationen bzw. offene Fragen die Planung kuenftiger Studien wesentlich beeinflussen koennen. Systematische Uebersicht aller zwischen 2000 und 2015 veroeffentlichten Studien (Literatursuche ueber PubMed, Scopus und Web of Science). Ausgewertet wurden 9 Studien, in die vor allem Patienten mit Kopf-Hals-Tumoren eingeschlossen waren. Im Median hatten 69 Patienten teilgenommen. Das

  12. Detecting Signage and Doors for Blind Navigation and Wayfinding.

    Wang, Shuihua; Yang, Xiaodong; Tian, Yingli


    Signage plays a very important role to find destinations in applications of navigation and wayfinding. In this paper, we propose a novel framework to detect doors and signage to help blind people accessing unfamiliar indoor environments. In order to eliminate the interference information and improve the accuracy of signage detection, we first extract the attended areas by using a saliency map. Then the signage is detected in the attended areas by using a bipartite graph matching. The proposed method can handle multiple signage detection. Furthermore, in order to provide more information for blind users to access the area associated with the detected signage, we develop a robust method to detect doors based on a geometric door frame model which is independent to door appearances. Experimental results on our collected datasets of indoor signage and doors demonstrate the effectiveness and efficiency of our proposed method.

  13. Oral vs. pharyngeal dysphagia: surface electromyography randomized study.

    Vaiman, Michael; Nahlieli, Oded


    A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG) studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis. Parameters evaluated during swallowing for patients after dental surgery (1: n = 62), oral infections (2: n = 49), acute tonsillitis (3: n = 66) and healthy controls (4: n = 50) included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles. The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high. Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.

  14. Oral vs. pharyngeal dysphagia: surface electromyography randomized study

    Nahlieli Oded


    Full Text Available Abstract Background A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis. Methods Parameters evaluated during swallowing for patients after dental surgery (1: n = 62, oral infections (2: n = 49, acute tonsillitis (3: n = 66 and healthy controls (4: n = 50 included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles. Results The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high. Conclusion Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.

  15. A randomized, prospective study of adjunctive Ampicillin in preterm labor

    Tehranian A


    Full Text Available Acute amniotic fluid infection has emerged as a possible cause of many heretofore unexplained preterm births. Our purpose was to determine the effect of ampicillin in the prolongation of pregnancies receiving tocolysis for preterm labor. A blinded, placebo-controlled, randomized trial was conducted to study ampicillin in women hospitalized for preterm labor between 24 and 37 weeks' gestation. A total of 60 patients with intact membranes and without chorioamnionitis who were receiving magnesium sulfate were screened. Thirty women with preterm labor received ampicillin, and 30 received placebos. The primary end point was prolongation of gestation. There was no difference in age of delivery (37.6±9.7 days vs 36.08±3.9 days, P=0.085 and no difference in retardation of delivery (4.7±3.1 vs 4.1±2.1, P=0.39. The mean degree of preterm delivery were 0.62±1.93 and 1.8±3.3 weeks in ampicillin and placebo groups, respectively (not significant, P>0.1. Conclusions: Ampicillin had no effect on interval to delivery or duration of pregnancy in women treated for preterm labor. So rotine clinical use of ampicillin during tocolysis should not be recommended.

  16. Microbiota-based Signature of Gingivitis Treatments: A Randomized Study.

    Huang, Shi; Li, Zhen; He, Tao; Bo, Cunpei; Chang, Jinlan; Li, Lin; He, Yanyan; Liu, Jiquan; Charbonneau, Duane; Li, Rui; Xu, Jian


    Plaque-induced gingivitis can be alleviated by various treatment regimens. To probe the impacts of various anti-gingivitis treatments on plaque microflora, here a double blinded, randomized controlled trial of 91 adults with moderate gingivitis was designed with two anti-gingivitis regimens: the brush-alone treatment and the brush-plus-rinse treatment. In the later group, more reduction in both Plaque Index (TMQHI) and Gingival Index (mean MGI) at Day 3, Day 11 and Day 27 was evident, and more dramatic changes were found between baseline and other time points for both supragingival plaque microbiota structure and salivary metabonomic profiles. A comparison of plaque microbiota changes was also performed between these two treatments and a third dataset where 50 subjects received regimen of dental scaling. Only Actinobaculum, TM7 and Leptotrichia were consistently reduced by all the three treatments, whereas the different microbial signatures of the three treatments during gingivitis relieve indicate distinct mechanisms of action. Our study suggests that microbiota based signatures can serve as a valuable approach for understanding and potentially comparing the modes of action for clinical treatments and oral-care products in the future.

  17. ['Door de beugel': resorption at dental elements].

    Leunisse, M; Barendrecht, D S


    A twenty-year-old man was referred to an orthodontist for orthodontic re-treatment of dental element 32 by his dentist and a periodontist. At the buccal surface of the dental element a significant gingival resorption had occurred and the root of the element was located outside of the processus alveolaris buccally. This case will be presented at the thematic tour 'Door de beugel: team up' on 27 October 2015, which is organised by the Nederlandse Vereniging van Tandartsen (Dutch Dentists' Society) and will be held at 4 different locations in the Netherlands. Readers of the Nederlands Tijdschrift voor Tandheelkunde get an exclusive preview of the case. The treatment of choice will be published in the December 2015 issue.

  18. Hazard Management with DOORS: Rail Infrastructure Projects

    Hughes, Dave; Saeed, Amer

    LOI is a major rail infrastructure project that will contribute to a modernised transport system in time for the 2012 Olympic Games. A review of the procedures and tool infrastructure was conducted in early 2006, coinciding with a planned move to main works. A hazard log support tool was needed to provide: an automatic audit trial, version control and support collaborative working. A DOORS based Hazard Log (DHL) was selected as the Tool Strategy. A systematic approach was followed for the development of DHL, after a series of tests and acceptance gateways, DHL was handed over to the project in autumn 2006. The first few months were used for operational trials and he Hazard Management rocedure was modified to be a hybrid approach that used the strengths of DHL and Excel. The user experience in the deployment of DHL is summarised and directions for future improvement identified.

  19. Behavioral approach with or without surgical intervention to the vulvar vestibulitis syndrome : A prospective randomized and non randomized study

    Schultz, WCMW; Gianotten, WL; vanderMeijden, WI; vandeWiel, HBM; Blindeman, L; Chadha, S; Drogendijk, AC


    This article describes the outcome of a behavioral approach with or without preceding surgical intervention in 48 women with the vulvar vestibulitis syndrome. In the first part of the study, 14 women with the vulvar vestibulitis syndrome were randomly assigned to one of two treatment programs: eithe

  20. Perspectives on randomization and readiness for change in a workplace intervention study

    Nabe-Nielsen, Kirsten; Persson, Roger; Nielsen, Karina;


    , it is important to investigate differences between study groups in readiness for change. To meet this aim, we used data from an intervention study of the effects of work-time control. The study design entailed both self-selection (i.e. non-random) and random allocation into intervention and control groups. Some...... team leaders rejected randomization because they considered it to be fairest to increase work-time control among employees in most need. Others accepted randomization arguing that it was fairer to allocate a potential benefi t by random. We found no difference in readiness for changes when comparing...

  1. Sugammadex versus neostigmine in pediatric patients: a prospective randomized study

    Turhan Kara


    Full Text Available Background and objectives: Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures. Methods: 80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6 mgkg−1 rocuronium and monitorized with train-of-four. Group RN (n = 40 received 0.03 mgkg−1 neostigmine, Group RS (n = 40 received 2 mgkg−1 sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation, train-of-four ratio during this time, time to reach train-of-four > 0.9, and probable complications were recorded. Results: There was no significant difference between the patients' characteristics. Extubation time and time to reach train-of-four > 0.9 were significantly higher in Group RN (p = 0.001, p = 0.002. Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (p = 0.020. Extubation train-of-four ratio was significantly lower in Group RN (p = 0.002. Conclusion: Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.

  2. The Statistical Power of the Cluster Randomized Block Design with Matched Pairs--A Simulation Study

    Dong, Nianbo; Lipsey, Mark


    This study uses simulation techniques to examine the statistical power of the group- randomized design and the matched-pair (MP) randomized block design under various parameter combinations. Both nearest neighbor matching and random matching are used for the MP design. The power of each design for any parameter combination was calculated from…


    John Alexandris


    Full Text Available The Random Walk with d Choice RWC d( is a recently proposed variation of the simple Random Walk that first selects a subset of d neighbor nodes and then decides to move to the node which minimizes the value of a certain parameter; this parameter captures the number of past visits of the walk to that node. In this paper, we propose the Enhanced Random Walk with d Choice algorithm ERWC d h ( , which first selects a subset of d neighbor nodes and then decides to move to the node which minimizes a value H defined at every node; this H value depends on a parameter h and captures information about past visits of the walk to that node and - with a certain weight - to its neighbors. Simulations of the Enhanced Random Walk with d Choice algorithm on various types of graphs indicate beneficial results with respect to Cover Time and Load Balancing. The graph types used are the Random Geometric Graph, Torus, Grid, Hypercube, Lollipop and Bernoulli.

  4. DoOR 2.0 - Comprehensive Mapping of Drosophila melanogaster Odorant Responses

    Münch, Daniel; Galizia, C. Giovanni


    Odors elicit complex patterns of activated olfactory sensory neurons. Knowing the complete olfactome, i.e. the responses in all sensory neurons for all relevant odorants, is desirable to understand olfactory coding. The DoOR project combines all available Drosophila odorant response data into a single consensus response matrix. Since its first release many studies were published: receptors were deorphanized and several response profiles were expanded. In this study, we add unpublished data to the odor-response profiles for four odorant receptors (Or10a, Or42b, Or47b, Or56a). We deorphanize Or69a, showing a broad response spectrum with the best ligands including 3-hydroxyhexanoate, alpha-terpineol, 3-octanol and linalool. We include all of these datasets into DoOR, provide a comprehensive update of both code and data, and new tools for data analyses and visualizations. The DoOR project has a web interface for quick queries (, and a downloadable, open source toolbox written in R, including all processed and original datasets. DoOR now gives reliable odorant-responses for nearly all Drosophila olfactory responding units, listing 693 odorants, for a total of 7381 data points.

  5. Improving Emergency Department Door to Doctor Time and Process Reliability: A Successful Implementation of Lean Methodology.

    El Sayed, Mazen J; El-Eid, Ghada R; Saliba, Miriam; Jabbour, Rima; Hitti, Eveline A


    The aim of this study is to determine the effectiveness of using lean management methods on improving emergency department door to doctor times at a tertiary care hospital.We performed a before and after study at an academic urban emergency department with 49,000 annual visits after implementing a series of lean driven interventions over a 20 month period. The primary outcome was mean door to doctor time and the secondary outcome was length of stay of both admitted and discharged patients. A convenience sample from the preintervention phase (February 2012) was compared to another from the postintervention phase (mid-October to mid-November 2013). Individual control charts were used to assess process stability.Postintervention there was a statistically significant decrease in the mean door to doctor time measure (40.0 minutes ± 53.44 vs 25.3 minutes ± 15.93 P < 0.001). The postintervention process was more statistically in control with a drop in the upper control limits from 148.8 to 72.9 minutes. Length of stay of both admitted and discharged patients dropped from 2.6 to 2.0 hours and 9.0 to 5.5 hours, respectively. All other variables including emergency department visit daily volumes, hospital occupancy, and left without being seen rates were comparable.Using lean change management techniques can be effective in reducing door to doctor time in the Emergency Department and improving process reliability.

  6. DoOR 2.0--Comprehensive Mapping of Drosophila melanogaster Odorant Responses.

    Münch, Daniel; Galizia, C Giovanni


    Odors elicit complex patterns of activated olfactory sensory neurons. Knowing the complete olfactome, i.e. the responses in all sensory neurons for all relevant odorants, is desirable to understand olfactory coding. The DoOR project combines all available Drosophila odorant response data into a single consensus response matrix. Since its first release many studies were published: receptors were deorphanized and several response profiles were expanded. In this study, we add unpublished data to the odor-response profiles for four odorant receptors (Or10a, Or42b, Or47b, Or56a). We deorphanize Or69a, showing a broad response spectrum with the best ligands including 3-hydroxyhexanoate, alpha-terpineol, 3-octanol and linalool. We include all of these datasets into DoOR, provide a comprehensive update of both code and data, and new tools for data analyses and visualizations. The DoOR project has a web interface for quick queries (, and a downloadable, open source toolbox written in R, including all processed and original datasets. DoOR now gives reliable odorant-responses for nearly all Drosophila olfactory responding units, listing 693 odorants, for a total of 7381 data points.

  7. Cannabis use and risk of schizophrenia: a Mendelian randomization study.

    Vaucher, J; Keating, B J; Lasserre, A M; Gan, W; Lyall, D M; Ward, J; Smith, D J; Pell, J P; Sattar, N; Paré, G; Holmes, M V


    Cannabis use is observationally associated with an increased risk of schizophrenia, but whether the relationship is causal is not known. Using a genetic approach, we took 10 independent genetic variants previously identified to associate with cannabis use in 32 330 individuals to determine the nature of the association between cannabis use and risk of schizophrenia. Genetic variants were employed as instruments to recapitulate a randomized controlled trial involving two groups (cannabis users vs nonusers) to estimate the causal effect of cannabis use on risk of schizophrenia in 34 241 cases and 45 604 controls from predominantly European descent. Genetically-derived estimates were compared with a meta-analysis of observational studies reporting ever use of cannabis and risk of schizophrenia or related disorders. Based on the genetic approach, use of cannabis was associated with increased risk of schizophrenia (odds ratio (OR) of schizophrenia for users vs nonusers of cannabis: 1.37; 95% confidence interval (CI), 1.09-1.67; P-value=0.007). The corresponding estimate from observational analysis was 1.43 (95% CI, 1.19-1.67; P-value for heterogeneity =0.76). The genetic markers did not show evidence of pleiotropic effects and accounting for tobacco exposure did not alter the association (OR of schizophrenia for users vs nonusers of cannabis, adjusted for ever vs never smoker: 1.41; 95% CI, 1.09-1.83). This adds to the substantial evidence base that has previously identified cannabis use to associate with increased risk of schizophrenia, by suggesting that the relationship is causal. Such robust evidence may inform public health messages about cannabis use, especially regarding its potential mental health consequences.Molecular Psychiatry advance online publication, 24 January 2017; doi:10.1038/mp.2016.252.

  8. Study protocol: The Adherence and Intensification of Medications (AIM study - a cluster randomized controlled effectiveness study

    Selby Joe


    Full Text Available Abstract Background Many patients with diabetes have poor blood pressure (BP control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen. Methods In this cluster-randomized controlled effectiveness study, primary care teams within sites were randomized to a program led by a clinical pharmacist trained in motivational interviewing-based behavioral counseling approaches and authorized to make BP medication changes or to usual care. This study involved the collection of data during a 14-month intervention period in three Department of Veterans Affairs facilities and two Kaiser Permanente Northern California facilities. The clinical pharmacist was supported by clinical information systems that enabled proactive identification of, and outreach to, eligible patients identified on the basis of poor BP control and either medication refill gaps or lack of recent medication intensification. The primary outcome is the relative change in systolic blood pressure (SBP measurements over time. Secondary outcomes are changes in Hemoglobin A1c, low-density lipoprotein cholesterol (LDL, medication adherence determined from pharmacy refill data, and medication intensification rates. Discussion Integration of the three intervention elements - proactive identification, adherence counseling and medication intensification - is essential to achieve optimal levels of control for high-risk patients. Testing the effectiveness of this intervention at the team level allows us to study the program as it would typically be implemented within a clinic setting, including how it integrates with other elements of care. Trial Registration The registration number is NCT

  9. Prevalence of epilepsy, beliefs and attitudes in a rural community in Mexico: A door-to-door survey.

    San-Juan, Daniel; Alvarado-León, Susana; Barraza-Díaz, Jorge; Davila-Avila, Ned Merari; Ruíz, Axel Hernandez; Anschel, David J


    The study aimed to establish the prevalence of seizure history (SH) and epilepsy in a rural community in Hidalgo, Mexico and determine the patients' beliefs and attitudes towards the disease and its initial medical treatment. A transverse, descriptive, door-to-door epidemiological study (April 2011-November 2012) was conducted with 863 inhabitants from Xocotitla, Huejutla, Hidalgo, Mexico (162 housing units). Patients with SH were identified with an adaptation of the WHO protocol for epidemiological studies of neurological diseases. Afterwards, the subjects identified with seizure history (SH) or epilepsy were interviewed with a 20-question Likert type questionnaire regarding the management and belief set of their SH. The interviews were conducted in Spanish and Nahuatl. The prevalence of epilepsy and isolated nonrecurring seizures was 38.2/1000 and 25.4/1000, respectively. Out of the total population of 863 inhabitants, 33/863 were identified with SH: only 39.3% were able to identify an epileptic seizure as such, 48.5% sought medical attention upon the first seizure, 33.3% used a traditional healer, 15.2% took no action, 3% sought a religious representative, 85% lacked any lab analysis, and 60% received no antiepileptic drugs. Only 39% received free local medical attention, 69.7% considered seizures and epilepsy to be a consequence of divine intervention, and 94% reported some type of discrimination. A high prevalence of epilepsy and SH was found in this rural community in Mexico. Divine/religious beliefs, discrimination, scarce access to basic health services and inadequate medical management of epilepsy and SH persist. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Design and Analysis of Single Plate Blast Resistant Door

    Nilesh S. Aitavade


    Full Text Available Blast Resistant Doors are used to withstand high intensity impulsive blast loads. They are designed to prevent the impact of the blast from travelling from one side to the other side of the door. Taking into account the limitations and the growing need of efficient blast resistant doors, a design was developed using ASTM A36 as the material of construction instead of concrete. Analytical calculations for the actual pressure-impulse loading condition were done as per the UFC 3-340-02, and the results of analytical calculations were compared with results of the simulation of the numerical model for the given boundary conditions.

  11. Door-to-door survey of major neurological disorders (project in Al Quseir City, Red Sea Governorate, Egypt

    El Tallawy HN


    Full Text Available Hamdy NA El Tallawy,1 Wafaa MA Farghaly,1 Tarek A Rageh,1 Ghaydaa A Shehata,1 Reda Badry,1 Nabil A Metwally,2 Esam A El Moselhy,2 Mahmoud Hassan,2 Mohamed A Sayed,3 Ahmed A Waris,1 Yaser Hamed,2 Islam Shaaban,2 Mohamed A Hamed,1 Mahmoud Raafat Kandil11Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Neurology and Public Health, Faculty of Medicine, Al-Azhar University (Assiut branch, Assiut, Egypt; 3Department of Neurology, Faculty of Medicine, Sohag University, Sohag, EgyptAbstract: A door-to-door survey, including every household, was conducted for all inhabitants of Al Quseir City (33,283, Red Sea Governorate, Egypt by three specialists of neurology as well as nine senior staff members of neurology and 15 female social workers to assess the epidemiology of major neurological disorders. Over six phases, from July 1, 2009 to January 31, 2012, screening of all eligible people in the population was carried out, by which case ascertainment of all major neurological disorders included in the study was done according to the accepted definitions and diagnostic criteria of the World Health Organization. The order of frequency of prevalence of the studied neurological disorders was dementia (3.83% for those aged > 60 years, migraine (2.8% for those aged > 8 years, stroke (6.2/1000 for those aged > 20 years, epilepsy (5.5/1000, Parkinson’s disease (452.1/100,000 for those aged > 40 years, cerebral palsy (3.6/1000 among children 37 years, chorea (21.03/100,000, athetosis (15/100,000, and multiple sclerosis (13.74/100,000. The incidence rates of stroke, epilepsy, and Bell’s palsy were 181/100,000, 48/100,000, and 98.9/100,000 per year, respectively.Keywords: prevalence, incidence, neurological disorders

  12. Fidelity under isospectral perturbations: a random matrix study

    Leyvraz, F.; García, A.; Kohler, H.; Seligman, T. H.


    The set of Hamiltonians generated by all unitary transformations from a single Hamiltonian is the largest set of isospectral Hamiltonians we can form. Taking advantage of the fact that the unitary group can be generated from Hermitian matrices we can take the ones generated by the Gaussian unitary ensemble with a small parameter as small perturbations. Similarly, the transformations generated by Hermitian antisymmetric matrices from orthogonal matrices form isospectral transformations among symmetric matrices. Based on this concept we can obtain the fidelity decay of a system that decays under a random isospectral perturbation with well-defined properties regarding time-reversal invariance. If we choose the Hamiltonian itself also from a classical random matrix ensemble, then we obtain solutions in terms of form factors in the limit of large matrices.

  13. Cluster-randomized Studies in Educational Research: Principles and Methodological Aspects.

    Dreyhaupt, Jens; Mayer, Benjamin; Keis, Oliver; Öchsner, Wolfgang; Muche, Rainer


    An increasing number of studies are being performed in educational research to evaluate new teaching methods and approaches. These studies could be performed more efficiently and deliver more convincing results if they more strictly applied and complied with recognized standards of scientific studies. Such an approach could substantially increase the quality in particular of prospective, two-arm (intervention) studies that aim to compare two different teaching methods. A key standard in such studies is randomization, which can minimize systematic bias in study findings; such bias may result if the two study arms are not structurally equivalent. If possible, educational research studies should also achieve this standard, although this is not yet generally the case. Some difficulties and concerns exist, particularly regarding organizational and methodological aspects. An important point to consider in educational research studies is that usually individuals cannot be randomized, because of the teaching situation, and instead whole groups have to be randomized (so-called "cluster randomization"). Compared with studies with individual randomization, studies with cluster randomization normally require (significantly) larger sample sizes and more complex methods for calculating sample size. Furthermore, cluster-randomized studies require more complex methods for statistical analysis. The consequence of the above is that a competent expert with respective special knowledge needs to be involved in all phases of cluster-randomized studies. Studies to evaluate new teaching methods need to make greater use of randomization in order to achieve scientifically convincing results. Therefore, in this article we describe the general principles of cluster randomization and how to implement these principles, and we also outline practical aspects of using cluster randomization in prospective, two-arm comparative educational research studies.

  14. [Prenatal diagnosis by ultrasonography. A randomized study of 3000 patients].

    García Roig, F; Hicks Gomez, J J


    From January through December, 1990 at Hospital de Ginecoobstetricia Tlatelolco, 3,000 pregnant women were subjected to ultrasonography at random using a real time, B mode apparatus with a 3.5 MHz lineal transducer. Fetal malformation were diagnosed, some of which would have passed undetected in the labor room with consequent delay of treatment and false raise of perinatal morbidity and mortality rates.

  15. Opto-mechanical door locking system

    Patil, Saurabh S.; Rodrigues, Vanessa M.; Patil, Ajeetkumar; Chidangil, Santhosh


    We present an Opto-mechanical Door Locking System which is an optical system that combines a simple combination of a coherent light source (Laser) and a photodiode based sensor with focus toward security applications. The basic construct of the KEY comprises a Laser source in a cylindrical enclosure that slides perfectly into the LOCK. The Laser is pulsed at a fixed encrypted frequency unique to that locking system. Transistor-transistor logic (TTL) circuitry is used to achieve encryption. The casing of the key is designed in such a way that it will power the pulsing laser only when the key is inserted in the slot provided for it. The Lock includes a photo-sensor that will convert the detected light intensity to a corresponding electrical signal by decrypting the frequency. The lock also consists of a circuit with a feedback system that will carry the digital information regarding the encryption frequency code. The information received from the sensor is matched with the stored code; if found a perfect match, a signal will be sent to the servo to unlock the mechanical lock or to carry out any other operation. This technique can be incorporated in security systems for residences and safe houses, and can easily replace all conventional locks which formerly used fixed patterns to unlock. The major advantage of this proposed optomechanical system over conventional ones is that it no longer relies on a solid/imprinted pattern to perform its task and hence makes it almost impossible to tamper with.

  16. SOFIA Closed- and Open-Door Aerodynamic Analyses

    Cumming, Stephen; Frederick, Mike; Smith, Mark


    Work to evaluate the aerodynamic characteristics and the cavity acoustic environment of the SOFIA (Stratospheric Observatory for Infrared Astronomy) airplane has been completed. The airplane has been evaluated in its closed-door configuration, as well as several open-door configurations. Work performed included: acoustic analysis tool development, cavity acoustic evaluation, stability and control parameter estimation, air data calibration, and external flow evaluation. Qualitative airflow data were obtained during the closed- and open-door flights using tufts on the aft portion of the fuselage. Video was taken from a chase plane. This video was analyzed for various flight conditions, and general flow descriptions of the aft fuselage of the 747SP were developed for the different closed and open door configurations.

  17. Ontwateren van zeugenmest door middel van omgekeerde osmose

    Thelosen, J.; Gastel, van J.; Cuyck, van J.


    In periodiek nummer 1 (februari 1991) is het proces van omgekeerde osmose reeds beschreven. In het kort komt omgekeerde osmose op het volgende neer: de te ontwateren vloeistof wordt onder hoge druk (55 bar) door filterbuizen gepompt.

  18. Rotational and frictional dynamics of the slamming of a door

    Klein, Pascal; Müller, Andreas; Gröber, Sebastian; Molz, Alexander; Kuhn, Jochen


    A theoretical and experimental investigation of the rotational dynamics, including friction, of a slamming door is presented. Based on existing work regarding different damping models for rotational and oscillatory motions, we examine different forms for the (angular) velocity dependence (ωn, n = 0, 1, 2) of the frictional force. An analytic solution is given when all three friction terms are present and several solutions for specific cases known from the literature are reproduced. The motion of a door is investigated experimentally using a smartphone, and the data are compared with the theoretical results. A laboratory experiment under more controlled conditions is conducted to gain a deeper understanding of the movement of a slammed door. Our findings provide quantitative evidence that damping models involving quadratic air drag are most appropriate for the slamming of a door. Examining this everyday example of a physical phenomenon increases student motivation, because they can relate it to their own personal experience.

  19. Energiebesparing bij de bewaring van plantgoed van tulp door temperatuurintegratie

    Gude, H.; Dijkema, M.H.G.E.


    Onderzoek naar de mogelijkheden van TI (temperatuurintegratie) bij de bewaring van tulpenplantgoed door het vaststellen van de tolerantie van enkele cultivars voor verhogingen van de dagtemperatuur en verlagingen van de nachttemperatuur

  20. Epidemiologie en basisgezondheidszorg : analyse van volksgezondheid door basisgezondheidsdiensten

    Davidse, W.; Ginneken, J.K.S. van; Water, H.P.A. van de


    Dit boekje bevat de bijdragen aan het symposium, dat op 30 september 1988 werd georganiseerd door de sector Gezondheidszorg en Epidemiologie van het Nederlands Instituut voor Praeventieve Gezondheidszorg/TNO te Leiden.

  1. Glutamine Randomized Studies in Early Life: The Unsolved Riddle of Experimental and Clinical Studies

    Efrossini Briassouli


    Full Text Available Glutamine may have benefits during immaturity or critical illness in early life but its effects on outcome end hardpoints are controversial. Our aim was to review randomized studies on glutamine supplementation in pups, infants, and children examining whether glutamine affects outcome. Experimental work has proposed various mechanisms of glutamine action but none of the randomized studies in early life showed any effect on mortality and only a few showed some effect on inflammatory response, organ function, and a trend for infection control. Although apparently safe in animal models (pups, premature infants, and critically ill children, glutamine supplementation does not reduce mortality or late onset sepsis, and its routine use cannot be recommended in these sensitive populations. Large prospectively stratified trials are needed to better define the crucial interrelations of “glutamine-heat shock proteins-stress response” in critical illness and to identify the specific subgroups of premature neonates and critically ill infants or children who may have a greater need for glutamine and who may eventually benefit from its supplementation. The methodological problems noted in the reviewed randomized experimental and clinical trials should be seriously considered in any future well-designed large blinded randomized controlled trial involving glutamine supplementation in critical illness.

  2. Glutamine randomized studies in early life: the unsolved riddle of experimental and clinical studies.

    Briassouli, Efrossini; Briassoulis, George


    Glutamine may have benefits during immaturity or critical illness in early life but its effects on outcome end hardpoints are controversial. Our aim was to review randomized studies on glutamine supplementation in pups, infants, and children examining whether glutamine affects outcome. Experimental work has proposed various mechanisms of glutamine action but none of the randomized studies in early life showed any effect on mortality and only a few showed some effect on inflammatory response, organ function, and a trend for infection control. Although apparently safe in animal models (pups), premature infants, and critically ill children, glutamine supplementation does not reduce mortality or late onset sepsis, and its routine use cannot be recommended in these sensitive populations. Large prospectively stratified trials are needed to better define the crucial interrelations of "glutamine-heat shock proteins-stress response" in critical illness and to identify the specific subgroups of premature neonates and critically ill infants or children who may have a greater need for glutamine and who may eventually benefit from its supplementation. The methodological problems noted in the reviewed randomized experimental and clinical trials should be seriously considered in any future well-designed large blinded randomized controlled trial involving glutamine supplementation in critical illness.

  3. Randomized double blind placebo control studies, the "Gold Standard" in intervention based studies

    Shobha Misra


    Full Text Available Studies follow a hierarchy in terms of the quality of evidence that they can provide. Randomized double blind placebo control (RDBPC studies are considered the "gold standard" of epidemiologic studies. And the same is discussed at length in this paper taking example of a real journal article employing this study design to answer the research question; "Does once daily dose of Valacyclovir reduce the risk of transmission of genital herpes in a susceptible partner?" RDBPC studies remain the most convincing research design in which randomly assigning the intervention can eliminate the influence of unknown or immeasurable confounding variables that may otherwise lead to biased and incorrect estimate of treatment effect. Also, randomization eliminates confounding by baseline variables and blinding eliminates confounding by co-interventions, thus eliminating the possibility that the observed effects of intervention are due to differential use of other treatments. The best comparison is placebo control that allows participants, investigators and study staff to be blinded. The advantage of trial over an observational study is the ability to demonstrate causality. Hope, this will be useful to neophyte researchers to understand causal hierarchy when critically evaluating epidemiologic literature.

  4. Randomized double blind placebo control studies, the "Gold Standard" in intervention based studies.

    Misra, Shobha


    Studies follow a hierarchy in terms of the quality of evidence that they can provide. Randomized double blind placebo control (RDBPC) studies are considered the "gold standard" of epidemiologic studies. And the same is discussed at length in this paper taking example of a real journal article employing this study design to answer the research question; "Does once daily dose of Valacyclovir reduce the risk of transmission of genital herpes in a susceptible partner?" RDBPC studies remain the most convincing research design in which randomly assigning the intervention can eliminate the influence of unknown or immeasurable confounding variables that may otherwise lead to biased and incorrect estimate of treatment effect. Also, randomization eliminates confounding by baseline variables and blinding eliminates confounding by co-interventions, thus eliminating the possibility that the observed effects of intervention are due to differential use of other treatments. The best comparison is placebo control that allows participants, investigators and study staff to be blinded. The advantage of trial over an observational study is the ability to demonstrate causality. Hope, this will be useful to neophyte researchers to understand causal hierarchy when critically evaluating epidemiologic literature.

  5. Landing Gear Door Liners for Airframe Noise Reduction

    Jones, Michael G. (Inventor); Howerton, Brian M. (Inventor); Van De Ven, Thomas (Inventor)


    A landing gear door for retractable landing gear of aircraft includes an acoustic liner. The acoustic liner includes one or more internal cavities or chambers having one or more openings that inhibit the generation of sound at the surface and/or absorb sound generated during operation of the aircraft. The landing gear door may include a plurality of internal chambers having different geometries to thereby absorb broadband noise.

  6. Perspectives on randomization and readiness for change in a workplace intervention study

    Nabe-Nielsen, Kirsten; Persson, Roger; Nielsen, Karina


    team leaders rejected randomization because they considered it to be fairest to increase work-time control among employees in most need. Others accepted randomization arguing that it was fairer to allocate a potential benefi t by random. We found no difference in readiness for changes when comparing......, it is important to investigate differences between study groups in readiness for change. To meet this aim, we used data from an intervention study of the effects of work-time control. The study design entailed both self-selection (i.e. non-random) and random allocation into intervention and control groups. Some...... refl ect the local leaders’ rather than the employees’ readiness for changes and that randomization may infl uence the participants’ attitude towards the intervention perhaps by evoking an experience of ‘winning or losing in the lottery’....

  7. Study on Multi-array Shaker Random Vibration Test Control

    Gao Chun-hua


    Full Text Available Some basic algorithms and theories are discussed for 9-shaker random vibration test control in this paper. A correct algorithm RMS is presented without considering influence of cross spectrum. The algorithm can make the control spectrum of convergence stably and fastly. In order to solve the problem of multiple-point input and output synthetically weighting control,  Finite Markov Chains and Algorithmic is set forth for the first time to form the main control matrix. Finally through Matlab simulation and the results show that the method can meet the engineering demand.  

  8. Door Opening Affects Operating Room Pressure During Joint Arthroplasty.

    Mears, Simon C; Blanding, Renee; Belkoff, Stephen M


    Many resources are expended to ensure a sterile operating room environment. Efforts are made to prevent exposure of patients to personnel and to achieve positive room pressure to keep out airborne contaminants. Foot traffic into and out of the operating room during surgery can undermine these efforts. The authors investigated the number and duration of operating room door openings during hip and knee arthroplasty procedures and the effect of the door openings on room pressure. They tested the hypothesis that door openings defeat positive pressure, permitting air flow into the room. Room pressure and door status were monitored electronically during 191 hip and knee arthroplasty procedures. Operating room staff were unaware that data were being collected. The authors evaluated the data with regression analysis to determine whether the number and duration of door openings had an effect on room pressure. Significance was set at Poperating room. Total time with the door open significantly affected the minimum pressure recorded in the room (Poperating room sterility. The causes of excessive operating room traffic must be evaluated to identify ways to reduce this traffic and the associated risks.

  9. Air curtain development: an energy harvesting solution for hinged doors

    Dayal, Vineed; Lee, Soobum


    The paper proposes a fully mechanical air curtain system that will be powered solely by harvested energy from common hinged doors. The average person uses this type of door several times a day with an almost unconscious amount of applied force and effort. This leads to a high potential of energy to be harvested in doorways that see high traffic and frequent operation7 . Frequently opened door entry ways have always been regarded as a major element that causes significant energy loss and contaminated air conditions in buildings6 . Private companies, particularly those with warehouses, have introduced commercial electrical air curtains to block the open entrances from invading cold air11. This project intends to introduce an original design of air curtain which operates fans only when the door opens and closes, by directly converting door motion to fan rotation without any electronic motor or power cable. The air stream created by this device will prevent the transfer of outside air and contaminants. Research will be conducted to determine the most efficient method of harvesting energy from door use, and the prototyping process will be conducted to meet the required performance of current air curtain models.

  10. Blower-door techniques for measuring interzonal leakage

    Hult, Erin L.; Sherman, Max H.; Walker, Iain


    Abstract The standard blower door test methods, such as ASTM E779, describe how to use a single blower door to determine the total leakage of a single-zone structure such as a detached single-family home. There are no standard test methods for measuring interzonal leakage in a two-zone or multi-zone building envelope such as might be encountered in with an attached garage or in a multifamily building. Some practitioners have been using techniques that involve making multiple measurements with a single blower door as well as combined measurements using multiple blower doors. Even for just two zones there are dozens of combinations of one-door and two-door test protocols that could conceivably be used to determine the interzonal air tightness. We examined many of these two-zone configurations using both simulation and measured data to estimate the accuracy and precision of each technique for realistic measurement scenarios. We also considered the impact of taking measurements at a single pressure versus over multiple pressures. We compared the various techniques and evaluated them for specific uses. Some techniques work better in one leakage regime; some are more sensitive to wind and other noise; some are more suited to determining only a subset of the leakage values. This paper makes recommendations on which techniques to use or not use for various cases and provides data that could be used to develop future test methods.

  11. Cluster-randomized Studies in Educational Research: Principles and Methodological Aspects

    Dreyhaupt, Jens


    Full Text Available An increasing number of studies are being performed in educational research to evaluate new teaching methods and approaches. These studies could be performed more efficiently and deliver more convincing results if they more strictly applied and complied with recognized standards of scientific studies. Such an approach could substantially increase the quality in particular of prospective, two-arm (intervention studies that aim to compare two different teaching methods. A key standard in such studies is randomization, which can minimize systematic bias in study findings; such bias may result if the two study arms are not structurally equivalent. If possible, educational research studies should also achieve this standard, although this is not yet generally the case. Some difficulties and concerns exist, particularly regarding organizational and methodological aspects. An important point to consider in educational research studies is that usually individuals cannot be randomized, because of the teaching situation, and instead whole groups have to be randomized (so-called “cluster randomization”. Compared with studies with individual randomization, studies with cluster randomization normally require (significantly larger sample sizes and more complex methods for calculating sample size. Furthermore, cluster-randomized studies require more complex methods for statistical analysis. The consequence of the above is that a competent expert with respective special knowledge needs to be involved in all phases of cluster-randomized studies.Studies to evaluate new teaching methods need to make greater use of randomization in order to achieve scientifically convincing results. Therefore, in this article we describe the general principles of cluster randomization and how to implement these principles, and we also outline practical aspects of using cluster randomization in prospective, two-arm comparative educational research studies.

  12. [Chuzhen therapy for sub-health: a randomized controlled study].

    Hu, You-Ping; Xu, Zhen-Jie; Wu, Jia; Xing, Lin; Zhang, Lei-Xiao; Zhang, Jin-Xing; Tan, Hui; Mao, Shi-Zhi; Zhou, Cong-Quan


    To observe the effect on intervention of sub-health with pestle needle (Chuzhen). Randomized controlled trail was adopted for this research. One hundred and fifty-three cases were randomly divided into two groups of a Chuzhen group (79 cases) and a massage group (74 cases). Acupoint of Bazhen (Baihui Bazhen, Shendao Bazhen, Zhiyang Bazhen, Mingmen Bazhen, Yaoyangguan Bazhen), Hechelu on the head, the neck and the lumbar area were adopted in Chuzhen group. While regular whole-body massage was applied in the massage group. The human sub-health score, the cornell medical index (CMI) and thermal texture maps system (TTM) technology of the two groups before and after the intervention were observed. 1) After treatment, sub-health condition score, the CMI score, the M-R score and the TTM index were all increased in both groups (all P0.05). 3) The sub-health condition score in Chuzhen group was higher than that in the massage group (P<0.01). Chuzhen therapy has definite effect on intervention of sub-health, which is better than regular general massage.

  13. Inverse probability weighting for covariate adjustment in randomized studies.

    Shen, Changyu; Li, Xiaochun; Li, Lingling


    Covariate adjustment in randomized clinical trials has the potential benefit of precision gain. It also has the potential pitfall of reduced objectivity as it opens the possibility of selecting a 'favorable' model that yields strong treatment benefit estimate. Although there is a large volume of statistical literature targeting on the first aspect, realistic solutions to enforce objective inference and improve precision are rare. As a typical randomized trial needs to accommodate many implementation issues beyond statistical considerations, maintaining the objectivity is at least as important as precision gain if not more, particularly from the perspective of the regulatory agencies. In this article, we propose a two-stage estimation procedure based on inverse probability weighting to achieve better precision without compromising objectivity. The procedure is designed in a way such that the covariate adjustment is performed before seeing the outcome, effectively reducing the possibility of selecting a 'favorable' model that yields a strong intervention effect. Both theoretical and numerical properties of the estimation procedure are presented. Application of the proposed method to a real data example is presented.

  14. Failure case of a garage door opener

    Habib, K.


    Full Text Available A failure analysis of a garage door opener was conducted for determination of the cause of the failure. The analysis included visual inspections of broken parts as well as electron microscopy examinations of the fracture surface. The visual inspections showed that a bolt connected to the inner trolley of the garage opener assembly was initially fractured. Also, the results of electron microscopy examinations revealed that the broken bolt failed by fatigue damage phenomenon, due to alternating torsional stresses throughout 25 years of an operational life of the garage opener. In addition, a mathematical model corresponding to the failure mechanism was derived along the failure analysis. The model comprises of both design philosophy and fracture mechanics approaches.

    Se analizó el fallo del mecanismo de apertura de una puerta de garaje con el fin de determinar sus causas. El análisis incluyó una inspección visual de las piezas rotas así como un examen mediante microscopía de la superficie de fractura. La inspección visual reveló que primero se fracturó un perno conectado al carro interior del mecanismo de apertura. Los resultados del análisis por microscopía electrónica también mostraron que el perno roto falló debido a fenómenos de daño por fatiga, debido a los esfuerzos torsionales alternos a la largo de 25 años de vida en servicio del mecanismo de apertura. Por otra parte, se construyó un modelo matemático correspondiente al mecanismo de rotura durante el análisis del mismo. Este modelo comprende enfoques, tanto de la filosofía de diseño como de la mecánica de fractura.

  15. Multivariate parametric random effect regression models for fecundability studies.

    Ecochard, R; Clayton, D G


    Delay until conception is generally described by a mixture of geometric distributions. Weinberg and Gladen (1986, Biometrics 42, 547-560) proposed a regression generalization of the beta-geometric mixture model where covariates effects were expressed in terms of contrasts of marginal hazards. Scheike and Jensen (1997, Biometrics 53, 318-329) developed a frailty model for discrete event times data based on discrete-time analogues of Hougaard's results (1984, Biometrika 71, 75-83). This paper is on a generalization to a three-parameter family distribution and an extension to multivariate cases. The model allows the introduction of explanatory variables, including time-dependent variables at the subject-specific level, together with a choice from a flexible family of random effect distributions. This makes it possible, in the context of medically assisted conception, to include data sources with multiple pregnancies (or attempts at pregnancy) per couple.

  16. Prenatal emotion management improves obstetric outcomes: a randomized control study.

    Huang, Jian; Li, He-Jiang; Wang, Jue; Mao, Hong-Jing; Jiang, Wen-Ying; Zhou, Hong; Chen, Shu-Lin


    Negative emotions can cause a number of prenatal problems and disturb obstetric outcomes. We determined the effectiveness of prenatal emotional management on obstetric outcomes in nulliparas. All participants completed the PHQ-9 at the baseline assessment. Then, the participants were randomly assigned to the emotional management (EM) and usual care (UC) groups. The baseline evaluation began at 31 weeks gestation and the participants were followed up to 42 days postpartum. Each subject in the EM group received an extra EM program while the participants in the UC groups received routine prenatal care and education only. The PHQ-9 and Edinburgh Postnatal Depression scale (EPDS) were used for assessment. The EM group had a lower PHQ-9 score at 36 weeks gestation, and 7 and 42 days after delivery (P Prenatal EM intervention could control anxiety and depressive feelings in nulliparas, and improve obstetric outcomes. It may serve as an innovative approach to reduce the cesarean section rate in China.

  17. A numerical study of rays in random media. [Monte Carlo method simulation

    Youakim, M. Y.; Liu, C. H.; Yeh, K. C.


    Statistics of electromagnetic rays in a random medium are studied numerically by the Monte Carlo method. Two dimensional random surfaces with prescribed correlation functions are used to simulate the random media. Rays are then traced in these sample media. Statistics of the ray properties such as the ray positions and directions are computed. Histograms showing the distributions of the ray positions and directions at different points along the ray path as well as at given points in space are given. The numerical experiment is repeated for different cases corresponding to weakly and strongly random media with isotropic and anisotropic irregularities. Results are compared with those derived from theoretical investigations whenever possible.

  18. Jamming of fingers: an experimental study to determine force and deflection in participants and human cadaver specimens for development of a new bionic test device for validation of power-operated motor vehicle side door windows.

    Hohendorff, Bernd; Weidermann, Christian; Pollinger, Philipp; Burkhart, Klaus J; Müller, Lars Peter


    The deformability of human fingers is central to addressing the real-life hazard of finger jamming between the window and seal entry of a power-operated motor vehicle side door window. The index and little fingers of the left hand of 109 participants and of 20 cadaver specimens were placed in a measurement setup. Participants progressively jammed their fingers at five different dorsal-palmar jam positions up to the maximum tolerable pain threshold, whereas the cadaver specimens were jammed up to the maximum possible deflection. Force-deflection curves were calculated corresponding to increasing deflection of the compressed tissue layers of the fingers. The average maximum force applied by the participants was 42 N to the index finger and 35 N to the little finger. In the cadaver fingers, the average of the maximum force applied was 1886 N for the index finger and 1833 N for the little finger. In 200 jam positions, 25 fractures were observed on radiographs; fractures occurred at an average force of 1485 N. These data assisted the development of a prototype of a bionic test device for more realistic validation of power-operated motor vehicle windows.

  19. PBL and Critical Thinking Disposition in Chinese Medical Students--A Randomized Cross-Sectional Study

    Du, XiangYun; Emmersen, Jeppe; Toft, Egon; Sun, Baozhi


    The purpose of this study was to explore the relationship of problem-based learning (PBL) and the development of critical thinking disposition (CT) and academic achievement in Chinese medical students using a cross-sectional randomized design. Medical students from China Medical University (CMU) were randomized to PBL or non-PBL teaching at the…

  20. A Randomized Controlled Study of the Virginia Student Threat Assessment Guidelines in Kindergarten through Grade 12

    Cornell, Dewey G.; Allen, Korrie; Fan, Xitao


    This randomized controlled study examined disciplinary outcomes for 201 students who made threats of violence at school. The students attended 40 schools randomly assigned to use the Virginia Student Threat Assessment Guidelines or follow a business-as-usual disciplinary approach in a control group. Logistic regression analyses found, after…

  1. A randomized RSA study concentrating especially on continuous migration.

    Molt, Mats; Ryd, Leif; Toksvig-Larsen, Sören


    Background and purpose - There is a general call for phased introduction of new implants, and one step in the introduction is an early evaluation of micromotion. We compared the micromotion in the Triathlon and its predecessor, the Duracon total knee prosthesis, concentrating especially on continuous migration over 5 years of follow-up. Patients and methods - 60 patients were randomized to receive either a cemented Triathlon total knee prosthesis or a cemented Duracon total knee prosthesis. 3-D tibial component migration was measured by radiostereometric analysis (RSA) at 3 months and at 1, 2, and 5 years. Results - There was no statistically significant difference in maximum total point motion (MTPM) between the 2 groups (p = 0.1). The mean MTPM at 5 years for the Duracon was 1.10 (SD 1.21) mm and for the Triathlon it was 0.66 (SD 0.38) mm. The numbers of continuously migrating prostheses were similar in the groups at the fifth year of follow-up; 6 of 21 prostheses in the Duracon group and 3 of 21 in the Triathlon group had migrated more than 0.3 mm between the second year and the fifth year of follow-up (p = 0.2). Interpretation - The Triathlon has a micromotion pattern similar to that of the Duracon total knee system at both short-term and medium-term follow-up, and may therefore, over time, show the same good long-term mechanical stability.

  2. Study of Random Wire Type Regenerators for Stirling Cryocoolers

    Jeong, Sangkwon; Nam, Kwanwoo; Choi, Sungryel


    This paper describes the performance evaluation for the random wire type regenerator used in Stirling cryocoolers. Metallic and non-metallic regenerators are tested and analyzed. Non-metallic regenerator we test is made of high-temperature resistant polymer. First, the ineffectiveness is determined by measuring the instantaneous pressure, the flow rate and the gas temperature at both ends of the regenerator. The cold-end temperature is maintained around 100 K and the operating frequency is fixed at 60 Hz. It is found that the non-metallic regenerator with high heat transfer area has a low ineffectiveness even though its volumetric heat capacity is lower than the metallic regenerator. Second, dynamic analysis is performed for the displacer of Stirling cryocooler containing the above regenerators. Oscillating flow model is proposed to accurately predict the pressure drop through the regenerator. Amplitude and phase angle of the displacer are calculated both from the oscillating flow model and the steady flow model. Superiority of the proposed oscillating flow model is demonstrated by the comparison between the analysis result and the experimental measurements.

  3. [Randomized controlled study on acupuncture treatment for chronic fatigue syndrome].

    Chen, Xing-Hua; Li, Lu-Qian; Zhang, Wen; Yang, Juan; Dai, Yi-Shuang; Xu, Dong-Hua; Tang, Chun-Zhi


    To observe the therapeutic effect of acpuncture treatment for chronic fatigue syndrome (CFS). Nighty cases of CFS were randomly divided into an observation group and a control group, 45 cases in each group. The observation group was treated with acupunture at Renying (ST 9), Fengfu (GV 16), Baihui (GV 20); the control group was treated with 250 mL 5% Glucose injectio combined with 20 mL Shenmai injectio. Fatigue Scale (FS) was used to compare the scores between the two groups after treatment. The total scores in the observation group were 9.37 +/- 2.33 and 5.41 +/- 1.96 before and after treatment respectively, and in the control group, they were 9.08 +/- 2.27 and 7.34 +/- 2.03 respectively. FS brainwork integral, physical fatigue integral, and total integral all decreased after treatment in two groups (all P < 0.001), and it decreased much more obviously in the observation group (P < 0.05, P < 0.01). Both of the acpuncture treatment and Shenmai injectio are able to decrease fatigue scale score, improve the fatigue symptoms of CFS patients, and the effect of acupucture treatment is obviously superior to that of Shenmai injectio.

  4. Multi-Criterion Optimal Design of Automotive Door Based on Metamodeling Technique and Genetic Algorithm


    A method for optimizing automotive doors under multiple criteria involving the side impact,stiffness, natural frequency, and structure weight is presented. Metamodeling technique is employed to construct approximations to replace the high computational simulation models. The approximating functions for stiffness and natural frequency are constructed using Taylor series approximation. Three popular approximation techniques, i. e. polynomial response surface (PRS), stepwise regression (SR), and Kriging are studied on their accuracy in the construction of side impact functions. Uniform design is employed to sample the design space of the door impact analysis. The optimization problem is solved by a multi-objective genetic algorithm. It is found that SR technique is superior to PRS and Kriging techniques in terms of accuracy in this study. The numerical results demonstrate that the method successfully generates a well-spread Pareto optimal set. From this Pareto optimal set, decision makers can select the most suitable design according to the vehicle program and its application.

  5. Effects of Rainfall on E. coli Concentrations at Door County, Wisconsin Beaches

    Gregory T. Kleinheinz; McDermott, Colleen M.; Sarah Hughes; Amanda Brown


    Rainfall and its associated storm water runoff have been associated with transport of many pollutants into beach water. Fecal material, from a variety of animals (humans, pets, livestock, and wildlife), can wash into beach water following rainfall and result in microbial contamination of the beach. Many locales around the world issue pre-emptive beach closures associated with rainfall. This study looked at eight beaches located in Door County, Wisconsin, on Lake Michigan to determine the impa...



    Be careful! What happened?   Unsignaled reinforced glass.   Signaled safety glass.   A visitor recently hurt his leg when he walked into a glass door which shattered from the impact. This door was made of reinforced glass, a material which is inappropriate for this kind of use as it is too fragile. Indeed, it shatters into sharp splinters which can cause serious injury. Furthermore, the door was not easily visible (badly lit, no warning signs, ...). Corrective measures Just after the accident: glass doors were signed to make them more visible; replacement of dangerous glass panes planned for 2003. What preventive measures can be taken against this kind of accident? If you are in charge of projects and works: In the call for tender, specify the acceptable shock resistance level of the glass pane; Before the door is mounted, insist on receiving technical documentation and/or certificate of conformity from the supplier; If in doubt, ask advice from the TIS/GS sa...

  7. Design and Development of Sound Control Door Lock System

    Elechi Promise


    Full Text Available Security is very important, especially the security of lives and properties. This work involves the use of sound in controlling the opening and closing of doors using electromechanical application. In this work, sound is used to activate the mechanisms which opens and closes the door without any external effort. The system is made up of two main features, the Security Access system and Control Mechanism. The security access system was designed using circuit wizard software and then constructed on a veroboard and other materials while the control mechanism was constructed using a simple DC motor for the opening and closing of the door. In its operation, a specific sound pattern in form of a positive voltage is sent to pin 14 of IC1, pin 14 of IC1 is connected to a transistor(Q2 which causes the 555timer to oscillate sending pulses to pin 14 of IC2, during this, the output of IC2 then operates in a sequential mode. The code switch then sets the number of beat that will set IC3 into the desire sequential output set by the operator. The output signal energizes the relay which controls the DC motor to open the door and closes after a preset time.The testing showed quick and fast response in operation of the door lock system.

  8. Study on MAX-MIN Ant System with Random Selection in Quadratic Assignment Problem

    Iimura, Ichiro; Yoshida, Kenji; Ishibashi, Ken; Nakayama, Shigeru

    Ant Colony Optimization (ACO), which is a type of swarm intelligence inspired by ants' foraging behavior, has been studied extensively and its effectiveness has been shown by many researchers. The previous studies have reported that MAX-MIN Ant System (MMAS) is one of effective ACO algorithms. The MMAS maintains the balance of intensification and diversification concerning pheromone by limiting the quantity of pheromone to the range of minimum and maximum values. In this paper, we propose MAX-MIN Ant System with Random Selection (MMASRS) for improving the search performance even further. The MMASRS is a new ACO algorithm that is MMAS into which random selection was newly introduced. The random selection is one of the edgechoosing methods by agents (ants). In our experimental evaluation using ten quadratic assignment problems, we have proved that the proposed MMASRS with the random selection is superior to the conventional MMAS without the random selection in the viewpoint of the search performance.

  9. Rapid, easy, and cheap randomization: prospective evaluation in a study cohort

    Parker Melissa J


    Full Text Available Abstract Background When planning a randomized controlled trial (RCT, investigators must select randomization and allocation procedures based upon a variety of factors. While third party randomization is cited as being among the most desirable randomization processes, many third party randomization procedures are neither feasible nor cost-effective for small RCTs, including pilot RCTs. In this study we present our experience with a third party randomization and allocation procedure that utilizes current technology to achieve randomization in a rapid, reliable, and cost-effective manner. Methods This method was developed by the investigators for use in a small 48-participant parallel group RCT with four study arms. As a nested study, the reliability of this randomization procedure was prospectively evaluated in this cohort. The primary outcome of this nested study was the proportion of subjects for whom allocation information was obtained by the Research Assistant within 15 min of the initial participant randomization request. A secondary outcome was the average time for communicating participant group assignment back to the Research Assistant. Descriptive information regarding any failed attempts at participant randomization as well as costs attributable to use of this method were also recorded. Statistical analyses included the calculation of simple proportions and descriptive statistics. Results Forty-eight participants were successfully randomized and group allocation instruction was received for 46 (96% within 15 min of the Research Assistant placing the initial randomization request. Time elapsed in minutes until receipt of participant allocation instruction was Mean (SD 3.1 +/− 3.6; Median (IQR 2 (2,3; Range (1–20 for the entire cohort of 48. For the two participants for whom group allocation information was not received by the Research Assistant within the 15-min pass threshold, this information was obtained following a second

  10. Do transfusions cause necrotizing enterocolitis? The complementary role of randomized trials and observational studies.

    Kirpalani, Haresh; Zupancic, John A F


    A systematic review and a meta-analysis of the published literature on the association between transfusions in newborns and the occurrence of transfusion-associated necrotizing enterocolitis were performed. We discuss the differences between findings in randomized trials, and the results of observational studies that first explored this putative link. We suggest the following framework: where observational studies play a hypothesis generating- role for therapies and harm, and randomized studies allow an acid test of that hypothesis. It is acknowledged that not all questions can be subject to a randomized evaluation, but argued that this particular association is amenable to such a test. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Numerical modeling of cold room's hinged door opening and closing processes

    Carneiro, R.; Gaspar, P. D.; Silva, P. D.; Domingues, L. C.


    The need of rationalize energy consumption in agrifood industry has fasten the development of methodologies to improve the thermal and energy performances of cold rooms. This paper presents a three-dimensional (3D) transient Computational Fluid Dynamics (CFD) modelling of a cold room to evaluate the air infiltration rate through hinged doors. A species transport model is used for modelling the tracer gas concentration decay technique. Numerical predictions indicate that air temperature difference between spaces affects the air infiltration. For this case study, the infiltration rate increases 0.016 m3 s-1 per K of air temperature difference. The knowledge about the evolution of air infiltration during door opening/closing times allows to draw some conclusions about its influence on the air conditions inside the cold room, as well as to suggest best practices and simple technical improvements that can minimize air infiltration, and consequently improve thermal performance and energy consumption rationalization.

  12. Misidentification of English Language Proficiency in Triage: Impact on Satisfaction and Door-to-Room Time.

    Balakrishnan, Vamsi; Roper, Jamie; Cossey, Kori; Roman, Crystal; Jeanmonod, Rebecca


    We examined triage nurses' assessment of patients' language proficiency compared to patients' self-reported proficiency and the impact of language discordance on door-to-room time and patient satisfaction. This was a prospective study of emergency department walk-in patients. Patients completed a survey in which they identified their language proficiency. On a Likert scale, patients ranked how well they felt they were understood and how satisfied they were with the triage process. Nurses completed surveys identifying the patient's primary language and how well they felt they understood the patient. Door-to-room times were obtained from medical records. 163 patients were enrolled. 66% of patients identified themselves as having good English proficiency, while 34% of patients had limited English proficiency. Nurses misclassified 27% of self-identified Spanish-speaking patients as being English proficient. Spanish-speakers felt less satisfied with triage than English-speakers (p English-speakers.

  13. Simulation Optimization of the Crossdock Door Assignment Problem

    Aickelin, Uwe


    The purpose of this report is to present the Crossdock Door Assignment Problem, which involves assigning destinations to outbound dock doors of Crossdock centres such that travel distance by material handling equipment is minimized. We propose a two fold solution; simulation and optimization of the simulation model simulation optimization. The novel aspect of our solution approach is that we intend to use simulation to derive a more realistic objective function and use Memetic algorithms to find an optimal solution. The main advantage of using Memetic algorithms is that it combines a local search with Genetic Algorithms. The Crossdock Door Assignment Problem is a new domain application to Memetic Algorithms and it is yet unknown how it will perform.

  14. A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study)

    Dill, T; Dietz, U; Hamm, C W; Küchler, R; Rupprecht, H J; Haude, M; Cyran, J; Ozbek, C; Kuck, K H; Berger, J; Erbel, R


    .... The Comparison of Balloon-Angioplasty versus Rotational Atherectomy study (COBRA) is a multicentre, prospective, randomized trial to compare short- and long-term effects of percutaneous transluminal coronary angioplasty (PTCA...

  15. The effect of Christmas joy on the mood among medical doctors - a randomized, blinded intervention study

    Ilkjær, Christine; Møller, Marianne Birkebæk; Lauridsen, Mette H;


    -centre blinded intervention study with crossover at three hospital departments. JN intervention of three days was randomized. Median ± standard deviation was given. The level of significance was p laugh index increased...

  16. Sequential monitoring of response-adaptive randomized clinical trials

    Zhu, Hongjian; 10.1214/10-AOS796


    Clinical trials are complex and usually involve multiple objectives such as controlling type I error rate, increasing power to detect treatment difference, assigning more patients to better treatment, and more. In literature, both response-adaptive randomization (RAR) procedures (by changing randomization procedure sequentially) and sequential monitoring (by changing analysis procedure sequentially) have been proposed to achieve these objectives to some degree. In this paper, we propose to sequentially monitor response-adaptive randomized clinical trial and study it's properties. We prove that the sequential test statistics of the new procedure converge to a Brownian motion in distribution. Further, we show that the sequential test statistics asymptotically satisfy the canonical joint distribution defined in Jennison and Turnbull (\\citeyearJT00). Therefore, type I error and other objectives can be achieved theoretically by selecting appropriate boundaries. These results open a door to sequentially monitor res...

  17. Localization in random bipartite graphs: Numerical and empirical study

    Slanina, František


    We investigate adjacency matrices of bipartite graphs with a power-law degree distribution. Motivation for this study is twofold: first, vibrational states in granular matter and jammed sphere packings; second, graphs encoding social interaction, especially electronic commerce. We establish the position of the mobility edge and show that it strongly depends on the power in the degree distribution and on the ratio of the sizes of the two parts of the bipartite graph. At the jamming threshold, where the two parts have the same size, localization vanishes. We found that the multifractal spectrum is nontrivial in the delocalized phase, but still near the mobility edge. We also study an empirical bipartite graph, namely, the Amazon reviewer-item network. We found that in this specific graph the mobility edge disappears, and we draw a conclusion from this fact regarding earlier empirical studies of the Amazon network.

  18. Localization of optical excitations on random surfaces: SNOM studies

    Bozhevolnyi, Sergey I.


    Localization of optical excitations on nanostructured metal surfaces and fractal colloid silver aggregates are studied by using a scanning near-field optical microscope (SNOM). The SNOM images obtained in both configurations exhibit spatially localized (within 150 to 250 nm) light intensity...

  19. Random duality

    GUO TieXin; CHEN XinXiang


    The purpose of this paper is to provide a random duality theory for the further development of the theory of random conjugate spaces for random normed modules.First,the complicated stratification structure of a module over the algebra L(μ,K) frequently makes our investigations into random duality theory considerably different from the corresponding ones into classical duality theory,thus in this paper we have to first begin in overcoming several substantial obstacles to the study of stratification structure on random locally convex modules.Then,we give the representation theorem of weakly continuous canonical module homomorphisms,the theorem of existence of random Mackey structure,and the random bipolar theorem with respect to a regular random duality pair together with some important random compatible invariants.

  20. Random duality


    The purpose of this paper is to provide a random duality theory for the further development of the theory of random conjugate spaces for random normed modules. First, the complicated stratification structure of a module over the algebra L(μ, K) frequently makes our investigations into random duality theory considerably difierent from the corresponding ones into classical duality theory, thus in this paper we have to first begin in overcoming several substantial obstacles to the study of stratification structure on random locally convex modules. Then, we give the representation theorem of weakly continuous canonical module homomorphisms, the theorem of existence of random Mackey structure, and the random bipolar theorem with respect to a regular random duality pair together with some important random compatible invariants.

  1. A study of serial ranks via random graphs

    Haeusler, Erich; Mason, David M.; Turova, Tatyana S.


    Serial ranks have long been used as the basis for nonparametric tests of independence in time series analysis. We shall study the underlying graph structure of serial ranks. This will lead us to a basic martingale which will allow us to construct a weighted approximation to a serial rank process. To show the applicability of this approximation, we will use it to prove two very general central limit theorems for Wald-Wolfowitz-type serial rank statistics.

  2. Study on the random simulation times of mining engineering reliability

    BI Zhong-wei; DING De-xin; ZHANG Xin-hua


    The theory of Monte-Carlo simulation method is that the event happened probability was estimated by happened frequency in the experiments. So it is very important to ascertain the times of simulation. The probability and statistic theory are used to determine the optimal simulation times through strict mathematic reasoning. The study of two cases is made to show the availability of the presented method, and some relative problems were discussed.

  3. Fetal response to abbreviated relaxation techniques. A randomized controlled study.

    Fink, Nadine S; Urech, Corinne; Isabel, Fornaro; Meyer, Andrea; Hoesli, Irène; Bitzer, Johannes; Alder, Judith


    stress during pregnancy can have adverse effects on the course of pregnancy and on fetal development. There are few studies investigating the outcome of stress reduction interventions on maternal well-being and obstetric outcome. this study aims (1) to obtain fetal behavioral states (quiet/active sleep, quiet/active wakefulness), (2) to investigate the effects of maternal relaxation on fetal behavior as well as on uterine activity, and (3) to investigate maternal physiological and endocrine parameters as potential underlying mechanisms for maternal-fetal relaxation-transferral. the behavior of 33 fetuses was analyzed during laboratory relaxation/quiet rest (control group, CG) and controlled for baseline fetal behavior. Potential associations between relaxation/quiet rest and fetal behavior (fetal heart rate (FHR), FHR variation, FHR acceleration, and body movements) and uterine activity were studied, using a computerized cardiotocogram (CTG) system. Maternal heart rate, blood pressure, cortisol, and norepinephrine were measured. intervention (progressive muscle relaxation, PMR, and guided imagery, GI) showed changes in fetal behavior. The intervention groups had higher long-term variation during and after relaxation compared to the CG (p=.039). CG fetuses had more FHR acceleration, especially during and after quiet rest (p=.027). Women in the PMR group had significantly more uterine activity than women in the GI group (p=.011) and than CG women. Maternal heart rate, blood pressure, and stress hormones were not associated with fetal behavior. this study indicates that the fetus might participate in maternal relaxation and suggests that GI is superior to PMR. This could especially be true for women who tend to direct their attention to body sensations such as abdominal activity. 2010 Elsevier Ltd. All rights reserved.

  4. Laparoscopic and open incisional hernia repair: A prospective randomized study

    Mehmet Zafer Sabuncuoğlu


    Full Text Available As the number of major surgical procedures has increased in recent years, so there has been an increase in incisional hernias. With gained experience and new materials, laparoscopic repair of incisional hernia is now applied. This study was aimed to compare the results of incisional hernia repair with the open surgery or laparoscopic approach at the only centre in the region for laparoscopic incisional hernia repair. A total of 55 cases of incisional hernia at the General Surgery Clinic of SDU between November 2012 and 2014 were underwent laparoscopic ventral hernia repair (L-VHR and conventional incisional hernia repair (C-VHR. From the L-VHR group 6 cases and from the C-VHR 9 cases were excluded from the study, as they did not meet the inclusion criteria or did not wish to participate in the study. The two techniques were compared in respect of operative time, length of hospital stay, postoperative pain scores, complications and recurrence. A total of 40 cases of incisional hernia repair were evaluated. The mean follow-up period was found as 12.75±4.19 months. No difference was determined between the characteristics of the patients due to age, body mass index, American Society of Anesthesiologists (ASA score, comorbidities, hernia size, and follow-up. In the laparoscopic repair group, the postoperative pain scores, complication rates and duration of hospital stay were found significantly superior to those of the open technique group. While there was no mortality seen and wound complications as a morbidity were 0 % in the L-VHR (n = 0 and 20 % in C-VHR group (n = 4. In the comparison of mean operative time, the duration of surgery was significantly shorter in the laparoscopic repair group (67.25±19.23 min compared to the open technique group (91.50±24.87 min (p=0.001. Laparoscopic repair was associated with less postoperative pain (4.35±1.03 vs 5.60±1.31, p=0.002, lesser postoperative complications (5% vs. 35%, p=0.044, and shorter

  5. Mouth-to-mouth ventilation reduces interruptions in chest compressions during lifeguard CPR: A randomized manikin study,

    Løfgren, Bo; Adelborg, Kasper; Dalgas, Christian

    Mouth-to-mouth ventilation reduces interruptions in chest compressions during lifeguard CPR: A randomized manikin study.......Mouth-to-mouth ventilation reduces interruptions in chest compressions during lifeguard CPR: A randomized manikin study....

  6. Transcutaneus electrical nerve stimulation for overactive bladder increases rectal motor activity in children: a randomized controlled study

    Jønsson, Iben; Hagstrøm, Søren; Siggaard, Charlotte

    Transcutaneus electrical nerve stimulation for overactive bladder increases rectal motor activity in children: a randomized controlled study......Transcutaneus electrical nerve stimulation for overactive bladder increases rectal motor activity in children: a randomized controlled study...

  7. Designing medical and educational intervention studies. A review of some alternatives to conventional randomized controlled trials

    Bradley, Clare


    The advantages and limitations of RCT designs are discussed, and a range of alternative designs for medical and educational intervention studies considered. Designs selected are those that address the much neglected psychological issues involved in the recruitment of patients and allocation of patients to treatments within trials. Designs include Zelen's (18) randomized consent design, Brewin and Bradley's (20) partially randomized patient-centered design, and Korn and Baumrind's (21) partial...

  8. Effect of yoga on quality of life of CLBP patients: A randomized control study

    Tekur Padmini; Chametcha Singphow; Hongasandra Ramarao; Raghuram Nagarathna


    Context: In two of the earlier Randomized Control Trials on yoga for chronic lower back pain (CLBP), 12 to 16 weeks of intervention were found effective in reducing pain and disability. Aim: To study the efficacy of a residential short term intensive yoga program on quality of life in CLBP. Materials and Methods: About 80 patients with CLBP (females 37) registered for a week long treatment at SVYASA Holistic Health Centre in Bengaluru, India. They were randomized into two groups (40 each). T...

  9. Locked doors in acute inpatient psychiatry: a literature review.

    van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K


    Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry.

  10. 77 FR 62446 - Every Door Direct Mail-Retail


    ... increase their marketing efforts. On July 10, 2012, the Postal Service filed a request with the Postal... alternative marketing name of Every Door Direct Mail for commercial mailings of Standard Mail flats with... positioning on the host piece. d. The attachment does not interfere with processing or delivery. Folded...

  11. De Rijnvervuiling door het ongeval bij Sandoz Ag

    Canton JH; van Gestel CAM; Greve PA; de Jong AP; Knoop J; de Kruijf HAM; van de Meent D; van Noort PCM; de Nijs T; Struijs J; Zwart; D. de


    Op basis van de door DBW/RIZA en het RIVM uitgevoerde metingen van de concentraties in Rijnwater van de bij Bazel geloosde bestrijdingsmiddelen zijn schattingen gemaakt van de maximale concentraties van deze stoffen in de Nederlandse oppervlaktewateren. Het betrof met name de stoffen disulfoton en

  12. Ontwikkeling van licht reflecterende deklagen door KWS: KonweBright

    ter Huerne, Henderikus L.; Hetebrij, Dirk; Elfring, Jan


    In het kader van het milieu staan op dit moment asfalt verhardingsmaterialen met sterker lichtreflecterende eigenschappen in de belangstelling. Dergelijke materialen hebben als voordeel dat door de verbeterde reflectie-eigenschappen op de wegen minder openbare verlichting nodig is en toch een goede

  13. DOORS English--The Cognitive Basis of Rhetorical Models.

    Taylor, Karl K.


    The Development of Operational Reasoning Skills (DOORS) program at Illinois Central College is an interdisciplinary experiment that guides students from concrete to formal operational levels of thought to ensure that they understand the concepts and cognitive skills undergirding the rhetorical modes. (RL)

  14. Melkweg haarscherp in kaart door stabiele meetsystemen TNO

    Gielesen, W.L.M.


    Sinds enkele maanden draait de Ga¡a-satel]¡et van Esa op anderhalf miljoen kilometer van de aarde. Doel is om een zeer nauwkeurige driedimensionale kaart te maken van ongeveer een miljard sterren in ons Melkwegstetsel. Aan boord zijn twee meetsystemen, door TNO ontwikketd en gebouwd,

  15. Eerste kwartaal 2010 sierteelt: omzetgroei door herstel in maart

    Jukema, G.D.; Knijff, van der A.


    Het eerste kwartaal van 2010 begon door het winterse weer in januari slecht, maar eindigde hoopvol. Zowel in eigen land als op belangrijke exportmarkten remde winterse omstandigheden de aanvoer, verkoop en handel in bloemen en planten sterk. In februari en met name maart herstelde de aanvoer en mark

  16. A Scholar Who Knocks at the Door to Friendship


    <正>Senegalese scholar Adama Gaye came from far away Africa to visit China in March when there was still a chill in the early spring air. He is not an ordinary scholar, but an African friend who has come to knock at the door to friendship.The government of Senegal established diplomatic relations

  17. Melkweg haarscherp in kaart door stabiele meetsystemen TNO

    Gielesen, W.L.M.


    Sinds enkele maanden draait de Ga¡a-satel]¡et van Esa op anderhalf miljoen kilometer van de aarde. Doel is om een zeer nauwkeurige driedimensionale kaart te maken van ongeveer een miljard sterren in ons Melkwegstetsel. Aan boord zijn twee meetsystemen, door TNO ontwikketd en gebouwd, verantwoordelij

  18. Schade aan gewassen door ozon in het groeiseizoen van 1994

    Tonneijck, A.E.G.; Dijk, van C.J.


    Op vier locaties is het effect van ozon op klaver (Trifolium subterraneum) en boon (Phaseolus vulgaris L.) onderzocht. Bij beide planten is substantiele bladbeschadiging door ozon op alle locaties waargenomen. Bij de teelt van gewassen moet rekening worden gehouden met de negatieve effecten van ozon

  19. Portal: Your Door to World Languages and Cultures

    Elliott, Don; Lawton, Rachele


    Portal: Your Door to World Languages and Cultures was a series of public cultural events, in a variety of formats, created through a new partnership between the credit and continuing education (noncredit) foreign language programs at the Community College of Baltimore County (CCBC). Portal was designed to cultivate interest in foreign languages…

  20. ORIGINAL ARTICLES Door-to-needle time for administration of ...

    4 SAMJ. 241. Ischaemic heart disease (IHD) is a major cause of mortality and ... seen when the fibrinolytic is given within the first hour of symptom ... (AHA/ACC) guidelines recommend a door-to-needle time of .... The final number included in.

  1. Laparoscopically Assisted Proximal Gastrectomy with Esophagogastrostomy Using a Novel "Open-Door" Technique : LAPG with Novel Reconstruction.

    Hosoda, Kei; Yamashita, Keishi; Moriya, Hiromitsu; Mieno, Hiroaki; Ema, Akira; Washio, Marie; Watanabe, Masahiko


    Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using a novel "open-door" technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.

  2. 16 CFR 1211.13 - Inherent force activated secondary door sensors.


    ... sensors. 1211.13 Section 1211.13 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT... § 1211.13 Inherent force activated secondary door sensors. (a) Normal operation test. (1) A force activated door sensor of a door system installed according to the installation instructions shall actuate...

  3. Mixture randomized item-response modeling: a smoking behavior validation study.

    Fox, J-P; Avetisyan, M; van der Palen, J


    Misleading response behavior is expected in medical settings where incriminating behavior is negatively related to the recovery from a disease. In the present study, lung patients feel social and professional pressure concerning smoking and experience questions about smoking behavior as sensitive and tend to conceal embarrassing or threatening information. The randomized item-response survey method is expected to improve the accuracy of self-reports as individual item responses are masked and only randomized item responses are observed. We explored the validation of the randomized item-response technique in a unique experimental study. Therefore, we administered a new multi-item measure assessing smoking behavior by using a treatment-control design (randomized response (RR) or direct questioning). After the questionnaire, we administered a breath test by using a carbon monoxide (CO) monitor to determine the smoking status of the patient. We used the response data to measure the individual smoking behavior by using a mixture item-response model. It is shown that the detected smokers scored significantly higher in the RR condition compared with the directly questioned condition. We proposed a Bayesian latent variable framework to evaluate the diagnostic test accuracy of the questionnaire using the randomized-response technique, which is based on the posterior densities of the subject's smoking behavior scores together with the breath test measurements. For different diagnostic test thresholds, we obtained moderate posterior mean estimates of sensitivity and specificity by observing a limited number of discrete randomized item responses. Copyright © 2013 John Wiley & Sons, Ltd.

  4. A Randomized Double-Blind Crossover Study of Phase-Shift Sound Therapy for Tinnitus

    Heijneman, Karin M.; de Kleine, Emile; van Dijk, Pim


    Objective. The purpose of this study was to compare the efficacy of the treatment of tinnitus with a phase-shifting pure tone to that of the same tone treatment without phase shifting. Study Design. A double-blind crossover randomized controlled trial. Setting. This study was conducted at the Univer

  5. Predictors of Consent in a Randomized Field Study in Child Welfare.

    McDonald, Tom; Bhattarai, Jackie; Akin, Becci


    Randomized controlled trials (RCTs) are often viewed as the "gold standard" for proving the efficacy and effectiveness of new interventions. However, some are skeptical of the generalizability of the findings that RCTs produce. The characteristics of those willing to participate in research studies have the potential to affect the generalizability of its findings. This study examined factors that could influence consent among families recruited to participate in a randomized field trial in a real-world child welfare setting. This study tested the Parent Management Training Oregon Model for children in foster care with serious emotional disturbance. It employed a post-randomization consent design, whereby the entire sample of eligible participants, not just those who are willing to consent to randomization, are included in the sample. Initial eligibility assessment data and data from the federally mandated reporting system for public child welfare agencies provided the pool of potential predictors of consent. Bivariate and multivariate analyses were conducted to identify statistically significant predictors of consent. Being a dual reunification family was the most significant factor in predicting consent. Unmarried individuals, younger, female parents, cases where parental incarceration was the reason for removal and cases where the removal reason was not due to their children's behavioral problem(s) were also more likely to participate. As one of the first research studies to examine predictors of consent to a randomized field study in child welfare settings, results presented here can act as a preliminary guide for conducting RCTs in child welfare settings.

  6. Pain after microlaparoscopic cholecystectomy. A randomized double-blind controlled study

    Bisgaard, T; Klarskov, B; Trap, R;


    BACKGROUND: Laparoscopic cholecystectomy (LC) is traditionally performed with two 10-mm and two 5-mm trocars. The effect of smaller port incisions on pain has not been established in controlled studies. METHODS: In a double-blind controlled study, patients were randomized to LC or cholecystectomy......: The study was discontinued after inclusion of 26 patients because five of the 13 patients (38%) randomized to micro-LC were converted to LC. In the remaining 21 patients, overall pain and incisional pain intensity during the first 3 h postoperatively increased in the LC group (n = 13) compared...

  7. Psychological treatment of depression: A meta-analytic database of randomized studies

    Cuijpers, P.; Straten, van A.; Warmerdam, E.H.; Andersson, G.


    Abstract Background A large number of randomized controlled studies have clearly demonstrated that psychological interventions are effective in the treatment of depression. The number of studies in this area is increasing rapidly. In this paper, we present a database of controlled and comparative ou

  8. Increasing Parent Involvement in Youth HIV Prevention: A Randomized Caribbean Study

    Baptiste, Donna R.; Kapungu, Chisina; Miller, Steve; Crown, Laurel; Henry, David; Da Costa Martinez, Dona; Jo-Bennett, Karen


    This article presents preliminary findings of a randomized HIV prevention study in Trinidad and Tobago in the Caribbean. The study centers on a family HIV workshop aimed at strengthening parenting skills that are empirically linked to reducing adolescent HIV exposure and other sexual risks. These skills include parental monitoring; educating youth…

  9. [Ketanserin and random skin flaps. An experimental study in the rat].

    Achouche, J; Teisseire, B; Laccourreye, O; Hadjean, E


    This prospective randomised study in a rodent model was designed to analyse the value of a serotonin antagonist, ketanserin, on the survival of random skin flaps in Wistar rats. Our study demonstrates the statistical value of this molecule. The surface of skin necrosis was statistically lower in the group of rats treated with pre and post operative subcutaneous injection of ketanserin.

  10. Ultrasonic root-end preparation in apical surgery : a prospective randomized study

    de Lange, Jan; Putters, Thomas; Baas, Erik M.; van Ingen, Johan M.


    Objective. The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment. Study design. A randomized prospective design was used in a standardized treatment protocol. Patients were allocated to treatment with an ultrasonic devic

  11. Dairy consumption, systolic blood pressure, and risk of hypertension: Mendelian randomization study

    This study examined whether previous observed inverse associations of dairy intake with systolic blood pressure and risk of hypertension were causal. A Mendelian randomization study was employed, using the single nucleotide polymorphism rs4988235 related to lactase persistence as an instrumental var...

  12. Melatonin for chronic sleep onset insomnia in children: A Randomized placebo-controlled study

    Smits, M.G.; Nagtegaal, J.E.; Heijden, J.A.M. van der; Coenen, A.M.L.; Kerkhof, G.A.


    To establish the efficacy of melatonin treatment in childhood sleep onset insomnia, 40 elementary school children, 6 to 12 years of age, who suffered more than 1 year from chronic sleep onset insomnia, were studied in a double-blind, placebo-controlled study. The children were randomly assigned to

  13. Melatonin for chronic sleep onset insomnia in children: A Randomized placebo-controlled study

    Smits, M.G.; Nagtegaal, J.E.; Heijden, J.A.M. van der; Coenen, A.M.L.; Kerkhof, G.A.


    To establish the efficacy of melatonin treatment in childhood sleep onset insomnia, 40 elementary school children, 6 to 12 years of age, who suffered more than 1 year from chronic sleep onset insomnia, were studied in a double-blind, placebo-controlled study. The children were randomly assigned to r

  14. Outcomes of usual chiropractic, harm & efficacy, the ouch study: study protocol for a randomized controlled trial

    Walker Bruce F


    Full Text Available Abstract Background Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, because of these studies design we do not know the frequency and extent of these events when compared to sham treatment. The principal aims of this study are to establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group. The secondary aim of this study is to establish the efficacy of usual short term chiropractic care for spinal pain when compared to a sham intervention. Methods One hundred and eighty participants will be randomly allocated to either usual chiropractic care or a sham intervention group. To be considered for inclusion the participants must have experienced non-specific spinal pain for at least one week. The study will be conducted at the clinics of registered chiropractors in Western Australia. Participants in each group will receive two treatments at intervals no less than one week. For the usual chiropractic care group, the selection of therapeutic techniques will be left to the chiropractors' discretion. For the sham intervention group, de-tuned ultrasound and de-tuned activator treatment will be applied by the chiropractors to the regions where spinal pain is experienced. Adverse events will be assessed two days after each appointment using a questionnaire developed for this study. The efficacy of short term chiropractic care for spinal pain will be examined at two week follow-up by assessing pain, physical function, minimum acceptable outcome, and satisfaction with care, with the use of the following outcome measures: Numerical Rating Scale, Functional Rating Index, Neck Disability Index, Minimum Acceptable Outcome Questionnaire, Oswestry Disability Index, and a global measure of treatment satisfaction. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Trial

  15. Meta-analysis of non-randomized studies in interventional cardiology: a critical appraisal

    Eliano Pio Navarese


    Full Text Available Utilisation of meta-analysis is becoming more and more common in interventional cardiology. The aim of this statistical approach is to collect a large number of patients from randomized clinical studies and nonrandomized registries in order to obtain a pooled estimate of the results. Nevertheless, simply pooling these results without a correct methodological approach can easily lead to biased conclusions. In this report we analyse the possible methodological drawbacks of such an approach and we suggest a simplified check-list of items to be considered in the effort of building-up a meta-analysis from non-randomized studies.

  16. Intelligent Vision System for Door Sensing Mobile Robot

    Jharna Majumdar


    Full Text Available Wheeled Mobile Robots find numerous applications in the Indoor man made structured environments. In order to operate effectively, the robots must be capable of sensing its surroundings. Computer Vision is one of the prime research areas directed towards achieving these sensing capabilities. In this paper, we present a Door Sensing Mobile Robot capable of navigating in the indoor environment. A robust and inexpensive approach for recognition and classification of the door, based on monocular vision system helps the mobile robot in decision making. To prove the efficacy of the algorithm we have designed and developed a ‘Differentially’ Driven Mobile Robot. A wall following behavior using Ultra Sonic range sensors is employed by the mobile robot for navigation in the corridors.  Field Programmable Gate Arrays (FPGA have been used for the implementation of PD Controller for wall following and PID Controller to control the speed of the Geared DC Motor.

  17. Tissue segmentation of computed tomography images using a Random Forest algorithm: a feasibility study

    Polan, Daniel F.; Brady, Samuel L.; Kaufman, Robert A.


    There is a need for robust, fully automated whole body organ segmentation for diagnostic CT. This study investigates and optimizes a Random Forest algorithm for automated organ segmentation; explores the limitations of a Random Forest algorithm applied to the CT environment; and demonstrates segmentation accuracy in a feasibility study of pediatric and adult patients. To the best of our knowledge, this is the first study to investigate a trainable Weka segmentation (TWS) implementation using Random Forest machine-learning as a means to develop a fully automated tissue segmentation tool developed specifically for pediatric and adult examinations in a diagnostic CT environment. Current innovation in computed tomography (CT) is focused on radiomics, patient-specific radiation dose calculation, and image quality improvement using iterative reconstruction, all of which require specific knowledge of tissue and organ systems within a CT image. The purpose of this study was to develop a fully automated Random Forest classifier algorithm for segmentation of neck-chest-abdomen-pelvis CT examinations based on pediatric and adult CT protocols. Seven materials were classified: background, lung/internal air or gas, fat, muscle, solid organ parenchyma, blood/contrast enhanced fluid, and bone tissue using Matlab and the TWS plugin of FIJI. The following classifier feature filters of TWS were investigated: minimum, maximum, mean, and variance evaluated over a voxel radius of 2 n , (n from 0 to 4), along with noise reduction and edge preserving filters: Gaussian, bilateral, Kuwahara, and anisotropic diffusion. The Random Forest algorithm used 200 trees with 2 features randomly selected per node. The optimized auto-segmentation algorithm resulted in 16 image features including features derived from maximum, mean, variance Gaussian and Kuwahara filters. Dice similarity coefficient (DSC) calculations between manually segmented and Random Forest algorithm segmented images from 21

  18. Emissie van Cryptosporidium en Giardia door landbouwhuisdieren

    Schrijven JF; Bruin HAM de; Engels GB; Leenen EJTM; MGB


    In this study, the relative contributions of the pathogenic protozoa Cryptosporidium and Giardia by manure of farm animals in The Netherlands to the total yearly environmental load was studied. Manure of veal calves forms a very large source of Cryptosporidium (1.5 m 10 square 16 oocysts per year) a

  19. Eliminatie van stikstof uit afvalwater door denitrificatie

    Klapwijk, A.


    A study was made on the use of denitrification to improve the conventional purification of sewage. Denitrification, the elimination of nitrogen, saves oxygen needed for elimination of organic compounds.The kinetics was studied of the activated sludge with either nitrate or oxygen as electron accepto

  20. Learning from failure - rationale and design for a study about discontinuation of randomized trials (DISCO study

    Kasenda Benjamin


    Full Text Available Abstract Background Randomized controlled trials (RCTs may be discontinued because of apparent harm, benefit, or futility. Other RCTs are discontinued early because of insufficient recruitment. Trial discontinuation has ethical implications, because participants consent on the premise of contributing to new medical knowledge, Research Ethics Committees (RECs spend considerable effort reviewing study protocols, and limited resources for conducting research are wasted. Currently, little is known regarding the frequency and characteristics of discontinued RCTs. Methods/Design Our aims are, first, to determine the prevalence of RCT discontinuation for specific reasons; second, to determine whether the risk of RCT discontinuation for specific reasons differs between investigator- and industry-initiated RCTs; third, to identify risk factors for RCT discontinuation due to insufficient recruitment; fourth, to determine at what stage RCTs are discontinued; and fifth, to examine the publication history of discontinued RCTs. We are currently assembling a multicenter cohort of RCTs based on protocols approved between 2000 and 2002/3 by 6 RECs in Switzerland, Germany, and Canada. We are extracting data on RCT characteristics and planned recruitment for all included protocols. Completion and publication status is determined using information from correspondence between investigators and RECs, publications identified through literature searches, or by contacting the investigators. We will use multivariable regression models to identify risk factors for trial discontinuation due to insufficient recruitment. We aim to include over 1000 RCTs of which an anticipated 150 will have been discontinued due to insufficient recruitment. Discussion Our study will provide insights into the prevalence and characteristics of RCTs that were discontinued. Effective recruitment strategies and the anticipation of problems are key issues in the planning and evaluation of trials

  1. Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo - controlled study


    Background Tribulus terrestris as a herbal remedy has shown beneficial aphrodisiac effects in a number of animal and human experiments. This study was designed as a randomized double-blind placebo-controlled trial to assess the safety and efficacy of Tribulus terrestris in women with hypoactive sexual desire disorder during their fertile years. Sixty seven women with hypoactive sexual desire disorder were randomly assigned to Tribulus terrestris extract (7.5 mg/day) or placebo for 4 weeks. De...

  2. Study of charge transport in highly conducting polymers based on a random resistor network

    Zhou Liping [Department of Physics, Suzhou University, Suzhou 215006 (China)]. E-mail:; Liu Bo [Department of Physics, Suzhou University, Suzhou 215006 (China); Department of Physics, Jiangsu Teachers University of Technology, Changzhou 213001 (China); Li Zhenya [CCAST (World Laboratory), P.O. Box 8730, Beijing 100080 (China) and Department of Physics, Suzhou University, Suzhou 215006 (China)]. E-mail:


    Based on a random resistor network (RRN), we study the unusual ac conductivity {sigma}({omega}) of highly conducting polymer such as PF{sub 6} doped polypyrrole. The system is modeled as a composite medium consisting of metallic regions randomly distributed in the amorphous parts. Within the metallic regions, the polymer chains are regularly and densely packed, outside which the poorly arranged chains form amorphous host. The metallic grains are connected by resonance quantum tunneling, which occurs through the strongly localized states in the amorphous media. {sigma}({omega}), calculated from this model, reproduces the main experimental features associated with the metal-insulator transition in these polymers.

  3. Efficiency of a Care Coordination Model: A Randomized Study with Stroke Patients

    Claiborne, Nancy


    Objectives: This study investigated the efficiency of a social work care coordination model for stroke patients. Care coordination addresses patient care and treatment resources across the health care system to reduce risk, improve clinical outcomes, and maximize efficiency. Method: A randomly assigned, pre-post experimental design measured…


    吕爱钟; 张路青


    The stress analysis of surrounding rock for two random geometry tunnels is studied inthis paper by using Schwarz's alternating method. The simple and effective alternating algorithm is found, in which the surplus surface force is approximated by Fourier series, thus the iteration derivation can be conducted according to the precision required, finally, the stress results with high precision are obtained.

  5. Does epicatechin contribute to the acute vascular function effects of dark chocolate? A randomized, crossover study

    Dower, James I.; Geleijnse, Marianne; Kroon, Paul A.; Philo, Mark; Mensink, Marco; Kromhout, Daan; Hollman, Peter C.H.


    Scope: Cocoa, rich in flavan-3-ols, improves vascular function, but the contribution of specific flavan-3-ols is unknown. We compared the effects of pure epicatechin, a major cocoa flavan-3-ol, and chocolate. Methods and results: In a randomized crossover study, twenty healthy men (40-80 years)

  6. Incentive Pay Programs Do Not Affect Teacher Motivation or Reported Practices: Results from Three Randomized Studies

    Yuan, Kun; Le, Vi-Nhuan; McCaffrey, Daniel F.; Marsh, Julie A.; Hamilton, Laura S.; Stecher, Brian M.; Springer, Matthew G.


    This study drew on teacher survey responses from randomized experiments exploring three different pay-for-performance programs to examine the extent to which these programs motivated teachers to improve student achievement and the impact of such programs on teachers' instruction, number of hours worked, job stress, and collegiality. Results showed…

  7. Genetic analysis of tolerance to infections using random regressions: a simulation study

    Kause, A.


    Tolerance to infections is the ability of a host to limit the impact of a given pathogen burden on host performance. This simulation study demonstrated the merit of using random regressions to estimate unbiased genetic variances for tolerance slope and its genetic correlations with other traits,

  8. An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study

    Nourbakhsh, Mohammad Reza; Fearon, Frank J.


    Objective: To investigate the effect of noxious level electrical stimulation on pain, grip strength and functional abilities in subjects with chronic lateral epicondylitis. Design: Randomized, placebo-control, double-blinded study. Setting: Physical Therapy Department, North Georgia College and Stat

  9. Power and sample size calculations for Mendelian randomization studies using one genetic instrument.

    Freeman, Guy; Cowling, Benjamin J; Schooling, C Mary


    Mendelian randomization, which is instrumental variable analysis using genetic variants as instruments, is an increasingly popular method of making causal inferences from observational studies. In order to design efficient Mendelian randomization studies, it is essential to calculate the sample sizes required. We present formulas for calculating the power of a Mendelian randomization study using one genetic instrument to detect an effect of a given size, and the minimum sample size required to detect effects for given levels of significance and power, using asymptotic statistical theory. We apply the formulas to some example data and compare the results with those from simulation methods. Power and sample size calculations using these formulas should be more straightforward to carry out than simulation approaches. These formulas make explicit that the sample size needed for Mendelian randomization study is inversely proportional to the square of the correlation between the genetic instrument and the exposure and proportional to the residual variance of the outcome after removing the effect of the exposure, as well as inversely proportional to the square of the effect size.

  10. Dealing with missing outcome data in randomized trials and observational studies.

    Groenwold, R.H.; Donders, A.R.T.; Roes, K.C.; Harrell Jr, F.E.; Moons, K.G.


    Although missing outcome data are an important problem in randomized trials and observational studies, methods to address this issue can be difficult to apply. Using simulated data, the authors compared 3 methods to handle missing outcome data: 1) complete case analysis; 2) single imputation; and 3)

  11. Medical Students' Comfort with Pregnant Women with Substance-Use Disorders: A Randomized Educational Study

    Albright, Brittany; Skipper, Betty; Riley, Shawne; Wilhelm, Peggy; Rayburn, William F.


    Objective: The study objective was to determine whether medical students' attendance at a rehabilitation residence for pregnant women with substance-use disorders yielded changes in their attitudes and comfort levels in providing care to this population. Methods: This randomized educational trial involved 96 consecutive medical students during…

  12. Measurement Error Correction Formula for Cluster-Level Group Differences in Cluster Randomized and Observational Studies

    Cho, Sun-Joo; Preacher, Kristopher J.


    Multilevel modeling (MLM) is frequently used to detect cluster-level group differences in cluster randomized trial and observational studies. Group differences on the outcomes (posttest scores) are detected by controlling for the covariate (pretest scores) as a proxy variable for unobserved factors that predict future attributes. The pretest and…

  13. Double-blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on postoperative pain.

    Arya, A; Donne, A J; Nigam, A


    This double-blind randomized controlled trial of coblation tonsillotomy versus coblation tonsillectomy uses visual analogue scoring to compare the pain experienced in the 24h postoperative period. No statistically significant difference in pain is demonstrated in the group of 14 patients studied. Tonsillectomy is recommended over tonsillotomy.

  14. Early cessation of triptorelin in in vitro fertilization : a double-blind, randomized study

    Simons, AHM; Roelofs, HJM; Schmoutziguer, APE; Roozenburg, BJ; van't Hof-van den Brink, EP; Schoonderwoerd, SA


    Objective: To compare the efficacy of two early cessation protocols of triptorelin treatment in controlled ovarian hyperstimulation with the conventional long protocol in in vitro ferfilization/intracytoplasmic sperm injection. Design: A double-blind, randomized, multicenter study. Setting: Three Du

  15. Adjunctive corticosteroid therapy for Pneumocystis carinii pneumonia in AIDS: a randomized European multicenter open label study

    Nielsen, T L; Eeftinck Schattenkerk, J K; Jensen, B N


    Fifty-nine human immunodeficiency virus type-1-infected patients with a microscopically proven first episode of moderate to severe Pneumocystis carinii pneumonia (PCP) were enrolled into a randomized European multicenter study. The effect of adjunctive corticosteroid (CS) therapy was assessed on (a...

  16. Does epicatechin contribute to the acute vascular function effects of dark chocolate? A randomized, crossover study

    Dower, James I.; Geleijnse, Marianne; Kroon, Paul A.; Philo, Mark; Mensink, Marco; Kromhout, Daan; Hollman, Peter C.H.


    Scope: Cocoa, rich in flavan-3-ols, improves vascular function, but the contribution of specific flavan-3-ols is unknown. We compared the effects of pure epicatechin, a major cocoa flavan-3-ol, and chocolate. Methods and results: In a randomized crossover study, twenty healthy men (40-80 years) w

  17. Treatment of traumatic thoracolumbar spine fractures : A multicenter prospective randomized study of operative versus nonsurgical treatment

    Siebenga, Jan; Leferink, Vincent J. M.; Segers, Michiel J. M.; Elzinga, Matthijs J.; Bakker, Fred C.; Haarman, Henk J. Th. M.; Rommens, Pol M.; ten Duis, Henk-Jan; Patka, Peter


    Study Design. Multicenter prospective randomized trial. Objective. To test the hypotheses that thoracolumbar AO Type A spine fractures without neurologic deficit, managed with short-segment posterior stabilization will show an improved radiographic outcome and at least the same functional outcome as

  18. Preferred mesh-based inguinal hernia repair in a teaching setting: results of a randomized study.

    Nienhuijs, S.W.; Kortmann, B.B.M.; Boerma, M.; Strobbe, L.J.; Rosman, C.


    HYPOTHESIS: Surgeons' preferences for any of 3 methods of inguinal hernia repair are comparable in terms of operating time, incision length, perceived difficulty, and surgeon's satisfaction. DESIGN: Randomized patient-blinded study. SETTING: Teaching hospital. PATIENTS: A total of 334 patients rando

  19. A Randomized Control Study of Instructional Approaches for Struggling Adult Readers

    Greenberg, Daphne; Wise, Justin C.; Morris, Robin; Fredrick, Laura D.; Rodrigo, Victoria; Nanda, Alice O.; Pae, Hye K.


    This study measured the effectiveness of various instructional approaches on the reading outcomes of 198 adults who read single words at the 3.0 through 5.9 grade equivalency levels. The students were randomly assigned to one of the following interventions: Decoding and Fluency; Decoding, Comprehension, and Fluency; Decoding, Comprehension,…

  20. An experimental randomized study of six different ventilatory modes in a piglet model with normal lungs

    Nielsen, J B; Sjöstrand, U H; Henneberg, S W


    A randomized study of 6 ventilatory modes was made in 7 piglets with normal lungs. Using a Servo HFV 970 (prototype system) and a Servo ventilator 900 C the ventilatory modes examined were as follows: SV-20V, i.e. volume-controlled intermittent positive-pressure ventilation (IPPV); SV-20VIosc, i...

  1. Melatonin Treatment in Individuals with Intellectual Disability and Chronic Insomnia: A Randomized Placebo-Controlled Study

    Braam, W.; Didden, R.; Smits, M.; Curfs, L.


    Background: While several small-number or open-label studies suggest that melatonin improves sleep in individuals with intellectual disabilities (ID) with chronic sleep disturbance, a larger randomized control trial is necessary to validate these promising results. Methods: The effectiveness of melatonin for the treatment of chronic sleep…

  2. Programmed Physical Exertion in Recovery From Sports-Related Concussion: A Randomized Pilot Study.

    Maerlender, Arthur; Rieman, Wanda; Lichtenstein, Jonathan; Condiracci, C


    Although no data exist, general practice recommends only rest following concussion. This randomized clinical trial found that programmed physical exertion during recovery produced no significant differences in recovery time between groups of participants. However, high levels of exertion were deleterious. This study provides initial evidence that moderate physical activity is a safe replacement behavior during recovery.

  3. Lesson Study to Scale up Research-Based Knowledge: A Randomized, Controlled Trial of Fractions Learning

    Lewis, Catherine; Perry, Rebecca


    An understanding of fractions eludes many U.S. students, and research-based knowledge about fraction, such as the utility of linear representations, has not broadly influenced instruction. This randomized trial of lesson study supported by mathematical resources assigned 39 educator teams across the United States to locally managed lesson study…

  4. Management of prelabor rupture of membranes at term. A randomized study

    Sperling, Lene; Schantz, A L; Wåhlin, A


    OBJECTIVE: To compare the rate of obstetric interventions, length of labor, and maternal morbidity in pregnancies with prelabor rupture of membranes at term after either early or late induction of labor in both primiparous and pluriparous women. DESIGN: Prospective, randomized study. SUBJECTS: 362...

  5. The Random Forests Statistical Technique: An Examination of Its Value for the Study of Reading

    Matsuki, Kazunaga; Kuperman, Victor; Van Dyke, Julie A.


    Studies investigating individual differences in reading ability often involve data sets containing a large number of collinear predictors and a small number of observations. In this article, we discuss the method of Random Forests and demonstrate its suitability for addressing the statistical concerns raised by such data sets. The method is…

  6. A door-to-door survey of bed bug (Cimex lectularius) infestations in row homes in Philadelphia, Pennsylvania.

    Wu, Yage; Tracy, Dylan M; Barbarin, Alexis M; Barbu, Corentin M; Levy, Michael Z


    We conducted a door-to-door survey in a residential census tract of Philadelphia to estimate the prevalence and spatial patterns of recent bed bug infestations. We interviewed 596 residents, of whom 66 (11.1%) reported recent bed bug infestations. We confirmed current infestations in a subset of 15 (68.2%) of 22 inspected households. Most residents reported that their infestation began within the past year (2012-2013). We found no correlation between property value and infestation status. Spatial analyses showed significant clustering of bed bug infestations only at fine scales, suggesting limited active dispersal of the insects. Residents used a large variety of treatment methods to eliminate bed bugs, but only 48.1% reported success. Our results provide a prevalence estimate of recent bed bug infestations and highlight the importance of passive rather than active dispersal of bed bugs even among dense urban row homes.

  7. Meta-analyses including non-randomized studies of therapeutic interventions: a methodological review

    Timor Faber


    Full Text Available Abstract Background There is an increasing number of meta-analyses including data from non-randomized studies for therapeutic evaluation. We aimed to systematically assess the methods used in meta-analyses including non-randomized studies evaluating therapeutic interventions. Methods For this methodological review, we searched MEDLINE via PubMed, from January 1, 2013 to December 31, 2013 for meta-analyses including at least one non-randomized study evaluating therapeutic interventions. Etiological assessments and meta-analyses with no comparison group were excluded. Two reviewers independently assessed the general characteristics and key methodological components of the systematic review process and meta-analysis methods. Results One hundred eighty eight meta-analyses were selected: 119 included both randomized controlled trials (RCTs and non-randomized studies of interventions (NRSI and 69 only NRSI. Half of the meta-analyses (n = 92, 49 % evaluated non-pharmacological interventions. “Grey literature” was searched for 72 meta-analyses (38 %. An assessment of methodological quality or risk of bias was reported in 135 meta-analyses (72 % but this assessment considered the risk of confounding bias in only 33 meta-analyses (18 %. In 130 meta-analyses (69 %, the design of each NRSI was not clearly specified. In 131 (70 %, whether crude or adjusted estimates of treatment effect for NRSI were combined was unclear or not reported. Heterogeneity across studies was assessed in 182 meta-analyses (97 % and further explored in 157 (84 %. Reporting bias was assessed in 127 (68 %. Conclusions Some key methodological components of the systematic review process—search for grey literature, description of the type of NRSI included, assessment of risk of confounding bias and reporting of whether crude or adjusted estimates were combined—are not adequately carried out or reported in meta-analyses including NRSI.

  8. Is Bonferroni correction more sensitive than Random Field Theory for most fMRI studies?

    Tierney, Tim M; Carmichael, David W


    Random Field Theory has been used in the fMRI literature to address the multiple comparisons problem. The method provides an analytical solution for the computation of precise p-values when its assumptions are met. When its assumptions are not met the thresholds generated by Random Field Theory can be more conservative than Bonferroni corrections, which are arguably too stringent for use in fMRI. As this has been well documented theoretically it is surprising that a majority of current studies (~80%) would not meet the assumptions of Random Field Theory and therefore would have reduced sensitivity. Specifically most data is not smooth enough to meet the good lattice assumption. Current studies smooth data on average by twice the voxel size which is rarely sufficient to meet the good lattice assumption. The amount of smoothing required for Random Field Theory to produce accurate p-values increases with image resolution and decreases with degrees of freedom. There is no rule of thumb that is valid for all study...

  9. Ervaringen van schaamte en psychologisch lijden door voedselbankklanten

    Hille Hoogland


    qualify for a food parcel. Shame is also felt when going to the foodbank and as result of the lack of choice of food. Thirdly, we found a category of shame that was related to the restrictions of consumption. The foodbank clients feel that they are unable to buy the food or clothing that they want or to take part in activities.In conclusion, we found, in line with other studies, that foodbank clients experience psychological suffering and feelings of shame. These feelings of shame relate to the stigma attached to being a foodbank client and are reinforced by the way the foodbanks operate. Foodbank clients feel that they have a lack of choice, not only at the foodbank, but also in the wider context of the consumer society. SAMENVATTINGErvaringen van schaamte en psychologisch lijden door voedselbankklanten Voedselbanken bestaan al meer dan tien jaar in Nederland en groeien in aantal en omvang. Er is beperkt wetenschappelijk onderzoek gedaan naar voedselbankklanten in Nederland en ook in internationale studies ontbreekt het klantperspectief. In dit artikel presenteren wij bevindingen uit 45 diepte-interviews met voedselbankklanten in Amsterdam, waarbij wij hun ervaring centraal stelden. De centrale vraag die wij in dit artikel beantwoorden is: welke rol spelen financiële problemen, schaamte en andere emoties bij voedselbankklanten in Amsterdam? Voedselbankklanten zeggen dat zij besparen op consumptiemiddelen en activiteiten vanwege hun gelimiteerde budget. Het gebrek aan geld beperkt een aantal respondenten in hun sociale leven. In reactie op geldzorgen laten sommigen hun post ongeopend of zij verdoven zich. De respondenten uiten dat zij stress, slapeloosheid, angst, paniek, depressie en/of somberheid door geldgebrek ervaren. Dit vatten wij samen als psychologisch lijden. Hiernaast is schaamte een veel genoemde emotie. Ook uit andere studies bleek dat schaamte veel voorkomt bij voedselbankklanten. Wij zagen hiervoor drie verschillende oorzaken: het stempel voedselbankklant

  10. Quality of life in symptomatic cervical myelopathy after open-door laminoplasty

    Rodrigo Yuiti Nakao


    Full Text Available OBJECTIVE: To analyze the results obtained by open-door laminoplasty using the Newbridge(r/Blackstone plate, in cases of myelopathy associated with cervical lordosis.METHODS: From December 2010 to October 2012, eight patients between the ages of 49 and 68 underwent open-door laminoplasty with the use of the Newbridge(r fixation system for maintenance and stabilization of the cervical laminoplasty. Minimum follow-up was four months. For the evaluation of quality of life the questionnaire SF-36 was applied at the following times: preoperative, one month and three months after surgery associated with the subjective assessment of the patient regarding satisfaction with the procedure and with the Nurick neurological scale applied prior to surgery and three months later.RESULTS: According to the SF-36, there was significant improvement in the domains functional ability, general health perceptions and emotional aspects over time; regarding physical limitations and social aspects there was no improvement in the first postoperative month, only in the third month. There were no statistically significant changes observed during the period covered by this study related to pain, vitality and mental health. According to Nurick scale, there was evidence of improvement in symptoms of cervical myelopathy. Based on the subjective evaluation of the patients, surprisingly, all patients were satisfied with the surgical procedure and the results.CONCLUSION: The open-door laminoplasty technique with rigid fixation to maintain the opening is useful in improving the symptoms of cervical myelopathy associated with lordosis, leading to improved quality of life and with a high degree of patient satisfaction and fewer complications.

  11. Mindfulness meditation in older adults with postherpetic neuralgia: a randomized controlled pilot study.

    Meize-Grochowski, Robin; Shuster, George; Boursaw, Blake; DuVal, Michelle; Murray-Krezan, Cristina; Schrader, Ron; Smith, Bruce W; Herman, Carla J; Prasad, Arti


    This parallel-group, randomized controlled pilot study examined daily meditation in a diverse sample of older adults with postherpetic neuralgia. Block randomization was used to allocate participants to a treatment group (n = 13) or control group (n = 14). In addition to usual care, the treatment group practiced daily meditation for six weeks. All participants completed questionnaires at enrollment in the study, two weeks later, and six weeks after that, at the study's end. Participants recorded daily pain and fatigue levels in a diary, and treatment participants also noted meditation practice. Results at the 0.10 level indicated improvement in neuropathic, affective, and total pain scores for the treatment group, whereas affective pain worsened for the control group. Participants were able to adhere to the daily diary and meditation requirements in this feasibility pilot study.

  12. Knocking on a wide open door

    Kragelund, Peter


    Chinese policies to gain access to resources and markets, but also the consequence of liberal African investment policies imposed by Western donors in the past. This article uses Zambia as a case study to challenge the often one-sided view of the local consequences of China's engagement with Africa......The current strong foothold of Chinese enterprises on the African continent concerns many western observers. They fear that the West will lose leverage in Africa and simultaneously postpone development. Paradoxically, the advance of Chinese enterprises in Africa is not only the result of deliberate......, and it shows that we need to consider the type of policies that guide investment flows in order to increase the local benefits of China's growing presence in the continent....

  13. A theoretical study of the spin glass-Kondo-magnetic disordered alloys in the presence of a random field

    Magalhaes, S. G.; Zimmer, F. M.; Coqblin, B.


    We study here the influence of a random applied magnetic field on the competition between the Kondo effect, the spin glass phase and a ferromagnetic order in disordered cerium systems such as CeNi1-xCux. The model used here takes an intrasite Kondo coupling and an intersite random coupling; both the intersite random coupling and the random magnetic field are described within the Sherrington-Kirkpatrick model and the one-step replica symmetry breaking procedure is also used here. We present phase diagrams giving Temperature versus the Kondo exchange parameter and the random magnetic field makes decrease particularly the importance of the spin glass and ferromagnetic phases.

  14. The effect of a paraffin screen on the neutron dose at the maze door of a 15 MV linear accelerator.

    Krmar, M; Nikolić, D; Kuzmanović, A; Kuzmanović, Z; Ganezer, K


    The purpose of this study was to explore the effects of a paraffin screen located at various positions in the maze on the neutron dose equivalent at the maze door. The neutron dose equivalent was measured at the maze door of a room containing a 15 MV linear accelerator for x-ray therapy. Measurements were performed for several positions of the paraffin screen covering only 27.5% of the cross-sectional area of the maze. The neutron dose equivalent was also measured at all screen positions. Two simple models of the neutron source were considered in which the first assumed that the source was the cross-sectional area at the inner entrance of the maze, radiating neutrons in an isotropic manner. In the second model the reduction in the neutron dose equivalent at the maze door due to the paraffin screen was considered to be a function of the mean values of the neutron fluence and energy at the screen. The results of this study indicate that the equivalent dose at the maze door was reduced by a factor of 3 through the use of a paraffin screen that was placed inside the maze. It was also determined that the contributions to the dosage from areas that were not covered by the paraffin screen as viewed from the dosimeter, were 2.5 times higher than the contributions from the covered areas. This study also concluded that the contributions of the maze walls, ceiling, and floor to the total neutron dose equivalent were an order of magnitude lower than those from the surface at the far end of the maze. This study demonstrated that a paraffin screen could be used to reduce the neutron dose equivalent at the maze door by a factor of 3. This paper also found that the reduction of the neutron dose equivalent was a linear function of the area covered by the maze screen and that the decrease in the dose at the maze door could be modeled as an exponential function of the product φ·E at the screen.

  15. The effect of a paraffin screen on the neutron dose at the maze door of a 15 MV linear accelerator

    Krmar, M.; Kuzmanović, A. [Physics Department, Faculty of Science, University of Novi Sad, Novi Sad 21000 (Serbia); Nikolić, D. [National Institute for Nanotechnology, Edmonton, Alberta T6G 2M9 (Canada); Kuzmanović, Z. [International Medical Centers, Banja Luka 78000, Republika Srpska, Bosnia and Herzegovina (Bosnia and Herzegowina); Ganezer, K. [Physics Department, California State University Dominguez Hills, Carson, California 90747 (United States)


    Purpose: The purpose of this study was to explore the effects of a paraffin screen located at various positions in the maze on the neutron dose equivalent at the maze door.Methods: The neutron dose equivalent was measured at the maze door of a room containing a 15 MV linear accelerator for x-ray therapy. Measurements were performed for several positions of the paraffin screen covering only 27.5% of the cross-sectional area of the maze. The neutron dose equivalent was also measured at all screen positions. Two simple models of the neutron source were considered in which the first assumed that the source was the cross-sectional area at the inner entrance of the maze, radiating neutrons in an isotropic manner. In the second model the reduction in the neutron dose equivalent at the maze door due to the paraffin screen was considered to be a function of the mean values of the neutron fluence and energy at the screen.Results: The results of this study indicate that the equivalent dose at the maze door was reduced by a factor of 3 through the use of a paraffin screen that was placed inside the maze. It was also determined that the contributions to the dosage from areas that were not covered by the paraffin screen as viewed from the dosimeter, were 2.5 times higher than the contributions from the covered areas. This study also concluded that the contributions of the maze walls, ceiling, and floor to the total neutron dose equivalent were an order of magnitude lower than those from the surface at the far end of the maze.Conclusions: This study demonstrated that a paraffin screen could be used to reduce the neutron dose equivalent at the maze door by a factor of 3. This paper also found that the reduction of the neutron dose equivalent was a linear function of the area covered by the maze screen and that the decrease in the dose at the maze door could be modeled as an exponential function of the product φ·E at the screen.

  16. Randomized Controlled Pilot Study Testing Use of Smartphone Technology for Obesity Treatment

    Allen, Jerilyn K.; Janna Stephens; Dennison Himmelfarb, Cheryl R.; Stewart, Kerry J.; Sara Hauck


    Background. The established interventions for weight loss are resource intensive which can create barriers for full participation and ultimate translation. The major goal of this pilot study was to evaluate the feasibility, acceptability, and preliminary efficacy of theoretically based behavioral interventions delivered by smartphone technology. Methods. The study randomized 68 obese adults to receive one of four interventions for six months: (1) intensive counseling intervention, (2) intensi...

  17. Treatment of Aspergillus fumigatus in patients with cystic fibrosis: a randomized, placebo-controlled pilot study.

    Shawn D Aaron

    Full Text Available BACKGROUND: Many patients with cystic fibrosis develop persistent airway infection/colonization with Aspergillus fumigatus, however the impact of A. fumigatus on clinical outcomes remains unclear. The objective of this study was to determine whether treatment directed against Aspergillus fumigatus improves pulmonary function and clinical outcomes in patients with cystic fibrosis (CF. METHODS: We performed a double-blind randomized placebo-controlled pilot clinical trial involving 35 patients with CF whose sputum cultures were chronically positive for A. fumigatus. Participants were centrally randomized to receive either oral itraconazole 5 mg/kg/d (N = 18 or placebo (N = 17 for 24 weeks. The primary outcome was the proportion of patients who experienced a respiratory exacerbation requiring intravenous antibiotics over the 24 week treatment period. Secondary outcomes included changes in FEV(1 and quality of life. RESULTS: Over the 24 week treatment period, 4 of 18 (22% patients randomized to itraconazole experienced a respiratory exacerbation requiring intravenous antibiotics, compared to 5 of 16 (31% placebo treated patients, P = 0.70. FEV(1 declined by 4.62% over 24 weeks in the patients randomized to itraconazole, compared to a 0.32% improvement in the placebo group (between group difference = -4.94%, 95% CI: -15.33 to 5.45, P = 0.34. Quality of life did not differ between the 2 treatment groups throughout the study. Therapeutic itraconazole blood levels were not achieved in 43% of patients randomized to itraconazole. CONCLUSION: We did not identify clinical benefit from itraconazole treatment for CF patients whose sputum was chronically colonized with A. fumigatus. Limitations of this pilot study were its small sample size, and failure to achieve therapeutic levels of itraconazole in many patients. TRIAL REGISTRATION: NCT00528190.

  18. Opening doors to knowledge in Bhutan.


    School girls, teachers, and health school students were surveyed, using 3 different questionnaires, in January 1993. Catherine Payne, former research associate of the Family Planning Council of Southeastern Pennsylvania, visited Bhutan from August 18 through September 4, 1993, to assist with the interpretation of results and to interview teachers in schools where the new curriculum would be introduced and officials who were writing it. Results were released in October 1993. 160 young women (10-20 years of age) from 5 schools were surveyed and another 60 were interviewed by Payne. 25% of the surveyed girls understood the connection between menstruation and reproduction. Of those who had heard of menstruation, 60% had heard about it from their friends; 30%, from siblings; 27%, from mothers; and 10%, from schools. Teachers in the survey were supportive of the study and recognized the importance of reproductive health education. Also, officials of the education and health ministries, epidemiologists, experts in information, education, and communication (IEC), and district health officers attended a 2-day workshop directed at local data collection and analysis of this type. Although teenage pregnancy and sexually transmitted diseases (STDs) are increasing in Bhutan, family planning services are not reaching youth, particularly those who do not attend school or do not have children. Hospitals provide contraceptives mainly to those over 21, and outreach clinics are not catering to the family planning needs of minors. One of the recommendations of this survey/workshop was to provide correct information on reproductive health to youth.

  19. Mini-flared Kelman tip, reverse tip, and sidewinder tip with torsional phaco: a prospective randomized comparative study

    Hida, Wilson Takashi; Tzelikis, Patrick Frensel; Nakano, Celso Takashi; Motta, Antonio Francisco Pimenta; Alves, Milton Ruiz


    ...: In this prospective, comparative, masked study, patients were randomly assigned to have torsional coaxial microincision cataract surgery using the mini-flared 45-degree Kelman tip, reversed mini...

  20. Virtual Doors to Brick and Mortar Learning

    Shaw, M. S.; Gay, P. L.; Meyer, D. T.; Zamfirescu, J. D.; Smith, J. E.; MIT Educational Studies Program Team


    The MIT Educational Studies Program (ESP) has spent the past year developing an online gateway for outreach programs. The website has a five-fold purpose: to introduce the organization to potential students, teachers, volunteers and collaborators; to allow teachers to create, design and interact with classes and to allow students to register for and dialogue with these classes; to provide an online forum for continuing dialogue; and to provide organizers a wiki for documenting program administration. What makes our site unique is the free and flexible nature of our easily edited and expanded code. In its standard installation, teachers setup classes, and administrators can approve/edit classes and make classes visible in an online catalogues. Student registration is completely customizable - students can register for self-selected classes, or they can register for a program and later get placed into teacher-selected classes. Free wiki software allows users to interactively create and edit documentation and knowledgebases. This allows administrators to track online what has been done while at the same time creating instant documentation for future programs. The online forum is a place where students can go after our programs end to learn more, interact with their classmates, and continue dialogues started in our classrooms. We also use the forum to get feedback on past and future programs. The ease with which the software handles program creation, registration, communications and more allows programs for roughly 3000 students per year to be handled by about 20 volunteering undergraduates. By combining all these elements - promotion, class creation, program registration, an organizational wiki, and student forums - we create a one-stop virtual entryway into face-to-face learning that allows students to continue their experience after they leave the classroom. The code for this site is available for free upon request to other organizations.

  1. Family psychoeducation for major depressive disorder - study protocol for a randomized controlled trial

    Timmerby, Nina; Austin, Stephen F; Ussing, Kristian;


    BACKGROUND: Major depressive disorder has been shown to affect many domains of family life including family functioning. Conversely, the influence of the family on the course of the depression, including the risk of relapse, is one reason for targeting the family in interventions. The few studies...... will investigate the effect of family psychoeducation compared to social support on the course of the illness in patients with major depressive disorder. METHOD/DESIGN: The study is designed as a dual center, two-armed, observer-blinded, randomized controlled trial. Relatives are randomized to participate in one...... conducted within this area indicate that family psychoeducation as a supplement to traditional treatment can effectively reduce the risk of relapse in patients with major depression as well as being beneficial for the relatives involved. However, the evidence is currently limited. This study...

  2. The Relationship with Self Esteem Between Self Monitoring Levels of Sub Elite In - Door Soccer Players

    Mehmet Behzat T U R A N


    Full Text Available The aim of this study was to investigate the relationship with self - esteem between self monitoring levels of sub - elite in - door soccer players. For this aim, 86 male and 91 female athletes at the ages of 18 – 28 years were participated in this study voluntarily. The participants were studying at 7 different universities that join ed the in - door soccer championship of Turkish University Sport Federati on. The Socio - demographic data form, Self - monitoring Scale , and Coopersmith Self - Esteem Inventory were performed by the participants. The d ata was analyzed by using IBM SPSS (version 20.0. The Spearman Correlation parameter calculated in order to comment the relationship with data, Multiple regret ion analysis were performed for the predictive power of self - esteem for self monitoring levels of the participants. According to the analysis, a negative relationship was found among self - esteem, self - monitoring total score , and extraversion levels . A nd it was found that self - esteem levels predictived self monitoring levels substantially. It was found that the s elf - monitoring and extraversion affected self - esteem negatively, it was thought that highly self - esteem ed athletes have a tendency to see themselves as superior than the other athletes, ignore the extraneous criticism. No matter what self - esteem levels is that extraversion and acting altitute (attitude ? has not change. Consequently, self - esteem has revers e relationship with self - monitoring properties since trainers and teachers both is raised self - esteem and is helped self - monitoring themselves.

  3. Critical behavior of the random-bond Ashkin-Teller model: A Monte Carlo study

    Wiseman, Shai; Domany, Eytan


    The critical behavior of a bond-disordered Ashkin-Teller model on a square lattice is investigated by intensive Monte Carlo simulations. A duality transformation is used to locate a critical plane of the disordered model. This critical plane corresponds to the line of critical points of the pure model, along which critical exponents vary continuously. Along this line the scaling exponent corresponding to randomness φ=(α/ν) varies continuously and is positive so that the randomness is relevant, and different critical behavior is expected for the disordered model. We use a cluster algorithm for the Monte Carlo simulations based on the Wolff embedding idea, and perform a finite size scaling study of several critical models, extrapolating between the critical bond-disordered Ising and bond-disordered four-state Potts models. The critical behavior of the disordered model is compared with the critical behavior of an anisotropic Ashkin-Teller model, which is used as a reference pure model. We find no essential change in the order parameters' critical exponents with respect to those of the pure model. The divergence of the specific heat C is changed dramatically. Our results favor a logarithmic type divergence at Tc, C~lnL for the random-bond Ashkin-Teller and four-state Potts models and C~ln lnL for the random-bond Ising model.

  4. Prevalence of Willis-Ekbom disease in rural coastal Ecuador. A two-phase, door-to-door, population-based survey.

    Del Brutto, Oscar H; Del Brutto, Victor J; Zambrano, Mauricio; Castillo, Pablo R


    To estimate the prevalence of Willis-Ekbom disease (WED) in a racially homogeneous population of adults Amerindians living in rural coastal Ecuador, and to assess the reliability of the International Restless Legs Syndrome Study Group (IRLSSG) questionnaire when used in population-based studies. Two-phase, door-to-door, population-based survey. During Phase I, rural doctors screened all Atahualpa residents aged ≥40 years with the IRLSSG questionnaire. In Phase II, neurologists evaluated suspected WED cases and a matched sample of negative individuals. The census identified 665 persons aged ≥40 years. An affirmative response to the questionnaire was obtained in 94 persons. Medical history and neurological examination confirmed the diagnosis of WED in 40 of them. The evaluation of 188 non-suspected individuals revealed no further cases. The questionnaire had a sensitivity of 100% (95% CI, 89% to 100%), a specificity of 78% (95% CI, 72% to 83%), a positive predictive value of 0.43 (95% CI, 0.33 to 0.53), and a negative predictive value of 1 (95% CI, 0.98 to 1). The prevalence of WED in Atahualpa residents aged ≥40 years was 6%. The prevalence of WED in this adult Ecuadorian population is higher than that reported from most studies conducted in tropical countries, but similar to that found in Brazil. Specificity and positive predictive value of the IRLSSG questionnaire are poor, which reinforces the need for a second phase that should include an expert interview. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Integrated AHP-TRIZ Innovation Method for Automotive Door Panel Design



    Full Text Available This research is intended to improve the ‘Theory of Inventive Problem Solving’ TRIZ methodology by integrating with the Multi Criteria Decision Making (MCDM tool; Analytical Hierarchy Process (AHP. This integration works as a support tool to assist the TRIZ practitioners or design engineers. AHP is employed to rank ideas generated by TRIZ in order to select the most ideal idea further to next stages. This integration was analyzed and validated by a study case of door panel of a sedan car. Both front and rear door panels are covered in this study. A survey of interior’s problems and customer’s preferences had been conducted in order to identify the criteria and weights for AHPevaluation processes. Basically, there were 10 ideas triggered by TRIZ contradiction and principle approach. The ideas were refined and ranked through AHP’s Expert Choice software. Several ideas hadbeen combined and finalized as one ideal improved design. Applying AHP into problem solving method of TRIZ results in avoiding cost waste and increasing the design efficiency during the product design and development processes.

  6. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: A randomized study.

    Dreyer, Nikol E; Cutshall, Susanne M; Huebner, Marianne; Foss, Diane M; Lovely, Jenna K; Bauer, Brent A; Cima, Robert R


    The purpose of this randomized controlled trial was to evaluate the effect of postoperative massage in patients undergoing abdominal colorectal surgery. One hundred twenty-seven patients were randomized to receive a 20-min massage (n = 61) or social visit and relaxation session (no massage; n = 66) on postoperative days 2 and 3. Vital signs and psychological well-being (pain, tension, anxiety, satisfaction with care, relaxation) were assessed before and after each intervention. The study results indicated that postoperative massage significantly improved the patients' perception of pain, tension, and anxiety, but overall satisfaction was unchanged. In conclusion, massage may be beneficial during postoperative recovery for patients undergoing abdominal colorectal surgery. Further studies are warranted to optimize timing and duration and to determine other benefits in this clinical setting.

  7. A pilot randomized study of skills training for African American cancer survivors.

    Davis, Cindy; Rust, Connie; Choi, Sam


    This study tested the efficacy of a psychosocial group intervention for African American breast cancer survivors based on the Cancer Survival Toolbox with the specific aim of decreasing distress and improving aspects of psychosocial functioning and quality of life. This pilot study utilized a randomized, repeated measures, experimental design. The study sample (N = 71) consisted of an intervention group (n = 23) of cancer survival skills training for 6 weeks and a control group (n = 48). The study could not confirm that cancer skills training in a psychoeducational group setting had a positive effect on decreasing stress or improving aspects of psychosocial functioning and quality of life.

  8. A professional curriculum vitae will open career doors.

    Harper, D S


    In today's challenging healthcare environment, it is essential for nurse practitioners to be able to describe themselves professionally on paper to compete for practice and academic opportunities. Nurse practitioners are competing with physician assistants as well as physicians for primary and acute care positions. A carefully compiled curriculum vitae will present the individual in the best light possible to help open career doors and enhance chances of success. Preparing a curriculum vitae will serve to highlight relevant professional accomplishments, whatever the setting, toward the fulfillment of professional goals. This article reviews the current professional print and electronic literature on preparing a curriculum vitae to assist the nurse practitioner in developing this vital document.

  9. Container lid gasket protective strip for double door transfer system

    Allen, Jr., Burgess M


    An apparatus and a process for forming a protective barrier seal along a "ring of concern" of a transfer container used with double door systems is provided. A protective substrate is supplied between a "ring of concern" and a safety cover in which an adhesive layer of the substrate engages the "ring of concern". A compressive foam strip along an opposite side of the substrate engages a safety cover such that a compressive force is maintained between the "ring of concern" and the adhesive layer of the substrate.

  10. Getting added value from using qualitative research with randomized controlled trials: a qualitative interview study


    Background Qualitative research is undertaken with randomized controlled trials of health interventions. Our aim was to explore the perceptions of researchers with experience of this endeavour to understand the added value of qualitative research to the trial in practice. Methods A telephone semi-structured interview study with 18 researchers with experience of undertaking the trial and/or the qualitative research. Results Interviewees described the added value of qualitative research for the...

  11. Anomalous scaling in the random-force-driven Burgers equation. A Monte Carlo study

    Mesterhazy, David [TU Darmstadt (Germany). Inst. fuer Kernphysik; Jansen, Karl [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann Inst. fuer Computing


    We present a new approach to determine the small-scale statistical behavior of hydrodynamic turbulence by means of lattice simulations. Using the functional integral representation of the random-force-driven Burgers equation we show that high-order moments of velocity differences satisfy anomalous scaling. The general applicability of Monte Carlo methods provides the opportunity to study also other systems of interest within this framework. (orig.)

  12. Study on Phylogenetic Relationships of Five Breeds of Pigs by Random Amplified Polymorphic DNA(RAPD)


    RAPD was used to study the genetic divergency and phylogenetic relationships of five breeds of domestic pigs,including Min pig,Duroc,Yorkshired,Landrace and Junmu I pig.We selected fourteen primers from eighty random primers,caculated genetic distance index matrix and constructed phylogenetic tree with UPGMA methods.Genetic distance index matrix indicated that the genetic relationship between Junmu I pig and Landrace was the closest and the farthest between Duroc and min pig.

  13. Directed polymer in random media, in two dimensions: numerical study of the aging dynamics

    Barrat, A.


    Following a recent work by Yoshino, we study the aging dynamics of a directed polymer in random media, in 1+1 dimensions. Through temperature quench, and temperature cycling numerical experiments similar to the experiments on real spin glasses, we show that the observed behaviour is comparable to the one of a well known mean field spin glass model. The observation of various quantities (correlation function, ``clonation'' overlap function) leads to an analysis of the phase space landscape.

  14. Improving Parental Stress Levels Among Mothers Living with HIV: A Randomized Control Group Intervention Study

    Johnson, Erica R.; Davies, Susan L.; Aban, Inmaculada; Mugavero, Michael J.; Shrestha, Sadeep; Kempf, Mirjam-Colette


    Limited knowledge exists regarding parenting efficacy interventions for mothers living with HIV (MLH). This study evaluated the impact of a supportive group intervention on lowering parenting stress among MLH. Eighty MLH were randomized to a parenting (N=34) or health focused (control) (N=46) group intervention. Pre- and post-intervention stress levels were assessed using the Parental Stress Index-Short Form (PSI/SF). Differences in PSI/SF scores were examined using ANOVA, and predictors of P...

  15. Impacts of Comprehensive Teacher Induction: Results from the First Year of a Randomized Controlled Study

    Steven Glazerman Sarah Dolfin Martha Bleeker Amy Johnson Eric Isenberg Julieta Lugo-Gil Mary Grider Edward Britton


    Comprehensive teacher induction provides novice teachers with carefully selected and trained full-time mentors, as well as a curriculum of intensive and structured support. This report presents the first round of results from a large-scale randomized controlled study of the effects of two comprehensive teacher induction programs. Intensive mentoring and professional development for teachers just entering the profession did not increase teacher retention or generate any significant improvement...

  16. Impacts of Comprehensive Teacher Induction: Results from the First Year of a Randomized Controlled Study.

    Steven Glazerman; Sarah Dolfin; Martha Bleeker; Amy Johnson; Eric Isenberg; Julieta Lugo-Gil; Mary Grider; Edward Britton


    Comprehensive teacher induction provides novice teachers with carefully selected and trained full-time mentors, as well as a curriculum of intensive and structured support. This report presents the first round of results from a large-scale randomized controlled study of the effects of two comprehensive teacher induction programs. Intensive mentoring and professional development for teachers just entering the profession did not increase teacher retention or generate any significant improvement...

  17. Genome Wide Association Study to predict severe asthma exacerbations in children using random forests classifiers

    Litonjua Augusto A


    Full Text Available Abstract Background Personalized health-care promises tailored health-care solutions to individual patients based on their genetic background and/or environmental exposure history. To date, disease prediction has been based on a few environmental factors and/or single nucleotide polymorphisms (SNPs, while complex diseases are usually affected by many genetic and environmental factors with each factor contributing a small portion to the outcome. We hypothesized that the use of random forests classifiers to select SNPs would result in an improved predictive model of asthma exacerbations. We tested this hypothesis in a population of childhood asthmatics. Methods In this study, using emergency room visits or hospitalizations as the definition of a severe asthma exacerbation, we first identified a list of top Genome Wide Association Study (GWAS SNPs ranked by Random Forests (RF importance score for the CAMP (Childhood Asthma Management Program population of 127 exacerbation cases and 290 non-exacerbation controls. We predict severe asthma exacerbations using the top 10 to 320 SNPs together with age, sex, pre-bronchodilator FEV1 percentage predicted, and treatment group. Results Testing in an independent set of the CAMP population shows that severe asthma exacerbations can be predicted with an Area Under the Curve (AUC = 0.66 with 160-320 SNPs in comparison to an AUC score of 0.57 with 10 SNPs. Using the clinical traits alone yielded AUC score of 0.54, suggesting the phenotype is affected by genetic as well as environmental factors. Conclusions Our study shows that a random forests algorithm can effectively extract and use the information contained in a small number of samples. Random forests, and other machine learning tools, can be used with GWAS studies to integrate large numbers of predictors simultaneously.

  18. The heat capacity of small metallic grains studied by the random matrices theory

    Chen Zhi-Qian; Cheng Nan-Pu; Shi Zhen-Gang


    The random matrices theory is applied to a study of the heat capacity of small metallic grains. The numerical calculations indicate that the level distribution and the difference between the particles respectively with an even and an odd numbers of electrons are important for the heat capacity of the small metallic grains at a low temperature and the level correlation mainly affects the heat capacity at a high temperature.

  19. Randomized, double-blind, comparative study of oral metronidazole and tinidazole in treatment of bacterial vaginosis

    Raja, Indu M.; Asha Basavareddy; Deepali Mukherjee; Bikash Ranjan Meher


    Objective: To compare the efficacy and tolerability of oral metronidazole and tinidazole in patients with bacterial vaginosis (BV) using Amsel's criteria. Patients and Methods: This was a randomized double-blind study, conducted by the Departments of Pharmacology and Gynecology of a tertiary care teaching hospital. Patients diagnosed with BV received either tablet metronidazole 500 mg twice daily for 5 days or tablet tinidazole 500 mg once daily + one placebo for 5 days and instructed to come...

  20. A Study on the Randomness of Stock Prices by Using the RMT-Test

    Yang, Xin; Tanka-Yamawaki, Mieko

    The authors proposed earlier a new method to measure the randomness of long sequences based on the Random Matrix Theory (RMT), which is called as the RMT-test, and proved its effectiveness by distinguishing subtle differences among the randomness of various random numbers generated by physical or algorithmic generators. However, the real application of this method would be on the real data of relatively low randomness. In this article, the RMT-test is applied to measure the randomness of intraday stock price time series. It is found that the stocks having high randomness tend to perform better in the next year, in comparison to the stocks of low randomness.

  1. Research of hail impact on aircraft wheel door with lattice hybrid structure

    Li, Shengze; Jin, Feng; Zhang, Weihua; Meng, Xuanzhu


    Aimed at a long lasting issue of hail impact on aircraft structures and aviation safety due to its high speed, the resistance performance of hail impact on the wheel door of aircraft with lattice hybrid structure is investigated. The proper anti-hail structure can be designed both efficiency and precision based on this work. The dynamic responses of 8 different sandwich plates in diverse impact speed are measured. Smoothed Particle Hydrodynamic (SPH) method is introduced to mimic the speciality of solid-liquid mixture trait of hailstone during the impact process. The deformation and damage degree of upper and lower panel of sandwich plate are analysed. The application range and failure mode for the relevant structure, as well as the energy absorbing ratio between lattice structure and aluminium foam are summarized. Results show that the tetrahedral sandwich plate with aluminium foam core is confirmed the best for absorbing energy. Furthermore, the high absorption characteristics of foam material enhance the capability of the impact resistance for the composition with lattice structure without increasing the structure surface density. The results of study are of worth to provide a reliable basis for reduced weight aircraft wheel door.

  2. Effect of obstacle position in the flow of sheep through a narrow door

    Zuriguel, Iker; Olivares, Jorge; Pastor, José M.; Martín-Gómez, César; Ferrer, Luis M.; Ramos, Juan J.; Garcimartín, Angel


    In a recent work [Phys. Rev. E 91, 022808 (2015), 10.1103/PhysRevE.91.022808] it was reported that placing an obstacle in front of a gate has a beneficial effect in the flow of sheep through it. Here, we extend such results by implementing three different obstacle positions. We have observed that the flow is improved in two cases, while it worsens in the other one; the last instance happens when the obstacle is too close to the door. In this situation, the outcomes suggest that clogging develops between the doorjamb and the obstacle, contrary to the cases when the obstacle is farther, in which case clogging always occurs at the very door. The effectiveness of the obstacle (a strategy put forward to alleviate clogging in emergency exits) is therefore quite sensitive to its location. In addition, the study of the temporal evolution of the flow rate as the test develops makes evident a steady behavior during the entire duration of the entrance. This result is at odds with recent findings in human evacuation tests where the flow rate varies over time, therefore challenging the fairness of straightforward comparisons between pedestrian behavior and animal experimental observations.

  3. Simple In-Hospital Interventions to Reduce Door-to-CT Time in Acute Stroke

    Taheraghdam, Aliakbar; Rikhtegar, Reza; Mehrvar, Kaveh; Mehrara, Mehrdad; Hassasi, Rogayyeh; Aliyar, Hannane; Farzi, Mohammadamin; Hasaneh Tamar, Somayyeh


    Background. Intravenous tissue plasminogen activator, a time dependent therapy, can reduce the morbidity and mortality of acute ischemic stroke. This study was designed to assess the effect of simple in-hospital interventions on reducing door-to-CT (DTC) time and reaching door-to-needle (DTN) time of less than 60 minutes. Methods. Before any intervention, DTC time was recorded for 213 patients over a one-year period at our center. Five simple quality-improvement interventions were implemented, namely, call notification, prioritizing patients for CT scan, prioritizing patients for lab analysis, specifying a bed for acute stroke patients, and staff education. After intervention, over a course of 44 months, DTC time was recorded for 276 patients with the stroke code. Furthermore DTN time was recorded for 106 patients who were treated with IV thrombolytic therapy. Results. The median DTC time significantly decreased in the postintervention period comparing to the preintervention period [median (IQR); 20 (12–30) versus 75 (52.5–105), P DTC time and resulted in an acceptable DTN time. These interventions are feasible in most hospitals and should be considered. PMID:27478641

  4. Checklists of Methodological Issues for Review Authors to Consider When Including Non-Randomized Studies in Systematic Reviews

    Wells, George A.; Shea, Beverley; Higgins, Julian P. T.; Sterne, Jonathan; Tugwell, Peter; Reeves, Barnaby C.


    Background: There is increasing interest from review authors about including non-randomized studies (NRS) in their systematic reviews of health care interventions. This series from the Ottawa Non-Randomized Studies Workshop consists of six papers identifying methodological issues when doing this. Aim: To format the guidance from the preceding…

  5. Reconstruction of anterior auricular conchal defect after malignancy excision: revolving-door flap versus full-thickness skin graft.

    Dessy, Luca Andrea; Figus, Andrea; Fioramonti, Paolo; Mazzocchi, Marco; Scuderi, Nicolò


    Skin tumours of the anterior auricular concha are not uncommon. Wider excision and immediate reconstruction are required to reduce the risks of recurrence of the disease, cartilage infection and external ear distortion. Many surgical methods have been described for reconstruction of conchal defects. Post-auricular island flaps, such as the revolving-door (RD) flap, and full-thickness skin grafts (FTSGs) are the most-performed procedures. Although the RD flap has been fully described, it is not widely accepted and many surgeons, in their daily practice, prefer to use FTSG. It is a common experience that FTSGs are more subjected to centripetal contraction, decreasing the structural firmness of the conchal cavity and affecting functional and aesthetic outcomes. Furthermore, FTSGs are more prone to delay in wound healing due to the difficult access to this region that hinders adequate tie-over dressings. Between March 2003 and January 2007, 40 patients affected by T1 and T2 non-melanotic skin cancer and T1 melanoma of the anterior conchal surface of the external ear were included in a prospective study and randomly assigned to the RD reconstructed group or to the FTSG reconstructed group to investigate, compare and define advantages and disadvantages of both the techniques. Visual Analogue Scale (VAS) was used to evaluate the overall outcome and the colour and texture match. No flap or skin graft total loss was observed. Six patients (30%) showed partial failure of FTSG. The RD group demonstrated excellent cosmetic outcome, ideal colour match, adequate structure of external ear, projection and shape. Wilcoxon matched-pairs rank-sum test demonstrated statistically significant higher scores for the RD group compared to the FTSG group (p<0.0001). The RD harvesting technique is easy and quicker than the FTSG technique. RD flap should be considered as the first choice for reconstruction of anterior auricular conchal defects following wider excision of skin tumours.

  6. Self- and manual mobilization improves spine mobility in men with ankylosing spondylitis--a randomized study.

    Widberg, Kyllikki; Karimi, Hossein; Hafström, Ingiäld


    To evaluate effects of physiotherapeutic intervention in terms of self- and manual mobilization on chest expansion, vital capacity, posture, spine mobility and experienced consequences of the disease in patients with ankylosing spondylitis. A prospective, randomized controlled study. Thirty-two men, aged between 23 and 60 years, with ankylosing spondylitis were randomized to active or no treatment for eight weeks. Physiotherapeutic intervention included individualized self- and manual mobilization for 1 hour twice a week and individually adjusted home exercises. Two blinded investigators made the assessments of chest expansion, posture and spinal mobility before and after the treatment period. The patient filled in three and the physiotherapist one of the four Bath Ankylosing Spondylitis scales (BAS scales). In the treatment group chest expansion increased at the level of processus xiphoideus (PAnkylosing Spondylitis Metrology Index total scoring improved (Pankylosing spondylitis.

  7. Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education.

    Pickett, Susan A; Diehl, Sita M; Steigman, Pamela J; Prater, Joy D; Fox, Anthony; Shipley, Patricia; Grey, Dennis D; Cook, Judith A


    This study examined the effectiveness of the Building Recovery of Individual Dreams and Goals (BRIDGES) peer-led education intervention in empowering mental health consumers to become better advocates for their own care. A total of 428 adults with mental illness were randomly assigned to BRIDGES (intervention condition) or a services as usual wait list (control condition). Interviews were conducted at enrollment, at the end of the intervention, and 6-months post-intervention. Random regression results indicate that, compared to controls, BRIDGES participants experienced significant increases in overall empowerment, empowerment-self-esteem, and self-advocacy-assertiveness, and maintained these improved outcomes over time. Peer-led education interventions may provide participants with the information, skills and support they need to become more actively involved in the treatment decision-making process.

  8. [Periprostatic anaesthesic infiltration for prostatic biopsy: a prospective, randomized, double blind and placebo-controlled study].

    Valero, Gonzalo; González, E U Roxana


    A prospective, randomized, double blind and placebo-controlled study to evaluate the effectiveness of periprostatic infiltration with lidocaine to reduce pain of prostatic biopsy. In a thirteen months period of time, 115 patients were randomized to receive 10 ml of lidocaine 1% (n=60) or saline (n=55). Evaluating the pain with visual analogue scale (0-10), the first group referred average pain of 3.83 and the second group of 6.87, being this difference clearly significant (panesthesic puncture. The periprostatic infiltration is easy to perform without complications and it is effective in reducing the pain of this procedure. It should be used as a routine procedure in prostatic biopsy.

  9. Posterior bulk-filled resin composite restorations. A 5-year randomized controlled clinical study

    van Dijken, Jan WV; Pallesen, Ulla


    mm as needed to fill the cavity 2 mm short of the occlusal cavosurface. The occlusal part was completed with the nano-hybrid resin composite (Ceram X mono+). In the other cavity, the resin composite-only (Ceram X mono+) was placed in 2 mm increments. The restorations were evaluated using slightly......Objective: To evaluate in a randomized controlled study the 5-year clinical durability of a flowable resin composite bulk-fill technique in Class I and Class II restorations. Material and methods: 38 pairs Class I and 62 pairs Class II restorations were placed in 44 male and 42 female (mean age 52.......4 years). Each patient received at least two, as similar as possible, extended Class I or Class II restorations. In all cavities, a 1-step self-etch adhesive (Xeno V+) was applied. Randomized, one of the cavities of each pair received the flowable bulk-filled resin composite (SDR), in increments up to 4...

  10. DVT prophylaxis after TKA: routine anticoagulation vs risk screening approach - a randomized study.

    Kulshrestha, Vikas; Kumar, Santhosh


    The American College of Chest Physicians (ACCP) recommended routine anticoagulation for thromboprophylaxis in patients undergoing lower limb arthroplasty. We compared results of routine anticoagulation Vs risk stratified approach for Deep Venous Thrombosis (DVT) prophylaxis after TKA in terms of symptomatic DVT and wound complications. Nine hundred TKAs done in 673 patients were randomized after DVT risk screening to routine anticoagulation (n = 450) or to risk stratification (n = 450) and selective anticoagulation. 194 patients in the risk screening group received only Aspirin. Primary outcome was symptomatic DVT and wound complication. This randomized study showed that the symptomatic DVT rates after TKA were similar whether patients were routinely anticoagulated or selectively anticoagulated after risk screening. However there was a significantly higher incidence of wound complications (P < 0.014) after routine anticoagulation.

  11. A Study and Comparative Analysis of Conditional Random Fields for Intrusion Detection

    Deepa Guleria


    Full Text Available Intrusion detection systems are an important component of defensive measures protecting computer systems and networks from abuse. Intrusion detection plays one of the key roles in computer security techniques and is one of the prime areas of research. Due to complex and dynamic nature of computer networks and hacking techniques, detecting malicious activities remains a challenging task for security experts, that is, currently available defense systems suffer from low detection capability and high number of false alarms. An intrusion detection system must reliably detect malicious activities in a network and must perform efficiently to cope with the large amount of network traffic. In this paper we study the Machine Learning and data mining techniques to solve Intrusion Detection problems within computer networks and compare the various approaches with conditional random fields and address these two issues of Accuracy and Efficiency using Conditional Random Fields and Layered Approach.

  12. Magnetic field and performance analysis of a tubular permanent magnet linear synchronous motor applied in elevator door system

    Xiao LIU; Yun-yue YE; Zhuo ZHENG; Qin-fen LU


    A novel elevator door driven by tubular permanent magnet linear synchronous motor (TPMLSM) is presented. This TPMLSM applies axial magnet array topology of the secondary rod, air-cored armature windings and slotless structure of the forcer to improve the stability of the thrust. The influence of two major dimensions, the pitch and radius of the permanent magnet (PM), on magnetic field was studied and the best values were given by the finite element analysis (FEA). The magnetic field, back EMF and thrust of the motor were analyzed and the PM size was optimized to reduce the harmonic components of the magnetic field and improve the performance of the motor. Predicted results are validated by the experiment. It is shown that the performance of the motor and the novel elevator door system is satisfying.

  13. Addition of gemcitabine to standard therapy in locally advanced cervical cancer: A randomized comparative study

    Sanjoy Roy


    Full Text Available Background: The concurrent chemoradiotherapy for cervical cancer treatment is well accepted since 1999. This randomized, phase III trial aimed to observe if any improved outcome could be obtained capitalizing on the synergistic activity of gemcitabine, cisplatin, XRT. Materials and Methods: Stage IIB-IIIB, 18-70 years of age, KPS score ≥70, were randomized to control group and study group. Control group received cisplatin 40 mg/m 2 weekly with concurrent XRT, followed by brachytherapy and study group received gemcitabine 125 mg/m 2 weekly top of the same control group treatment. The primary end point was pathological response and toxicities along with patient compliance to treatment, late reactions, DFS and OS. Fifty patients were randomized between two arms. Results: The complete response in study and control arm was 96% and 88% respectively. Toxicities was significantly high in the study group compared to control group [leucopenia (P=0.015, skin reaction (P=0.03 and bleeding (P=0.019]. Local recurrence rate: 8% in study arm, none in control arm. The distant failure prevailed in control arm (20% vs. 8%. On a median follow up of 21 months in control arm, the DFS was 73% whereas 83% in study arm in 16 months (P=0.69. OS in the study arm was 100% and 84.5% in the control arm (P=0.14. Conclusions: If the toxicity can be managed adequately in the combination chemo radiation group, it may produce an improvement in response. Survival benefit can also be obtained by introducing gemcitabine to cisplatin as radio sensitizer.

  14. The revolving door syndrome in internal medicine: a study on 11,846 subjects discharged from all Internal Medicine Departments of Tuscany with diagnosis of heart failure and pneumonia

    Matteo Tellini


    Full Text Available Rehospitalization is the return of a patient to a surgical or medical department within 30 days from discharge. We have limited information on the frequency and patterns of rehospitalization in Italy. Our purpose is to describe this phenomenon in Tuscany. We analyzed regional hospital discharge abstract data in Tuscany 2012, to describe 30-day all cause readmissions. We studied patients aged 18 or more (11,846 discharged with diagnoses of heart failure and pneumonia from Internal Medicine Departments. Relationships between 30-day readmission rates, demographic and clinical characteristics have been analyzed. 18% and 15% of subjects respectively discharged with diagnosis of heart failure and pneumonia were readmitted within 30 days. Risk factors significantly related to readmissions were longer length of stay, increasing number of different medications taken during the year preceding hospitalization and greater number of hospitalizations during the semester preceding admission. From the analysis of risk factors we found that frailty and complexity of patients (identified by long hospitalization stays, high number of drugs and previous admissions are the most important factors for unplanned readmissions.

  15. Nimodipine in aneurysmal subarachnoid hemorrhage: a randomized study of intravenous or peroral administration

    Kronvall, Erik; Undrén, Per; Rommer, Bertil Roland;


    OBJECT: The calcium antagonist nimodipine has been shown to reduce the incidence of ischemic complications following aneurysmal subarachnoid hemorrhage (SAH). Although most randomized studies have been focused on the effect of the peroral administration of nimodipine, intravenous infusion...... and new cerebral infarctions according to MR imaging studies were recorded. RESULTS: Baseline characteristics (age, sex distribution, clinical status on admission, radiological findings, and aneurysm treatment) did not differ between the treatment groups. There was no significant difference...... of patients with new infarctions on MR imaging. CONCLUSIONS: The results suggest that there is no clinically relevant difference in efficacy between peroral and intravenous administration of nimodipine in preventing DINDs or cerebral vasospasm following SAH....

  16. Preventive home visits to older people in Denmark: methodology of a randomized controlled study

    Vass, Mikkel; Avlund, Kirsten; Hendriksen, Carsten


    BACKGROUND AND AIMS: Preventive home visits were introduced by legislation in Denmark in 1998. This ongoing randomized controlled intervention study introduces a model where preventive home visits to elderly people are carried out in a standardized way, focusing on early signs of disability...... and on physical activity. The study includes general practitioners (GPs) in relevant parts of the assessment and endeavors coordinated interdisciplinary follow-up. Our main aim was to investigate whether this model gives enhanced active life expectancy, but the focus of the present paper is the design...

  17. A Virtual Reality Game for Chronic Pain Management: A Randomized, Controlled Clinical Study.

    Jin, Weina; Choo, Amber; Gromala, Diane; Shaw, Chris; Squire, Pamela


    Although Virtual Reality (VR) applications have been shown to reduce many forms of acute pain, such research of VR applications and their effects on chronic pain is still at its infancy. In this study, we designed a VR game Cryoslide, and examined its analgesic effect on chronic pain patients, its end users, in a clinical setting. In this randomized, controlled crossover clinical study of 20 chronic pain patients, Cryoslide significantly reduced perceived pain compared to the baseline and the control group. The results demonstrate that Cryoslide can be effectively used as an analgesic intervention for chronic pain management to lessen pain intensity during short-term symptom spikes.

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

    Callahan Christopher M


    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

  19. Impact of cyclosporine reduction with MMF: a randomized trial in chronic allograft dysfunction. The 'reference' study.

    Frimat, L; Cassuto-Viguier, E; Charpentier, B; Noël, C; Provôt, F; Rostaing, L; Glotz, D; Sraer, J D; Bourbigot, B; Moulin, B; Lang, P; Ducloux, D; Pouteil-Noble, C; Girardot-Seguin, S; Kessler, M


    Long-term use of calcineurine inhibitors (CNIs) may contribute to the development of chronic allograft dysfunction (CAD). We investigate the impact of the introduction of MMF combined with cyclosporine (CsA) 50% dose reduction. An open, randomized, controlled, multicenter, prospective study was conducted in 103 patients, receiving a CsA-based therapy with a serum creatinine between 1.7-3.4 mg/dL, more than 1 year after transplantation. They were randomized to receive MMF with half dose of CsA (MMF group) or to continue their maintenance CsA dose (control group). A total of 96 weeks after randomization, the evolution of renal function assessed by regression line analysis of 1/SeCr improved in the MMF group (positive slope) vs. the control group (negative slope), 4.2 x 10(-4) vs. -3.0 x 10(-4), respectively (p MMF group. No episode of biopsy-proven acute rejection occurred. One patient in each group lost his graft because of biopsy-proven chronic allograft nephropathy. There was a significant decrease of triglycerides level in the MMF group. Anemia and diarrhea were statistically more frequent in the MMF group. In CAD, the reduction of CsA in the presence of MMF results in significant improvement in renal function during a 2-year follow-up.

  20. Numerical Study of A Round Buoyant Jet Under the Effect of JONSWAP Random Waves

    CHEN Yong-ping; LI Chi-wai; ZHANG Chang-kuan; XU Zhen-shan


    This paper presents a numerical study on the hydrodynamic behaviours of a round buoyant jet under the effect of JONSWAP random waves.A three-dimensional large eddy simulation (LES) model is developed to simulate the buoyant jet in a stagnant ambient and JONSWAP random waves.By comparison of velocity and concentration fields,it is found that the buoyant jet exhibits faster decay of centedine velocity,wider lateral spreading and larger initial dilution under the wave effect,indicating that wave dynamics improves the jet entrainment and mixing in the near field,and subsequently mitigate the jet impacts in the far field.The effect of buoyancy force on the jet behaviours in the random waves is also numerically investigated.The results show that the wave effect on the jet entrainment and mixing is considerably weakened under the existence of buoyancy force,resulting in a slower decay rate of centerline velocity and a narrower jet width for the jet with initial buoyancy.

  1. Sleep Promotion Program for Improving Sleep Behaviors in Adolescents: A Randomized Controlled Pilot Study

    Bindu John


    Full Text Available Aims. The purpose of this pilot trial was to determine the efficacy of sleep promotion program to adapt it for the use of adolescents studying in various schools of Mangalore, India, and evaluate the feasibility issues before conducting a randomized controlled trial in a larger sample of adolescents. Methods. A randomized controlled trial design with stratified random sampling method was used. Fifty-eight adolescents were selected (mean age: 14.02 ± 2.15 years; intervention group, n=34; control group, n=24. Self-report questionnaires, including sociodemographic questionnaire with some additional questions on sleep and activities, Sleep Hygiene Index, Pittsburgh Sleep Quality Index, The Cleveland Adolescent Sleepiness Questionnaire, and PedsQL™ Present Functioning Visual Analogue Scale, were used. Results. Insufficient weekday-weekend sleep duration with increasing age of adolescents was observed. The program revealed a significant effect in the experimental group over the control group in overall sleep quality, sleep onset latency, sleep duration, daytime sleepiness, and emotional and overall distress. No significant effect was observed in sleep hygiene and other sleep parameters. All target variables showed significant correlations with each other. Conclusion. The intervention holds a promise for improving the sleep behaviors in healthy adolescents. However, the effect of the sleep promotion program treatment has yet to be proven through a future research. This trial is registered with ISRCTN13083118.

  2. Open-Label, Randomized Study of Transition From Tacrolimus to Sirolimus Immunosuppression in Renal Allograft Recipients

    Tedesco-Silva, Helio; Peddi, V. Ram; Sánchez-Fructuoso, Ana; Marder, Brad A.; Russ, Graeme R.; Diekmann, Fritz; Flynn, Alison; Hahn, Carolyn M.; Li, Huihua; Tortorici, Michael A.; Schulman, Seth L.


    Background Calcineurin inhibitor–associated nephrotoxicity and other adverse events have prompted efforts to minimize/eliminate calcineurin inhibitor use in kidney transplant recipients. Methods This open-label, randomized, multinational study evaluated the effect of planned transition from tacrolimus to sirolimus on kidney function in renal allograft recipients. Patients received tacrolimus-based immunosuppression and then were randomized 3 to 5 months posttransplantation to transition to sirolimus or continue tacrolimus. The primary end point was percentage of patients with 5 mL/min per 1.73 m2 or greater improvement in estimated glomerular filtration rate from randomization to month 24. Results The on-therapy population included 195 patients (sirolimus, 86; tacrolimus, 109). No between-group difference was noted in percentage of patients with 5 mL/min per 1.73 m2 or greater estimated glomerular filtration rate improvement (sirolimus, 34%; tacrolimus, 42%; P = 0.239) at month 24. Sirolimus patients had higher rates of biopsy-confirmed acute rejection (8% vs 2%; P = 0.02), treatment discontinuation attributed to adverse events (21% vs 3%; P < 0.001), and lower rates of squamous cell carcinoma of the skin (0% vs 5%; P = 0.012). Conclusions Our findings suggest that renal function improvement at 24 months is similar for patients with early conversion to sirolimus after kidney transplantation versus those remaining on tacrolimus. PMID:27500260

  3. HDL Cholesterol, LDL Cholesterol, and Triglycerides as Risk Factors for CKD: A Mendelian Randomization Study.

    Lanktree, Matthew B; Thériault, Sébastien; Walsh, Michael; Paré, Guillaume


    High-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride concentrations are heritable risk factors for vascular disease, but their role in the progression of chronic kidney disease (CKD) is unclear. 2-sample Mendelian randomization analysis of data derived from the largest published lipid and CKD studies. Effect of independent genetic variants significantly associated with lipid concentrations was obtained from the Global Lipids Genetics Consortium (n=188,577), and the effect of these same variants on estimated glomerular filtration rate (eGFR), CKD (defined as eGFRGenetics Consortium (n=133,814). Using conventional, multivariable, and Egger Mendelian randomization approaches, we assessed the causal association between genetically determined lipid concentrations and kidney traits. eGFR, dichotomous eGFRGenetically higher triglyceride concentrations appeared associated with higher eGFRs, but this finding was driven by a single pleiotropic variant in the glucokinase regulator gene (GCKR). After exclusion, genetically higher triglyceride concentration was not associated with any kidney trait. Individual patient-level phenotype and genotype information were unavailable. 2-sample Mendelian randomization analysis of data from the largest lipid and CKD cohorts supports genetically higher HDL cholesterol concentration as causally associated with better kidney function. There was no association between genetically altered LDL cholesterol or triglyceride concentration and kidney function. Further analysis of CKD outcomes in HDL cholesterol intervention trials is warranted. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  4. Acupuncture at local and distant points for tinnitus: study protocol for a randomized controlled trial

    Shi Guang-Xia


    Full Text Available Abstract Background Tinnitus is the perception of a sound in the absence of an objective physical source. Up to now, there is no generally accepted view how these phantom sounds come about, and also no efficient treatment. Patients are turning to complementary or alternative medical therapies, such as acupuncture. Based on the theory of traditional Chinese medicine, acupoints located on both the adjacent and distal area of the disease can be needled to treat disease. Furthermore, the way of combining acupoints is for strengthening the curative effect. We aim to evaluate the efficacy of acupuncture at local points in combination with distal points in subjective tinnitus patients. Method This trial is a randomized, single-blind, controlled study. A total of 112 participants will be randomly assigned to one of four treatment groups receiving acupuncture treatment for 4 weeks. The primary outcome measure is subjective tinnitus loudness and annoyance perception, which is graded using the Visual Analogue Scale (VAS. The assessment is at baseline (before treatment initiation, 4 weeks after the first acupuncture session, and 8 weeks after the first acupuncture session. Discussion Completion of this trial will help to identify whether acupuncture at local acupoints in combination with distal acupoints may be more effective than needling points separately. Trial registration International Standard Randomized Controlled Trial Number Register: ISRCTN29230777

  5. Design and Development on Elevator Hall Door System%电梯厅门设计与系统开发探究

    许耀光; 郑李明; 严曙辉


    Technological level of rising elevator industry has made great achievements with the rapid development of China's economy in China. Elevator landing door system is an important part of the elevator, the elevator’s safety and stable operations are closely linked. Business-to-elevator hoist way door design puts forward higher requirements due to fierce competition in the market at this stage. Based on the elevator hoist way door design and system development, we studies on the hall door design problems and improvement of lack, and the landing door system is constantly improved. With a view to the elevator hall doors provide some useful reference design for elevator safety, stable, fast operation to provide protection.%电梯厅门系统作为电梯的重要组成部分,对电梯的安全、稳定运行有着密切的联系。为了与环境协调一致,更为了安全,企业对电梯厅门的设计提出了更高、更个性化、成本更低的要求。基于此,本文对电梯厅门设计与系统开发进行了研究,对厅门设计中存在的问题与不足进行改进,提升厅门系统与电梯安全、稳定、快速运行协调一致,以期为电梯厅门设计提供一些有益参考。

  6. Study of Randomness in AES Ciphertexts Produced by Randomly Generated S-Boxes and S-Boxes with Various Modulus and Additive Constant Polynomials

    Das, Suman; Sadique Uz Zaman, J. K. M.; Ghosh, Ranjan


    In Advanced Encryption Standard (AES), the standard S-Box is conventionally generated by using a particular irreducible polynomial {11B} in GF(28) as the modulus and a particular additive constant polynomial {63} in GF(2), though it can be generated by many other polynomials. In this paper, it has been shown that it is possible to generate secured AES S-Boxes by using some other selected modulus and additive polynomials and also can be generated randomly, using a PRNG like BBS. A comparative study has been made on the randomness of corresponding AES ciphertexts generated, using these S-Boxes, by the NIST Test Suite coded for this paper. It has been found that besides using the standard one, other moduli and additive constants are also able to generate equally or better random ciphertexts; the same is true for random S-Boxes also. As these new types of S-Boxes are user-defined, hence unknown, they are able to prevent linear and differential cryptanalysis. Moreover, they act as additional key-inputs to AES, thus increasing the key-space.

  7. Childhood adiposity and risk of type 1 diabetes: A Mendelian randomization study.

    Censin, J C; Nowak, Christoph; Cooper, Nicholas; Bergsten, Peter; Todd, John A; Fall, Tove


    The incidence of type 1 diabetes (T1D) is increasing globally. One hypothesis is that increasing childhood obesity rates may explain part of this increase, but, as T1D is rare, intervention studies are challenging to perform. The aim of this study was to assess this hypothesis with a Mendelian randomization approach that uses genetic variants as instrumental variables to test for causal associations. We created a genetic instrument of 23 single nucleotide polymorphisms (SNPs) associated with childhood adiposity in children aged 2-10 years. Summary-level association results for these 23 SNPs with childhood-onset (Mendelian randomization analysis, we found support for an effect of childhood adiposity on T1D risk (odds ratio 1.32, 95% CI 1.06-1.64 per standard deviation score in body mass index [SDS-BMI]). A sensitivity analysis provided evidence of horizontal pleiotropy bias (p = 0.04) diluting the estimates towards the null. We therefore applied Egger regression and multivariable Mendelian randomization methods to control for this type of bias and found evidence in support of a role of childhood adiposity in T1D (odds ratio in Egger regression, 2.76, 95% CI 1.40-5.44). Limitations of our study include that underlying genes and their mechanisms for most of the genetic variants included in the score are not known. Mendelian randomization requires large sample sizes, and power was limited to provide precise estimates. This research has been conducted using data from the Early Growth Genetics (EGG) Consortium, the Genetic Investigation of Anthropometric Traits (GIANT) Consortium, the Tobacco and Genetics (TAG) Consortium, and the Social Science Genetic Association Consortium (SSGAC), as well as meta-analysis results from a T1D genome-wide association study. This study provides genetic support for a link between childhood adiposity and T1D risk. Together with evidence from observational studies, our findings further emphasize the importance of measures to reduce the

  8. Door to Door Survey and Community Participation to Implement a New County Mosquito Control Program in Wayne County, North Carolina, USA

    Timothy Kelley


    Full Text Available Community involvement in mosquito management programs provides more sustainable and effective organization and service. A door to door survey in Wayne County, NC carried out by student volunteers, resulted in 60 household responses. Residents had not previously experienced outreach from the county (88%, and 95% of them thought the student door to door survey was an effective form of outreach. One third of the residents thought mosquitoes were severe where they lived, but only 9% thought they had any containers in their yard that might breed mosquitoes. Only 15% of the residents were concerned about mosquito borne diseases. These responses provide evidence that outreach and education on mosquito control and diseases were necessary steps for future mosquito control community planning.

  9. Randomized controlled trial of mailed Nicotine Replacement Therapy to Canadian smokers: study protocol

    Leatherdale Scott T


    Full Text Available Abstract Background Considerable public health efforts are ongoing Canada-wide to reduce the prevalence of smoking in the general population. From 1985 to 2005, smoking rates among adults decreased from 35% to 19%, however, since that time, the prevalence has plateaued at around 18-19%. To continue to reduce the number of smokers at the population level, one option has been to translate interventions that have demonstrated clinical efficacy into population level initiatives. Nicotine Replacement Therapy (NRT has a considerable clinical research base demonstrating its efficacy and safety and thus public health initiatives in Canada and other countries are distributing NRT widely through the mail. However, one important question remains unanswered - do smoking cessation programs that involve mailed distribution of free NRT work? To answer this question, a randomized controlled trial is required. Methods/Design A single blinded, panel survey design with random assignment to an experimental and a control condition will be used in this study. A two-stage recruitment process will be employed, in the context of a general population survey with two follow-ups (8 weeks and 6 months. Random digit dialing of Canadian home telephone numbers will identify households with adult smokers (aged 18+ years who are willing to take part in a smoking study that involves three interviews, with saliva collection for 3-HC/cotinine ratio measurement at baseline and saliva cotinine verification at 8-week and 6-month follow-ups (N = 3,000. Eligible subjects interested in free NRT will be determined at baseline (N = 1,000 and subsequently randomized into experimental and control conditions to receive versus not receive nicotine patches. The primary hypothesis is that subjects who receive nicotine patches will display significantly higher quit rates (as assessed by 30 day point prevalence of abstinence from tobacco at 6-month follow-up as compared to subjects who do not

  10. Environmental tipping points in random dynamical systems: a quasigeostrophic case study

    Pierini, S.


    Environmental tipping points (TPs) leading to abrupt state changes are usually considered in an autonomous dynamical systems framework, in which case early warnings may be identified in signals with increased autocorrelation and variance. An essential step toward a more realistic description of abrupt transitions in the environment and climate is to analyze TPs in random dynamical systems. In this context, a case study based on an operational definition of stochastic TPs and on a nonlinear low-order quasigeostrophic model is presented (Pierini, Phys. Rev. E, 2012). Let us suppose that in an autonomous dynamical system (DS), self-sustained relaxation oscillations emerge if (and only if) a control parameter Q is such that Q > Qo: Qo is therefore a (deterministic) TP. The same system perturbed by noise is said to be "excitable" if a range Q excitable random DS (a case likely to be quite common in environmental and climate dynamics) a stochastic TP is defined here as the random variable Ro whose realizations satisfy the same conditions required for Qo in the deterministic case. The low-order model (with four degrees of freedom) used in this study describes an excitable DS driven by a stationary forcing with amplitude Q (the deterministic control parameter) plus a colored noise characterized by its amplitude A and autocorrelation time scale Ta. A 10-member ensemble is constructed by performing forward time integrations of length T, and by letting A and Ta vary within a broad parametric range. The ensemble averages and (where the random variable N is the number of relaxation oscillations emerging in T) are then computed. The results suggest that in an excitable random DS coherence resonance may be the predominant transition mechanism, in which case stochastic TPs should be considered instead of their classical deterministic counterpart. Possible early warning signals (different from those of the deterministic case) are investigated: a preliminary analysis shows a variety

  11. The prevalence of ibuprofen-sensitive asthma in children: a randomized controlled bronchoprovocation challenge study.

    Debley, Jason S; Carter, Edward R; Gibson, Ronald L; Rosenfeld, Margaret; Redding, Gregory J


    To determine the prevalence of ibuprofen-sensitive asthma in school-aged children with mild or moderate persistent asthma. A randomized, double-blind, placebo-controlled, crossover bronchoprovocation challenge study in children 6 to 18 years of age with mild or moderate persistent asthma. Patients received a single dose of ibuprofen or placebo, per randomization, and then returned 2 to 7 days later to repeat the procedures after taking that study drug not received at the first visit. At each visit, patients performed spirometry before and (1/2), 1, 2, and 4 hours after administration of study drug. We defined bronchospasm as a > or =20% decrease from baseline in the forced expired volume in the first second (FEV1) and ibuprofen sensitivity as bronchospasm following administration of ibuprofen but not placebo. Of the 127 patients screened, 100 (mean age, 11 years) completed the study. Two patients met criteria for ibuprofen-sensitive asthma, resulting in a prevalence of 2% (95% CI: 0.2%-7%). Neither patient was known to have had any exposure to ibuprofen before the study. The prevalence of ibuprofen-sensitive asthma was low but non-zero in this group of children with mild or moderate asthma. The possibility of ibuprofen-induced bronchospasm should be considered before administering ibuprofen to children with asthma.

  12. Manual and Electroacupuncture for Labour Pain: Study Design of a Longitudinal Randomized Controlled Trial

    Linda Vixner


    Full Text Available Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women’s experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at NCT01197950.

  13. Mendelian randomization study of body mass index and colorectal cancer risk

    Thrift, Aaron P.; Gong, Jian; Peters, Ulrike; Chang-Claude, Jenny; Rudolph, Anja; Slattery, Martha L.; Chan, Andrew T.; Locke, Adam E.; Kahali, Bratati; Justice, Anne E.; Pers, Tune H.; Gallinger, Steven; Hayes, Richard B; Baron, John A.; Caan, Bette J.; Ogino, Shuji; Berndt, Sonja I.; Chanock, Stephen J.; Casey, Graham; Haile, Robert W.; Du, Mengmeng; Harrison, Tabitha A.; Thornquist, Mark; Duggan, David J.; Le Marchand, Loïc; Lindor, Noralane M.; Seminara, Daniela; Song, Mingyang; Wu, Kana; Thibodeau, Stephen N.; Cotterchio, Michelle; Win, Aung Ko; Jenkins, Mark A.; Hopper, John L.; Ulrich, Cornelia M.; Potter, John D.; Newcomb, Polly A.; Hoffmeister, Michael; Brenner, Hermann; White, Emily; Hsu, Li; Campbell, Peter T.


    Background High body mass index (BMI) is consistently linked to increased risk of colorectal cancer (CRC) for men, whereas the association is less clear for women. As risk estimates from observational studies may be biased and/or confounded, we conducted a Mendelian randomization study to estimate the causal association between BMI and CRC. Methods We used data from 10,226 CRC cases and 10,286 controls of European ancestry. The Mendelian randomization analysis used a weighted genetic risk score, derived from 77 genome-wide association study identified variants associated with higher BMI, as an instrumental variable (IV). We compared the IV odds ratio (IV-OR) with the OR obtained using a conventional covariate-adjusted analysis. Results Individuals carrying greater numbers of BMI-increasing alleles had higher CRC risk (per weighted allele OR, 1.31; 95% confidence interval [CI], 1.10–1.57). Our IV estimation results support the hypothesis that genetically influenced BMI is directly associated with risk for CRC (IV-OR per 5 kg/m2, 1.50; 95% CI, 1.13–2.01). In the sex-specific IV analyses higher BMI was associated with higher risk of CRC among women (IV-OR per 5 kg/m2, 1.82; 95% CI, 1.26–2.61). For men, genetically influenced BMI was not associated with CRC (IV-OR per 5 kg/m2, 1.18; 95% CI, 0.73–1.92). Conclusions High BMI was associated with increased CRC risk for women. Whether abdominal obesity, rather than overall obesity, is a more important risk factor for men requires further investigation. Impact Overall, conventional epidemiologic and Mendelian randomization studies suggest a strong association between obesity and the risk of CRC. PMID:25976416

  14. Early skin-to-skin contact after cesarean section: A randomized clinical pilot study

    Kollmann, Martina; Aldrian, Lisa; Scheuchenegger, Anna; Mautner, Eva; Herzog, Sereina A.; Urlesberger, Berndt; Raggam, Reinhard B.; Lang, Uwe; Obermayer-Pietsch, Barbara; Klaritsch, Philipp


    Objective Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response. Study design This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative (“early”) SCC (n = 17) versus postoperative (“late”) SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase. Results There was no evidence for differences in parameters reflecting neonatal transition or stress response between the ‘Early SSC Group’ and the ‘Late SSC Group’. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’ (p = 0.004). Conclusions This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’, which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial. Trial

  15. The effects of assertiveness training in patients with schizophrenia: a randomized, single-blind, controlled study.

    Lee, Tso-Ying; Chang, Shih-Chin; Chu, Hsin; Yang, Chyn-Yng; Ou, Keng-Liang; Chung, Min-Huey; Chou, Kuei-Ru


    In this study, we investigated the effects of group assertiveness training on assertiveness, social anxiety and satisfaction with interpersonal communication among patients with chronic schizophrenia. Only limited studies highlighted the effectiveness of group assertiveness training among inpatients with schizophrenia. Given the lack of group assertiveness training among patients with schizophrenia, further development of programmes focusing on facilitating assertiveness, self-confidence and social skills among inpatients with chronic schizophrenia is needed. This study used a prospective, randomized, single-blinded, parallel-group design. This study employed a prospective, randomized, parallel-group design. Seventy-four patients were randomly assigned to experimental group receiving 12 sessions of assertiveness training, or a supportive control group. Data collection took place for the period of June 2009-July 2010. Among patients with chronic schizophrenia, assertiveness, levels of social anxiety and satisfaction with interpersonal communication significantly improved immediately after the intervention and at the 3-month follow-up in the intervention group. The results of a generalized estimating equation (GEE) indicated that: (1) assertiveness significantly improved from pre- to postintervention and was maintained until the follow-up; (2) anxiety regarding social interactions significantly decreased after assertiveness training; and (3) satisfaction with interpersonal communication slightly improved after the 12-session intervention and at the 3-month follow-up. Assertivenss training is a non-invasive and inexpensive therapy that appears to improve assertiveness, social anxiety and interpersonal communication among inpatients with chronic schizophrenia. These findings may provide a reference guide to clinical nurses for developing assertiveness-training protocols. © 2013 Blackwell Publishing Ltd.

  16. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies.

    Benzo, Roberto; Wigle, Dennis; Novotny, Paul; Wetzstein, Marnie; Nichols, Francis; Shen, Robert K; Cassivi, Steve; Deschamps, Claude


    Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD which increases their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention to decrease surgical morbidity but there is no established protocol and no randomized study has been published to date. We tested two preoperative PR interventions in patients undergoing lung cancer resection and with moderate-severe COPD in a randomized single blinded design. Outcomes were length of hospital stay and postoperative complications. The first study tested 4 weeks of guideline-based PR vs. usual care: that study proved to be very difficult to recruit as patients and providers were reluctant to delay surgery. Nine patients were randomized and no differences were found between arms. The second study tested ten preoperative PR sessions using a customized protocol with nonstandard components (exercise prescription based on self efficacy, inspiratory muscle training, and the practice of slow breathing) (n=10) vs. usual care (n=9). The PR arm had shorter length of hospital stay by 3 days (p=0.058), fewer prolonged chest tubes (11% vs. 63%, p=0.03) and fewer days needing a chest tube (8.8 vs. 4.3 days p=0.04) compared to the controlled arm. A ten-session preoperative PR intervention may improve post operative lung reexpansion evidenced by shorter chest tube times and decrease the length of hospital stay, a crude estimator of post operative morbidity and costs. Our results suggest the potential for short term preoperative pulmonary rehabilitation interventions in patients with moderate-severe COPD undergoing curative lung resection. 4 weeks of conventional preoperative PR seems non feasible.

  17. Biases in Estimating Treatment Effects Due to Attrition in Randomized Controlled Trials and Cluster Randomized Controlled Trials: A Simulation Study

    Dong, Nianbo; Lipsey, Mark W.


    Attrition occurs when study participants who were assigned to the treatment and control conditions do not provide outcome data and thus do not contribute to the estimation of the treatment effects. It is very common in experimental studies in education as illustrated, for instance, in a meta-analysis studying "the effects of attrition on baseline…

  18. Orienterende studie naar blootstellingsrisico's door met asbest verontreinigde bodem

    Tromp, P.C.


    Bij belanghebbenden bestaat grote behoefte aan een duidelijker vaststelling van de risico's verbonden aan asbest in de bodem en de inpassing daarvan in de verschillende beleidskaders. Het inschatten van risico's op het gebied van asbest in de bodem is op dit moment nog een werkveld wat in de kinders

  19. Choice of Moisturiser for Eczema Treatment (COMET): study protocol for a randomized controlled trial.

    Ridd, Matthew J; Redmond, Niamh M; Hollinghurst, Sandra; Ball, Nicola; Shaw, Lindsay; Guy, Richard; Wilson, Victoria; Metcalfe, Chris; Purdy, Sarah


    Eczema is common in children and in the UK most cases are managed in primary care. The foundation of all treatment is the regular use of leave-on emollients to preserve and restore moisture to the skin. This not only improves comfort but may also reduce the need for rescue treatment for 'flares', such as topical corticosteroids. However, clinicians can prescribe many different types of emollient and there is a paucity of evidence to guide this choice. One reason for this may be the challenges of conducting a clinical trial: are parents or carers of young children willing to be randomly allocated an emollient and followed up for a meaningful amount of time? This is a single-centre feasibility study of a pragmatic, four-arm, single-masked, randomized trial. Children with eczema who are eligible (from 1 month to less than 5 years of age, not known to be sensitive or allergic to any of study emollients or their constituents) are recruited via their general practices. Participants are allocated Aveeno® lotion, Diprobase® cream, Doublebase® gel or Hydromol® ointment via a web-based system, using a simple randomization process in a 1:1:1:1 fashion. Researchers are masked to the study emollient. Participants are assessed at baseline and followed up for 3 months. Data are collected by daily diaries, monthly researcher visits and review of electronic medical records. Because this is a feasibility study, a formal sample size calculation for the estimation of treatment effectiveness has not be made but we aim to recruit 160 participants. Recruitment is on-going. At the end of the study, as well as being able to answer the question, 'Is it is possible to recruit and retain children with eczema from primary care into a four-arm randomized trial of emollients?', we will also have collected important data on the acceptability and effectiveness of four commonly used emollients. Current Controlled Trials ISRCTN21828118 and Clinical Trials Register EudraCT2013-003001-26.

  20. Alcohol email assessment and feedback study dismantling effectiveness for university students (AMADEUS-1: study protocol for a randomized controlled trial

    McCambridge Jim


    Full Text Available Abstract Background Alcohol causes huge problems for population health and for society, which require interventions with individuals as well as populations to prevent and reduce harms. Brief interventions can be effective and increasingly take advantage of the internet to reach high-risk groups such as students. The research literature on the effectiveness of online interventions is developing rapidly and is confronted by methodological challenges common to other areas of e-health including attrition and assessment reactivity and in the design of control conditions. Methods/design The study aim is to evaluate the effectiveness of a brief online intervention, employing a randomized controlled trial (RCT design that takes account of baseline assessment reactivity, and other possible effects of the research process. Outcomes will be evaluated after 3 months both among student populations as a whole including for a randomized no contact control group and among those who are risky drinkers randomized to brief assessment and feedback (routine practice or to brief assessment only. A three-arm parallel groups trial will also allow exploration of the magnitude of the feedback and assessment component effects. The trial will be undertaken simultaneously in 2 universities randomizing approximately 15,300 students who will all be blinded to trial participation. All participants will be offered routine practice intervention at the end of the study. Discussion This trial informs the development of routine service delivery in Swedish universities and more broadly contributes a new approach to the study of the effectiveness of online interventions in student populations, with relevance to behaviors other than alcohol consumption. The use of blinding and deception in this study raise ethical issues that warrant further attention. Trial registration ISRCTN28328154

  1. Efficacy and safety of drotaverine hydrochloride in irritable bowel syndrome: A randomized double-blind placebo-controlled study

    Ramesh R Rai; Manisha Dwivedi; Nirmal Kumar


    Backgrounds/Aims: To study the efficacy and safety of drotaverine hydrochloride (HCl) 80 mg tablet given thrice a day in the symptomatic relief of patients with irritable bowel syndrome (IBS). Patients and Methods: The study was a multicentric, randomized, double-blind, placebo-controlled parallel group study performed at three centers. The patients who fulfilled Rome II Criteria of IBS were included in the study. A total of 180 patients with IBS were randomized to drotaverine and placebo tre...

  2. Clonidine versus tramadol for post spinal shivering during caesarean section: A randomized double blind clinical study

    Velayudha S Reddy


    Full Text Available Background : Control of post spinal shivering is essential for optimal perioperative care, which can be achieved either by oral or parental medications. The present study is designed to evaluate the efficacy and safety of intravenous low-dose clonidine and tramadol in the treatment of post spinal shivering. Materials and Methods : In this prospective, a double blind, randomized study, 90 ASA grade I or II, parturients aged 18 - 35 years, undergoing caesarean section under spinal anaesthesia, who subsequently developed shivering grade 3 or 4, were randomized into two groups, to receive either clonidine or tramadol. The efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting, hypotension, bradycardia, dry mouth, sedation, skin rash and headache, if present, were recorded. All data were analyzed by using the Chi square test and the Z-test. Results : There were significant differences in the response rate between the drugs (P < 0.05. Time taken from the starting of treatment to cessation of shivering was significantly less with the tramadol group (P < 0.05, however, the frequency of nausea, vomiting, sedation and headache were also significantly more in the tramadol group Conclusion : In our study we concluded that both clonidine and tramadol control shivering. However, the response rate was higher and time taken to control shivering was lesser with tramadol, but the response rate and the side effects were lesser with clonidine.

  3. Driving with Intuition: A Preregistered Study about the EEG Anticipation of Simulated Random Car Accidents

    Duma, Gian Marco; Mento, Giovanni; Manari, Tommaso; Martinelli, Massimiliano


    The study of neural pre-stimulus or “anticipatory” activity opened a new window for understanding how the brain actively constructs the forthcoming reality. Usually, experimental paradigms designed to study anticipatory activity make use of stimuli. The purpose of the present study is to expand the study of neural anticipatory activity upon the temporal occurrence of dichotomic, statistically unpredictable (random) stimuli within an ecological experimental paradigm. To this purpose, we used a simplified driving simulation including two possible, randomly-presented trial types: a car crash end trial and a no car crash end trial. Event Related Potentials (ERP) were extracted -3,000 ms before stimulus onset. We identified a fronto-central negativity starting around 1,000 ms before car crash presentation. By contrast, a whole-scalp distributed positivity characterized the anticipatory activity observed before the end of the trial in the no car crash end condition. The present data are in line with the hypothesis that the brain may also anticipate dichotomic, statistically unpredictable stimuli, relaying onto different pre-stimulus ERP activity. Possible integration with car-smart-systems is also suggested. PMID:28103303

  4. Strategies for Improving Power in School-Randomized Studies of Professional Development.

    Kelcey, Ben; Phelps, Geoffrey


    Group-randomized designs are well suited for studies of professional development because they can accommodate programs that are delivered to intact groups (e.g., schools), the collaborative nature of professional development, and extant teacher/school assignments. Though group designs may be theoretically favorable, prior evidence has suggested that they may be challenging to conduct in professional development studies because well-powered designs will typically require large sample sizes or expect large effect sizes. Using teacher knowledge outcomes in mathematics, we investigated when and the extent to which there is evidence that covariance adjustment on a pretest, teacher certification, or demographic covariates can reduce the sample size necessary to achieve reasonable power. Our analyses drew on multilevel models and outcomes in five different content areas for over 4,000 teachers and 2,000 schools. Using these estimates, we assessed the minimum detectable effect sizes for several school-randomized designs with and without covariance adjustment. The analyses suggested that teachers' knowledge is substantially clustered within schools in each of the five content areas and that covariance adjustment for a pretest or, to a lesser extent, teacher certification, has the potential to transform designs that are unreasonably large for professional development studies into viable studies. © The Author(s) 2014.

  5. Driving with Intuition: A Preregistered Study about the EEG Anticipation of Simulated Random Car Accidents.

    Duma, Gian Marco; Mento, Giovanni; Manari, Tommaso; Martinelli, Massimiliano; Tressoldi, Patrizio


    The study of neural pre-stimulus or "anticipatory" activity opened a new window for understanding how the brain actively constructs the forthcoming reality. Usually, experimental paradigms designed to study anticipatory activity make use of stimuli. The purpose of the present study is to expand the study of neural anticipatory activity upon the temporal occurrence of dichotomic, statistically unpredictable (random) stimuli within an ecological experimental paradigm. To this purpose, we used a simplified driving simulation including two possible, randomly-presented trial types: a car crash end trial and a no car crash end trial. Event Related Potentials (ERP) were extracted -3,000 ms before stimulus onset. We identified a fronto-central negativity starting around 1,000 ms before car crash presentation. By contrast, a whole-scalp distributed positivity characterized the anticipatory activity observed before the end of the trial in the no car crash end condition. The present data are in line with the hypothesis that the brain may also anticipate dichotomic, statistically unpredictable stimuli, relaying onto different pre-stimulus ERP activity. Possible integration with car-smart-systems is also suggested.

  6. 49 CFR 229.85 - Doors and cover plates marked “Danger”.


    ... System § 229.85 Doors and cover plates marked “Danger”. All doors and cover plates guarding high voltage equipment shall be marked “Danger—High Voltage” or with the word “Danger” and the normal voltage carried...

  7. Keeping the Doors of Learning Open for Adult Student-Workers within Higher Education?

    Walters, Shirley; Abrahams, Mark; Witbooi, Sally


    The Freedom Charter of the African National Congress (ANC), the triumphant South African liberation movement, proclaims that "the doors of learning shall be open" for all. Twenty years since coming to power, the doors of the universities are struggling to stay open for adult student-workers. An action research project into implementation…

  8. 77 FR 42016 - Product Change-Every Door Direct Mail-Retail


    ... Change--Every Door Direct Mail--Retail AGENCY: Postal Service\\TM\\. ACTION: Notice. SUMMARY: The Postal... Door Direct Mail--Retail to the market-dominant product list within the Mail Classification Schedule... Direct Mail--Retail to the Mail Classification Schedule, pursuant to 39 U.S.C. 3642. Documents...

  9. Study protocol: optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial

    Hasselaar Jeroen


    Full Text Available Abstract Background Due to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare. Methods/Design During a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS. Secondary outcomes are self-perceived burden from informal care (EDIZ, patient experienced continuity of medical care (NCQ, patient and caregiver satisfaction with the teleconsultation (PSQ, the experienced problems and needs in palliative care (PNPC-sv and the number of hospital admissions. Discussion This is one of the first randomized controlled trials in palliative telecare. Our data will verify whether telemedicine positively affects palliative homecare. Trial registration The Netherlands National Trial Register NTR2817

  10. Cap-assisted colonoscopy and detection of Adenomatous Polyps (CAP) study: a randomized trial.

    Pohl, Heiko; Bensen, Steve P; Toor, Arifa; Gordon, Stuart R; Levy, L Campbell; Berk, Brian; Anderson, Peter B; Anderson, Joseph C; Rothstein, Richard I; MacKenzie, Todd A; Robertson, Douglas J


    Cap-assisted colonoscopy has improved adenoma detection in some but not other studies. Most previous studies have been limited by small sample sizes and few participating endoscopists. The aim of the current study was to evaluate whether cap-assisted colonoscopy improves adenoma detection in a two-center, multi-endoscopist, randomized trial. Consecutive patients who presented for an elective colonoscopy were randomized to cap-assisted colonoscopy (4-mm cap) or standard colonoscopy performed by one of 10 experienced endoscopists. Primary outcome measures were mean number of adenomas per patient and adenoma detection rate (ADR). Secondary outcomes included procedural measures and endoscopist variation; a logistic regression model was employed to examine predictors of increased detection with cap use. A total of 1113 patients (64 % male, mean age 62 years) were randomized to cap-assisted (n = 561) or standard (n = 552) colonoscopy. The mean number of adenomas detected per patient in the cap-assisted and standard groups was similar (0.89 vs. 0.82; P = 0.432), as was the ADR (42 % vs. 40 %; P = 0.452). Cap-assisted colonoscopy achieved a faster cecal intubation time (4.9 vs. 5.8 minutes; P Cap-assisted colonoscopy resulted in a 20 % increase in ADR for some endoscopists and in a 15 % decrease for others. Individual preference for the cap was an independent predictor of increased adenoma detection in adjusted analysis (P cap-assisted colonoscopy, adenoma detection was not. Cap-assisted colonoscopy may be beneficial for selected endoscopists. (NCT01935180). © Georg Thieme Verlag KG Stuttgart · New York.

  11. Dense cranial electroacupuncture stimulation for major depressive disorder--a single-blind, randomized, controlled study.

    Zhang-Jin Zhang

    Full Text Available BACKGROUND: Previous studies suggest that electroacupuncture possesses therapeutic benefits for depressive disorders. The purpose of this study was to determine whether dense cranial electroacupuncture stimulation (DCEAS could enhance the antidepressant efficacy in the early phase of selective serotonin reuptake inhibitor (SSRI treatment of major depressive disorder (MDD. METHODS: In this single-blind, randomized, controlled study, patients with MDD were randomly assigned to 9-session DCEAS or noninvasive electroacupuncture (n-EA control procedure in combination with fluoxetine (FLX for 3 weeks. Clinical outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17, Clinical Global Impression-severity (CGI-S, and Self-rating Depression Scale (SDS as well as the response and remission rates. RESULTS: Seventy-three patients were randomly assigned to n-EA (n = 35 and DCEAS (n = 38, of whom 34 in n-EA and 36 in DCEAS group were analyzed. DCEAS-treated patients displayed a significantly greater reduction from baseline in HAMD-17 scores at Day 3 through Day 21 and in SDS scores at Day 3 and Day 21 compared to patients receiving n-EA. DCEAS intervention also produced a higher rate of clinically significant response compared to n-EA procedure (19.4% (7/36 vs. 8.8% (3/34. The incidence of adverse events was similar in the two groups. CONCLUSIONS: DCEAS is a safe and effective intervention that augments the antidepressant efficacy. It can be considered as an additional therapy in the early phase of SSRI treatment of depressed patients. TRIAL REGISTRATION: ISRCTN88008690.

  12. mHealth Physical Activity Intervention: A Randomized Pilot Study in Physically Inactive Pregnant Women.

    Choi, JiWon; Lee, Ji Hyeon; Vittinghoff, Eric; Fukuoka, Yoshimi


    Physical inactivity is prevalent in pregnant women, and innovative strategies to promote physical activity are strongly needed. The purpose of the study was to test a 12-week mobile health (mHealth) physical activity intervention for feasibility and potential efficacy. Participants were recruited between December 2012 and February 2014 using diverse recruitment methods. Thirty pregnant women between 10 and 20 weeks of gestation were randomized to an intervention (mobile phone app plus Fitbit) or a control (Fitbit) group. Both conditions targeted gradual increases in physical activity. The mHealth intervention included daily messages and a mobile phone activity diary with automated feedback and self-monitoring systems. On monthly average, 4 women were screened for initial eligibility by telephone and 2.5 were randomized. Intervention participants had a 1096 ± 1898 step increase in daily steps compared to an increase of 259 ± 1604 steps in control participants at 12 weeks. The change between groups in weekly mean steps per day during the 12-week study period was not statistically significant (p = 0.38). The intervention group reported lower perceived barrier to being active, lack of energy, than the control group at 12-week visit (p = 0.02). The rates of responding to daily messages and using the daily diary through the mobile app declined during the 12 week study period. It was difficult to recruit and randomize inactive women who wanted to increase physical activity during pregnancy. Pregnant women who were motivated to increase physical activity might find using mobile technologies in assessing and promoting PA acceptable. Possible reasons for the non-significant treatment effect of the mHealth intervention on physical activity are discussed. Public awareness of safety and benefits of physical activity during pregnancy should be promoted. Clinicaltrials.Gov Identifier NCT01461707.

  13. Exploring the Causal Pathway From Telomere Length to Coronary Heart Disease: A Network Mendelian Randomization Study.

    Zhan, Yiqiang; Karlsson, Ida K; Karlsson, Robert; Tillander, Annika; Reynolds, Chandra A; Pedersen, Nancy L; Hägg, Sara


    Observational studies have found shorter leukocyte telomere length (TL) to be a risk factor for coronary heart disease (CHD), and recently the association was suggested to be causal. However, the relationship between TL and common metabolic risk factors for CHD is not well understood. Whether these risk factors could explain pathways from TL to CHD warrants further attention. To examine whether metabolic risk factors for CHD mediate the causal pathway from short TL to increased risk of CHD using a network Mendelian randomization design. Summary statistics from several genome-wide association studies were used in a 2-sample Mendelian randomization study design. Network Mendelian randomization analysis-an approach using genetic variants as the instrumental variables for both the exposure and mediator to infer causality-was performed to examine the causal association between telomeres and CHD and metabolic risk factors. Summary statistics from the ENGAGE Telomere Consortium were used (n=37 684) as a TL genetic instrument, CARDIoGRAMplusC4D Consortium data were used (case=22 233 and control=64 762) for CHD, and other consortia data were used for metabolic traits (fasting insulin, triglyceride, total cholesterol, low-density lipoprotein cholesterol, fasting glucose, diabetes mellitus, glycohemoglobin, body mass index, waist circumference, and waist:hip ratio). One-unit increase of genetically determined TL was associated with -0.07 (95% confidence interval, -0.01 to -0.12; P=0.01) lower log-transformed fasting insulin (pmol/L) and 21% lower odds (95% confidence interval, 3-35; P=0.02) of CHD. Higher genetically determined log-transformed fasting insulin level was associated with higher CHD risk (odds ratio, 1.86; 95% confidence interval, 1.01-3.41; P=0.04). Overall, our findings support a role of insulin as a mediator on the causal pathway from shorter telomeres to CHD pathogenesis. © 2017 American Heart Association, Inc.

  14. No clear support for a role for vitamin D in Parkinson's disease: A Mendelian randomization study.

    Larsson, Susanna C; Singleton, Andrew B; Nalls, Mike A; Richards, J Brent


    Observational studies have found that relative to healthy controls, patients with Parkinson's disease have lower circulating concentrations of 25-hydroxyvitamin D, a clinical biomarker of vitamin D status. However, the causality of this association is uncertain. We undertook a Mendelian randomization study to investigate whether genetically decreased 25-hydroxyvitamin D concentrations are associated with PD to minimize confounding and prevent bias because of reverse causation. As instrumental variables for the Mendelian randomization analysis, we used 4 single-nucleotide polymorphisms that affect 25-hydroxyvitamin D concentrations (rs2282679 in GC, rs12785878 near DHCR7, rs10741657 near CYP2R1, and rs6013897 near CYP24A1). Summary effect size estimates of the 4 single-nucleotide polymorphisms on PD were obtained from the International Parkinson's Disease Genomics Consortium (including 5333 PD cases and 12,019 controls). The estimates of the 4 single-nucleotide polymorphisms were combined using an inverse-variance weighted meta-analysis. Of the 4 single-nucleotide polymorphisms associated with 25-hydroxyvitamin D concentrations, one (rs6013897 in CYP24A1) was associated with PD (odds ratio per 25-hydroxyvitamin D-decreasing allele, 1.09; 95% confidence interval, 1.02-1.16; P = 0.008), whereas no association was observed with the other 3 single-nucleotide polymorphisms (P > 0.23). The odds ratio of PD per genetically predicted 10% lower 25-hydroxyvitamin D concentration, based on the 4 single-nucleotide polymorphisms, was 0.98 (95% confidence interval, 0.93-1.04; P = 0.56). This Mendelian randomization study provides no clear support that lowered 25-hydroxyvitamin D concentration is causally associated with risk of PD. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  15. Reducing door to needle time for stroke thrombolysis.

    Gill, Sumanjit


    Better outcomes are obtained with stroke thrombolysis the more rapidly it is given, both in terms of the patient's level of functional ability and also mortality. Current UK performance targets (outside London) aim for a time of 45 minutes or less. Thrombolysis pathways involve multidisciplinary working across departmental boundaries as well as senior level decision making. Our system used telemedicine out of hours adding additional complexity to the pathway. The initial planning stages started by auditing current practice and mapping the existing pathway. The figures for door to needle times were held on a database on the stroke unit and collected in detail for the purposes of national reporting. The pathway was mapped by combining personal experience of working within the stroke service with the experiences of the general medical registrars who worked the system out of hours. The initial action was to present this information throughout the hospital at departmental meetings. Opinions were canvassed at these meetings on where the biggest barriers were within the pathway and how we could address them. An awareness campaign was held by advertising over the intranet. An intervention comprising the following elements was introduced over the period of a year: introduction of an ambulance pre-alert, revision of the existing pathway, and education to all those involved in thrombolysis. The cases where particularly long delays were noted were audited in more depth to identify barriers to flow through the system. This was reported in ward meetings for staff to contribute experience and to offer solutions. We went to commissioning group meetings to gain the support of the local ambulance service, and talked to A&E seniors about the project and the ways in which they could help. Median times were calculated from a stroke database. There was a fall in median door to needle time of 65.5 to 49 minutes over a period of 18 months. A complex intervention to improve door to needle

  16. Eating dark and milk chocolate: a randomized crossover study of effects on appetite and energy intake

    Sørensen, L B; Astrup, A.


    Objective: To compare the effect of dark and milk chocolate on appetite sensations and energy intake at an ad libitum test meal in healthy, normal-weight men. Subjects/methods: A total of 16 young, healthy, normal-weight men participated in a randomized, crossover study. Test meals were 100 g of either milk (2285 kJ) or dark chocolate (2502 kJ). Visual-analogue scales were used to record appetite sensations before and after the test meal was consumed and subsequently every 30 min for 5 h. An ...

  17. Exercise on prescription: a randomized study on the effect of counseling vs counseling and supervised exercise

    Sørensen, Jes Bak; Kragstrup, J; Skovgaard, T


    (counseling) using maximal oxygen uptake (VO(2max)) as the primary outcome. The study was conducted as a randomized trial in 2005-2006 with a high and a low-intensive group. All the patients referred to the EoP scheme by their GP in the counties of Vejle and Ribe, Denmark, were eligible for the trial....... The high-intensive EoP group received 4 months of group-based supervised training and attended five motivational counseling sessions. The low-intensive group only attended four motivational counseling sessions. Three hundred and twenty-seven patients entered the EoP scheme, and 52 (16%) volunteered...

  18. Comparing three knowledge communication strategies - Diffusion, Dissemination and Translation - through randomized controlled studies.

    Lane, Joseph P; Stone, Vathsala I


    This paper describes a series of three randomized controlled case studies comparing the effectiveness of three strategies for communicating new research-based knowledge (Diffusion, Dissemination, Translation), to different Assistive Technology (AT) stakeholder groups. Pre and post intervention measures for level of knowledge use (unaware, aware, interested, using) via the LOKUS instrument, assessed the relative effectiveness of the three strategies. The latter two approaches were both more effective than diffusion but also equally effective. The results question the value added by tailoring research findings to specific audiences, and instead supports the critical yet neglected role for relevance in determining knowledge use by stakeholders.

  19. X-ray tomography study of the random packing structure of ellipsoids.

    Xia, Chengjie; Zhu, Kuan; Cao, Yixin; Sun, Haohua; Kou, Binquan; Wang, Yujie


    We present an X-ray tomography study for the random packing of ellipsoids. The local structure displays short-range correlations. In addition to the contact number Z, we introduce ρshell, the average contact radius of curvature for contacting neighbors, as an additional parameter to characterize the local orientational geometry. In general, the local free volume w is affected by both Z and ρshell. We believe that the particle asphericity induces a polydispersity effect to influence the packing properties. A model is introduced which explicitly maps the ellipsoid packing onto a polydispersed sphere one, and it reproduces most of the experimental observations.

  20. Effect of dairy fat on plasma phytanic acid in healthy volunteers - a randomized controlled study

    Werner, Louise B.; Hellgren, Lars; Raff, Marianne;


    . DESIGN: In a double-blind, randomized, 4 wk, parallel intervention study 14 healthy young subjects were given 45 g milk fat/d from test butter and cheese with 0.24 wt% phytanic acid or a control diet with 0.13 wt% phytanic acid. Difference in phytanic acid was obtained by feeding roughage with low......BACKGROUND: Phytanic acid produced in ruminants from chlorophyll may have preventive effects on the metabolic syndrome, partly due to its reported RXR and PPAR- α agonist activity. Milk from cows fed increased levels of green plant material, contains increased phytanic acid concentrations...

  1. Renormalized Random Walk Study of Oxygen Absorption in the Human Lung

    Felici, M.; Filoche, M.; Sapoval, B.


    The possibility to renormalize random walks is used to study numerically the oxygen diffusion and permeation in the acinus, the diffusion cell terminating the mammalian airway tree. This is done in a 3D tree structure which can be studied from its topology only. The method is applied to the human acinus real morphology as studied by Haefeli-Bleuer and Weibel in order to compute the respiratory efficiency of the human lung. It provides the first quantitative evidence of the role of diffusion screening in real 3D mammalian respiration. The net result of this study is that, at rest, the efficiency of the human acinus is only of order 33%. Application of these results to CO2 clearance provides for the first time a theoretical support to the empirical relation between the O2 and CO2 partial pressures in blood.

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

    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 NCT00122954.

  3. A prospective randomized study of the efficacy of "Turning Point," an inpatient violence intervention program.

    Loveland-Jones, Catherine; Ferrer, Lucas; Charles, Scott; Ramsey, Frederick; van Zandt, Andrea; Volgraf, Jill; Santora, Thomas; Pathak, Abhijit; Dujon, Jay; Sjoholm, Lars; Rappold, Joseph; Goldberg, Amy


    From 2002 to 2011, there were more than 17,000 shootings in Philadelphia. "Turning Point," Temple University Hospital's inpatient violence intervention program, takes advantage of the teachable moment that occurs after violent injury. In addition to receiving traditional social work services, Turning Point patients watch their trauma bay resuscitation video and a movie about violence, meet with a gunshot wound survivor and an outpatient case manager, and also undergo psychiatric assessment. The purpose of this study was to determine the efficacy of Turning Point in changing attitudes toward guns and violence among victims of penetrating trauma. This prospective randomized study was conducted from January 2012 to January 2014. Patients who sustained a gunshot or stab wound were randomized to standard of care, which involved traditional social work services only, or Turning Point. The Attitudes Toward Guns and Violence Questionnaire was administered to assess attitude change. Analysis was performed with repeated-measures analysis of variance. A p violence. Turning Point is effective in changing attitudes toward guns and violence among victims of penetrating trauma. Longer follow-up is necessary to determine if this program can truly be a turning point in patients' lives. Therapeutic/care management study, level II.

  4. Antibiotic use in post-adenotonsillectomy morbidity: a randomized prospective study.

    Guerra, Marja Michelin; Garcia, Eduardo; Pilan, Renata Ribeiro de Mendonça; Rapoport, Priscila Bogar; Campanholo, Caio Barbosa; Martinelli, Eli Onivaldo


    Tonsillectomy with or without adenoidectomy still is one of the most commonly performed surgical procedures in the world, mostly in the pediatric population. to study the impact of amoxicillin for 7 days in post-adenotonsillectomy recovery, comparing results with a control group. prospective, randomized, controlled study with 120 patients. the patients were randomized according to surgery time to receive 7 days of amoxicillin associated with pain killers, or analgesic alone. During the first week of postoperative, we assessed the level of pain, oral intake acceptance, nausea and vomits, fever and return to daily activities. It was only in the fourth post-operative day that the group receiving antibiotic agents showed a statistically significant difference as far as pain is concerned. There was no difference between the two groups for other data analyzed. considering the results from our study and reviewing the literature on the use of antibiotic agents, we agree that there is no improvement in patient recovery after adenotonsillectomy with the use of amoxicillin for 7 days in the postoperative.

  5. Apolipoprotein e genotype, plasma cholesterol, and cancer: a Mendelian randomization study.

    Trompet, Stella


    Observational studies have shown an association between low plasma cholesterol levels and increased risk of cancer, whereas most randomized clinical trials involving cholesterol-lowering medications have not shown this association. Between 1997 and 2002, the authors assessed the association between plasma cholesterol levels and cancer risk, free from confounding and reverse causality, in a Mendelian randomization study using apolipoprotein E (ApoE) genotype. ApoE genotype, plasma cholesterol levels, and cancer incidence and mortality were measured during a 3-year follow-up period among 2,913 participants in the Prospective Study of Pravastatin in the Elderly at Risk. Subjects within the lowest third of plasma cholesterol level at baseline had increased risks of cancer incidence (hazard ratio (HR) = 1.90, 95% confidence interval (CI): 1.34, 2.70) and cancer mortality (HR = 2.03, 95% CI: 1.23, 3.34) relative to subjects within the highest third of plasma cholesterol. However, carriers of the ApoE2 genotype (n = 332), who had 9% lower plasma cholesterol levels than carriers of the ApoE4 genotype (n = 635), did not have increased risk of cancer incidence (HR = 0.86, 95% CI: 0.50, 1.47) or cancer mortality (HR = 0.70, 95% CI: 0.30, 1.60) compared with ApoE4 carriers. These findings suggest that low cholesterol levels are not causally related to increased cancer risk.

  6. A Randomized Clinical Study Investigating the Stain-Removal Potential of Two Experimental Dentifrices.

    Young, Sarah; Parkinson, Charlie; Hall, Claire; Wang, Nan; Milleman, Jeffery L; Milleman, Kimberly R


    To evaluate the ability of two experimental desensitizing dentifrices, both containing a chemical cleaning agent, one with ultra-low abrasivity and one with low abrasivity, a standard fluoride dentifrice, and a daily-use whitening dentifrice to remove extrinsic tooth stain. This was a single-center, examiner-blind, randomized, controlled, four-treatment, parallel-group study in healthy adults. Extrinsic stain was evaluated using the Macpherson modification of the Lobene Stain Index (MLSI). At baseline, eligible subjects with a total MLSI (area x intensity [A x I]) score of 15 for the facial surfaces of the 12 anterior teeth were stratified (based on total MLSI [A x I] score [dentifrices: an experimental ultra-low abrasivity desensitizing dentifrice (relative dentin abrasion [RDA] -12); an experimental low abrasivity desensitizing dentifrice (RDA -40); a standard fluoride dentifrice with moderate abrasivity (RDA -80); and a whitening dentifrice with higher abrasivity (RDA -142). Both desensitizing dentifrices contained 5% potassium nitrate and 5% sodium tripolyphosphate (a chemical cleaning agent). Treatment effects were evaluated after four and eight weeks of twice-daily brushing. In total, 142 subjects were randomized and 133 subjects completed the study. All study dentifrices demonstrated statistically significant reductions in extrinsic tooth stain from baseline after four and eight weeks of twice-daily use (p dentifrices reduced extrinsic tooth stain. The experimental ultra-low and low abrasivity desensitizing dentifrices containing 5% sodium tripolyphosphate performed similarly to both a moderate abrasivity standard fluoride dentifrice and a higher abrasivity whitening dentifrice.

  7. High incidence of bacteriuria in early post-kidney transplantation; results from a randomized controlled study.

    Parapiboon, W; Ingsathit, A; Jirasiritham, S; Sumethkul, V


    Since the incidence of bacteriuria in kidney transplant recipients varyes according to the study, we examined it among our cases. Our post hoc analysis of data from a single-center, parallel, randomized, controlled, open label study included 90 patients who underwent kidney transplantation at our hospital from April 2010 to January 2011. Patients were randomized to early ureteric stent removal at 8 days versus routine ureteric stent removal at 15 days after kidney transplantation. We identified the incidence of and causative organism for bacteriuria in the early posttransplant period. Seventy-Four patients (58% living donors) participated in this study. The overall incidence of bacteriuria was 56.7% during the first month after kidney transplantation. In patients who had bacteriuria, 48% showed symptomatic urinary tract infection, 40% asymptomatic bacteriuria and 12% urosepsis. The most common organism was Escherichia coli (40%) follow by Klebsiella pneumoniae (19%). The incidence of an ESBL producing organism was 34%. The incidence of bacteriuria was high during the early post-kidney transplant period, requiring increased awareness and surveillance. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. [Bipolar versus monopolar transurethral resection of the prostate: a prospective randomized study].

    Ghozzi, S; Ghorbel, J; Ben Ali, M; Dridi, M; Maarouf, J; Khiari, R; Ben Rais, N


    To compare bipolar with standard monopolar transurethral resection of the prostate (TURP). A prospectively randomized study was conducted between January 2010 and September 2011. Primary end points studied were efficacy (maximum flow rate [Qmax], International Prostate Symptom Score) and safety (adverse events, decline in postoperative serum sodium [Na+] and haemoglobin [Hb] levels). Secondary end points were operation time and duration of irrigation, catheterization, and hospitalization. Sixty consecutive patients were randomized and completed the study, with 29 patients in the monopolar TURP group and 31 in the TURIS group. At baseline, the two groups were comparable in age, prostate volume, mean prostate-specific antigen value, International Prostate Symptom Score, and they had at least 12 months of follow-up. Declines in the mean postoperative serum Na+ for bipolar and monopolar TURP groups were 1.2 and 8.7 mmol/L, respectively. However, there was no statistical difference in the decline in postoperative Hb between the two groups. The mean catheterization time was 26.6 and 52 hours in the bipolar and standard groups, respectively. This difference was statistically significant as was the difference in the time to hospital discharge. The IPSS and Qmax improvements were comparable between the two groups at 12 months of follow-up. No clinically relevant differences in short-term efficacy are existed between the two techniques, but bipolar TURP is preferable due to a more favorable safety profile and shorter catheterization duration. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. The Chronic CARe for diAbeTes study (CARAT: a cluster randomized controlled trial

    Birnbaum Beatrice


    Full Text Available Abstract Background Diabetes is a major challenge for the health care system and especially for the primary care provider. The Chronic Care Model represents an evidence-based framework for the care for chronically ill. An increasing number of studies showed that implementing elements of the Chronic Care Model improves patient relevant outcomes and process parameters. However, most of these findings have been performed in settings different from the Swiss health care system which is dominated by single handed practices. Methods/Design CARAT is a cluster randomized controlled trial with general practitioners as the unit of randomization (trial registration: ISRCTN05947538. The study challenges the hypothesis that implementing several elements of the Chronic Care Model via a specially trained practice nurse improves the HbA1c level of diabetes type II patients significantly after one year (primary outcome. Furthermore, we assume that the intervention increases the proportion of patients who achieve the recommended targets regarding blood pressure ( Discussion This study challenges the hypothesis that the Chronic Care Model can be easily implemented by a practice nurse focused approach. If our results will confirm this hypothesis the suggestion arises whether this approach should be implemented in other chronic diseases and multimorbid patients and how to redesign care in Switzerland.

  10. Piroxicam immediate release formulations: A fasting randomized open-label crossover bioequivalence study in healthy volunteers.

    Helmy, Sally A; El-Bedaiwy, Heba M


    Piroxicam is a NSAID with analgesic and antipyretic properties, used for the treatment of rheumatoid diseases. The aim of this study was to evaluate the bioequivalence of two brands of piroxicam capsules (20 mg) in 24 Egyptian volunteers. The in vivo study was established according to a single-center, randomized, single-dose, laboratory-blinded, 2-period, 2-sequence, crossover study with a washout period of 3 weeks. Under fasting conditions, 24 healthy male volunteers were randomly selected to receive a single oral dose of one capsule (20 mg) of either test or reference product. Plasma samples were obtained over a 144-hour interval and analyzed for piroxicam by HPLC with UV detection. The pharmacokinetic parameters Cmax , tmax , AUC0-t , AUC0-∞ , Vd /F, Cl/F, and t1/2 were determined from plasma concentration-time profiles. The 90% confidence intervals for the ratio of log transformed values of Cmax , AUC0-t , and AUC0-∞ of the two treatments were within the acceptable range (0.8-1.25) for bioequivalence. From PK perspectives, the two piroxicam formulations were considered bioequivalent, based on the rate and extent of absorption. No adverse events occurred or were reported after a single 20-mg piroxicam and both formulations were well-tolerated.

  11. Graft irradiation in the treatment of acute rejection of renal transplants: a randomized study

    Pilepich, M.V.; Anderson, C.B.; Etheredge, E.E.; Sicard, G.A.; Melzer, J.S.; Blum, J.


    A randomized study of graft irradiation in the treatment of acute rejection of renal transplants was conducted from 1978 to 1981. Patients developing clinical signs of an acute graft rejection received customary antirejection treatment in the form of intravenous administration of high-dose (1 gm per day) of methylprednisolone. They were at the same time randomized to either receive therapeutic irradiation (175 rad every other day to a total of 525 rad) or sham irradiation. Neither the patient nor the Transplant Service surgeons knew at any time whether the radiation treatment had been given. Eighty-three rejection episodes occurring in 64 grafts were entered into the study. Acute rejection was reversed in 84.5% of grafts in the control and 75% in the treated group. The incidence of recurrent rejection was higher in the treated group (66 vs. 46%) and graft survival was lower (22% vs. 54%). The study failed to demonstrate a beneficial effect of graft irradiation in the treatment of acute renal allograft rejection, when used in conjunction with high dose steriods.

  12. Safety and feasibility of transcranial direct current stimulation in pediatric hemiparesis: randomized controlled preliminary study.

    Gillick, Bernadette T; Feyma, Tim; Menk, Jeremiah; Usset, Michelle; Vaith, Amy; Wood, Teddi Jean; Worthington, Rebecca; Krach, Linda E


    Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that has shown improved adult stroke outcomes. Applying tDCS in children with congenital hemiparesis has not yet been explored. The primary objective of this study was to explore the safety and feasibility of single-session tDCS through an adverse events profile and symptom assessment within a double-blind, randomized placebo-controlled preliminary study in children with congenital hemiparesis. A secondary objective was to assess the stability of hand and cognitive function. A double-blind, randomized placebo-controlled pretest/posttest/follow-up study was conducted. The study was conducted in a university pediatric research laboratory. Thirteen children, ages 7 to 18 years, with congenital hemiparesis participated. Adverse events/safety assessment and hand function were measured. Participants were randomly assigned to either an intervention group or a control group, with safety and functional assessments at pretest, at posttest on the same day, and at a 1-week follow-up session. An intervention of 10 minutes of 0.7 mA tDCS was applied to bilateral primary motor cortices. The tDCS intervention was considered safe if there was no individual decline of 25% or group decline of 2 standard deviations for motor evoked potentials (MEPs) and behavioral data and no report of adverse events. No major adverse events were found, including no seizures. Two participants did not complete the study due to lack of MEP and discomfort. For the 11 participants who completed the study, group differences in MEPs and behavioral data did not exceed 2 standard deviations in those who received the tDCS (n=5) and those in the control group (n=6). The study was completed without the need for stopping per medical monitor and biostatisticial analysis. A limitation of the study was the small sample size, with data available for 11 participants. Based on the results of this study, tDCS appears to be safe

  13. Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials.

    Anglemyer, Andrew; Horvath, Hacsi T; Bero, Lisa


    Researchers and organizations often use evidence from randomized controlled trials (RCTs) to determine the efficacy of a treatment or intervention under ideal conditions. Studies of observational designs are often used to measure the effectiveness of an intervention in 'real world' scenarios. Numerous study designs and modifications of existing designs, including both randomized and observational, are used for comparative effectiveness research in an attempt to give an unbiased estimate of whether one treatment is more effective or safer than another for a particular population.A systematic analysis of study design features, risk of bias, parameter interpretation, and effect size for all types of randomized and non-experimental observational studies is needed to identify specific differences in design types and potential biases. This review summarizes the results of methodological reviews that compare the outcomes of observational studies with randomized trials addressing the same question, as well as methodological reviews that compare the outcomes of different types of observational studies. To assess the impact of study design (including RCTs versus observational study designs) on the effect measures estimated.To explore methodological variables that might explain any differences identified.To identify gaps in the existing research comparing study designs. We searched seven electronic databases, from January 1990 to December 2013.Along with MeSH terms and relevant keywords, we used the sensitivity-specificity balanced version of a validated strategy to identify reviews in PubMed, augmented with one term ("review" in article titles) so that it better targeted narrative reviews. No language restrictions were applied. We examined systematic reviews that were designed as methodological reviews to compare quantitative effect size estimates measuring efficacy or effectiveness of interventions tested in trials with those tested in observational studies

  14. Genetic determinants of telomere length and risk of common cancers: a Mendelian randomization study.

    Zhang, Chenan; Doherty, Jennifer A; Burgess, Stephen; Hung, Rayjean J; Lindström, Sara; Kraft, Peter; Gong, Jian; Amos, Christopher I; Sellers, Thomas A; Monteiro, Alvaro N A; Chenevix-Trench, Georgia; Bickeböller, Heike; Risch, Angela; Brennan, Paul; Mckay, James D; Houlston, Richard S; Landi, Maria Teresa; Timofeeva, Maria N; Wang, Yufei; Heinrich, Joachim; Kote-Jarai, Zsofia; Eeles, Rosalind A; Muir, Ken; Wiklund, Fredrik; Grönberg, Henrik; Berndt, Sonja I; Chanock, Stephen J; Schumacher, Fredrick; Haiman, Christopher A; Henderson, Brian E; Amin Al Olama, Ali; Andrulis, Irene L; Hopper, John L; Chang-Claude, Jenny; John, Esther M; Malone, Kathleen E; Gammon, Marilie D; Ursin, Giske; Whittemore, Alice S; Hunter, David J; Gruber, Stephen B; Knight, Julia A; Hou, Lifang; Le Marchand, Loic; Newcomb, Polly A; Hudson, Thomas J; Chan, Andrew T; Li, Li; Woods, Michael O; Ahsan, Habibul; Pierce, Brandon L


    Epidemiological studies have reported inconsistent associations between telomere length (TL) and risk for various cancers. These inconsistencies are likely attributable, in part, to biases that arise due to post-diagnostic and post-treatment TL measurement. To avoid such biases, we used a Mendelian randomization approach and estimated associations between nine TL-associated SNPs and risk for five common cancer types (breast, lung, colorectal, ovarian and prostate cancer, including subtypes) using data on 51 725 cases and 62 035 controls. We then used an inverse-variance weighted average of the SNP-specific associations to estimate the association between a genetic score representing long TL and cancer risk. The long TL genetic score was significantly associated with increased risk of lung adenocarcinoma (P = 6.3 × 10(-15)), even after exclusion of a SNP residing in a known lung cancer susceptibility region (TERT-CLPTM1L) P = 6.6 × 10(-6)). Under Mendelian randomization assumptions, the association estimate [odds ratio (OR) = 2.78] is interpreted as the OR for lung adenocarcinoma corresponding to a 1000 bp increase in TL. The weighted TL SNP score was not associated with other cancer types or subtypes. Our finding that genetic determinants of long TL increase lung adenocarcinoma risk avoids issues with reverse causality and residual confounding that arise in observational studies of TL and disease risk. Under Mendelian randomization assumptions, our finding suggests that longer TL increases lung adenocarcinoma risk. However, caution regarding this causal interpretation is warranted in light of the potential issue of pleiotropy, and a more general interpretation is that SNPs influencing telomere biology are also implicated in lung adenocarcinoma risk.

  15. Is the routine drainage after surgery for thyroid necessary? - A prospective randomized clinical study [ISRCTN63623153



    Full Text Available Abstract Background Drains are usually left after thyroid surgery to prevent formation of hematoma and seroma in the thyroid bed. This is done to reduce complications and hospital stay. Objective evaluation of the amount collected in the thyroid bed by ultrasonography (USG can help in assessing the role of drains. Methods A randomized prospective control study was conducted on 94 patients undergoing 102 thyroid surgeries, over a period of fifteen months. Patients included in the study were randomly allocated to drain and non-drain group on the basis of computer generated random number table. The surgeon was informed of the group just before the closure of the wound Postoperatively USG neck was done on first and seventh postoperative day by the same ultrasonologist each time. Any swelling, change in voice, tetany and tingling sensation were also recorded. The data was analyzed using two-sample t-test for calculating unequal variance. Results Both groups were evenly balanced according to age, sex, and size of tumor, type of procedure performed and histopathological diagnosis. There was no significant difference in collection of thyroid bed assessed by USG on D1 & D7 in the two groups (p = 0.313 but the hospital stay was significantly reduced in the non-drain group (p = 0.007. One patient in the drain group required needle aspiration for collection in thyroid bed. No patient in either group required re-operation for bleeding or haematoma. Conclusion Routine drainage of thyroid bed following thyroid surgery may not be necessary. Not draining the wound results in lesser morbidity and decreased hospital stay.

  16. Efficacy of smoking prevention program 'Smoke-free Kids': study protocol of a randomized controlled trial

    van Schayck Onno CP


    Full Text Available Abstract Background A strong increase in smoking is noted especially among adolescents. In the Netherlands, about 5% of all 10-year olds, 25% of all 13-year olds and 62% of all 17-year olds report ever smoking. In the U.S., an intervention program called 'Smoke-free Kids' was developed to prevent children from smoking. The present study aims to assess the effects of this home-based smoking prevention program in the Netherlands. Methods/Design A randomized controlled trial is conducted among 9 to 11-year old children of primary schools. Participants are randomly assigned to the intervention and control conditions. The intervention program consists of five printed activity modules designed to improve parenting skills specific to smoking prevention and parent-child communication regarding smoking. These modules will include additional sheets with communication tips. The modules for the control condition will include solely information on smoking and tobacco use. Initiation of cigarette smoking (first instance of puffing on a lighted cigarette, susceptibility to cigarette smoking, smoking-related cognitions, and anti-smoking socialization will be the outcome measures. To collect the data, telephone interviews with mothers as well as with their child will be conducted at baseline. Only the children will be examined at post-intervention follow-ups (6, 12, 24, and 36 months after the baseline. Discussion This study protocol describes the design of a randomized controlled trial that will evaluate the effectiveness of a home-based smoking prevention program. We expect that a significantly lower number of children will start smoking in the intervention condition compared to control condition as a direct result of this intervention. If the program is effective, it is applicable in daily live, which will facilitate implementation of the prevention protocol. Trial registration Netherlands Trial Register NTR1465

  17. Randomized withdrawal study of patients with symptomatic neurogenic orthostatic hypotension responsive to droxidopa.

    Biaggioni, Italo; Freeman, Roy; Mathias, Christopher J; Low, Phillip; Hewitt, L Arthur; Kaufmann, Horacio


    We evaluated whether droxidopa, a prodrug converted to norepinephrine, is beneficial in the treatment of symptomatic neurogenic orthostatic hypotension, which results from failure to generate an appropriate norepinephrine response to postural challenge. Patients with symptomatic neurogenic orthostatic hypotension and Parkinson disease, multiple system atrophy, pure autonomic failure, or nondiabetic autonomic neuropathy underwent open-label droxidopa titration (100-600 mg, 3× daily). Responders then received an additional 7-day open-label treatment at their individualized dose. Patients were subsequently randomized to continue with droxidopa or withdraw to placebo for 14 days. We then assessed patient-reported scores on the Orthostatic Hypotension Questionnaire and blood pressure measurements. Mean worsening of Orthostatic Hypotension Questionnaire dizziness/lightheadedness score from randomization to end of study (the primary outcome; N=101) was 1.9±3.2 with placebo and 1.3±2.8 units with droxidopa (P=0.509). Four of the other 5 Orthostatic Hypotension Questionnaire symptom scores and all 4 symptom-impact scores favored droxidopa, with statistical significance for the patient's self-reported ability to perform activities requiring standing a short time (P=0.033) and standing a long time (P=0.028). Furthermore, a post hoc analysis of a predefined composite score of all symptoms (Orthostatic Hypotension Questionnaire composite) demonstrated a significant benefit for droxidopa (P=0.013). There was no significant difference between groups for standing systolic blood pressure (P=0.680). Droxidopa was well tolerated. In summary, this randomized withdrawal droxidopa study failed to meet its primary efficacy end point. Additional clinical trials are needed to confirm that droxidopa is beneficial in symptomatic neurogenic orthostatic hypotension, as suggested by the positive secondary outcomes of this trial. Unique identifier: NCT00633880

  18. Can visual aides influence rehabilitation and length of stay following knee replacement? A randomized controlled study

    Simon Abson


    Full Text Available Arthroplasty is increasingly performed within Australia, with a 2.7% rate increase of total knee arthroplasty (TKR over the last year. With an increasing burden on the public health system and increasing waiting lists, all efforts are being made to decrease length of stay and improve the post operative rehabilitation process. There is currently insufficient evidence to make a conclusive statement about visual aids and improved goal attainment post TKR. The purpose of this study is to evaluate one such visual aid clinical photographs of patients knee range of motion (ROM pre- and post-operatively and their effect on length of stay. Photographs of knee range of motion were obtained pre and post-operatively while the patient was anesthetized. In this study, a randomized, single blinded design allocated patients to either be shown or not shown their photographs on day 1 post operatively. Primary outcome measures were the number of days the patient remained in hospital. Secondary measures were Western Ontario and McMaster Universities Arthritis Index scores, Oxford Knee Scores, American Society of Anesthesiologists Score and knee ROM. Thirty-two patients (3 exclusions were randomized to the photo group and 27 patients (4 exclusions were randomized to the no photo group. The median length of stay between groups was not significantly different. Currently there is not enough evidence to conclude that visual aids effect length of stay or rehabilitation pathways. Further assessment with larger cohort groups is needed. Preoperative targeting and rehabilitation for patients with lower functional status may shorten post operative length of patient stay in our institution.

  19. Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study.

    Bacha, Fida; Pyle, Laura; Nadeau, Kristen; Cuttler, Leona; Goland, Robin; Haymond, Morey; Levitsky, Lynne; Lynch, Jane; Weinstock, Ruth S; White, Neil H; Caprio, Sonia; Arslanian, Silva


    To investigate insulin sensitivity and secretion indices and determinants of glycemic control in youth with recent-onset type 2 diabetes (T2DM) at randomization in the TODAY study, the largest study of youth with T2DM to date. We examined estimates of insulin sensitivity [1/fasting insulin (1/I(F)), fasting glucose/insulin (G(F) /I(F)), 1/fasting C-peptide (1/C(F)), G(F) /C(F)], β-cell function [insulinogenic index (ΔI30/ΔG30), and ΔC30/ΔG30], and disposition index (DI) in the TODAY cohort of 704 youth (14.0 ± 2.0 yr; diabetes duration 7.8 ± 5.8 months; 64.9% female; 41.1% Hispanic, 31.5% Black, 19.6% White, 6.1% American Indian, and 1.7% Asian) according to hemoglobin A1c (HbA1c) quartiles at study randomization. The randomization visit followed a run-in period (median 71 d) during which glycemic control (HbA1c ≤ 8% for at least 2 months) was achieved with metformin alone. These measures were also examined in relation to screening HbA1c levels before run-in. Insulin secretion indices declined with increasing HbA1c quartiles, at randomization (ΔC30/ΔG30: 0.11 ± 0.09, 0.10 ± 0.19, 0.07 ± 0.06, and 0.03 ± 0.03 ng/mL per mg/dL, p DI: 0.03 ± 0.03, 0.03 ± 0.05, 0.02 ± 0.02, and 0.01 ± 0.01 mg/dL(-1) , p DI (r = -0.3, p < 0.001), with ΔC30/ΔG30, but not with insulin sensitivity estimates. In youth with recent-onset T2DM treated with metformin, glycemic control, as measured by HbA1c, appears to be associated with residual β-cell function and not insulin sensitivity. © 2012 John Wiley & Sons A/S.

  20. Simulation of the noise transmission through automotive door seals

    Hazir, Andreas


    Andreas Hazir is investigating the door seal contribution to the interior noise level of production vehicles. These investigations contain experimental contribution analyses of real production vehicles and of academic test cases as well as the development of a simulation methodology for noise transmission through sealing systems and side windows. The simulations are realized by coupling transient computational aeroacoustics of the exterior flow to nonlinear finite element simulations of the structural transmission. By introducing a linear transmission model, the setup and computational costs of the seal noise transmission are significantly reduced, resulting in the feasibility of numerical contribution analyses of real production vehicles. Contents Contribution Analyses of Production Vehicles Acoustic Excitation versus Aeroacoustic Excitation Development of a Simulation Methodology Sensitivity Analysis of Noise Transmission Simulations Target Groups Researchers and students in the field of automotive engineer...

  1. Windows to the world, doors to the space

    Vogler, A.; Jørgensen, Jesper


    functionality with mental representation and symbolic meaning. Space-connection interfaces such as doors and windows act as “sensory organs” of a building. They allow inside-out communication, but also allow the user to control the flow of light and air, which in a direct or indirect way are communication......Living in a confined environment with minimal external stimuli available, such as a space habitat, is a strain on normal human life and puts great pressure on groups and individuals. Designers working on a space habitat not only must work on its functional role, but also must integrate...... mediums. In this paper the authors advocate a closer connection among architecture, anthropology and psychology in designing space habitats as part of a new concept of environmental design strategy in space architecture....

  2. Bluetooth enables in-door mobile location services

    Thongthammachart, Saowanee; Olesen, Henning


    Several technologies can be applied to enable mobile location services, but most of them suffer from limited accuracy and availability. GPS can solve the problem of determining the location of users in most outdoor situations, but an end-user position inside a building cannot be pinpointed. Other...... mobile location techniques can also provide the user's position, but the accuracy is rather low. In order to improve the accuracy and make location-based services really attractive, existing approaches must be supplemented by new technologies. Wireless short-range technologies like Bluetooth could...... be candidates for solving these problems. This paper shows that Bluetooth can act as a key enabler of mobile location services in an in-door environment. The advantage of Bluetooth technology is, that it can provide rather precise location data inside a building or hotspot area, while the Bluetooth terminal...

  3. Requester's Acceptance and Non-Acceptance of the Refusal of the Initial Request: How to Improve the Door-in-the-Face Effects?

    Terrier, Lohyd; Joule, Robert-Vincent; Marfaing, Benedicte


    The door-in-the-face technique (Cialdini, Vincent, Lewis, Catalan, Wheeler & Darby, 1975) increases the likelihood that subjects will comply with a target request after they have been submitted first to a request too costly to for agreement. This study tests the effects of the requester's acceptance versus non-acceptance of the refusal of the…

  4. Bias analysis applied to Agricultural Health Study publications to estimate non-random sources of uncertainty

    Lash Timothy L


    Full Text Available Abstract Background The associations of pesticide exposure with disease outcomes are estimated without the benefit of a randomized design. For this reason and others, these studies are susceptible to systematic errors. I analyzed studies of the associations between alachlor and glyphosate exposure and cancer incidence, both derived from the Agricultural Health Study cohort, to quantify the bias and uncertainty potentially attributable to systematic error. Methods For each study, I identified the prominent result and important sources of systematic error that might affect it. I assigned probability distributions to the bias parameters that allow quantification of the bias, drew a value at random from each assigned distribution, and calculated the estimate of effect adjusted for the biases. By repeating the draw and adjustment process over multiple iterations, I generated a frequency distribution of adjusted results, from which I obtained a point estimate and simulation interval. These methods were applied without access to the primary record-level dataset. Results The conventional estimates of effect associating alachlor and glyphosate exposure with cancer incidence were likely biased away from the null and understated the uncertainty by quantifying only random error. For example, the conventional p-value for a test of trend in the alachlor study equaled 0.02, whereas fewer than 20% of the bias analysis iterations yielded a p-value of 0.02 or lower. Similarly, the conventional fully-adjusted result associating glyphosate exposure with multiple myleoma equaled 2.6 with 95% confidence interval of 0.7 to 9.4. The frequency distribution generated by the bias analysis yielded a median hazard ratio equal to 1.5 with 95% simulation interval of 0.4 to 8.9, which was 66% wider than the conventional interval. Conclusion Bias analysis provides a more complete picture of true uncertainty than conventional frequentist statistical analysis accompanied by a

  5. Telling About Southern Fluctuations: Elizabeth Spencer at the Back Door

    Gérald PRÉHER


    Full Text Available Le troisième roman d’Elizabeth Spencer, The Voice at the Back Door (1956, appartient à son cycle du Mississippi. Il traite des relations raciales et de la violence sudiste, deux thèmes qui n’avaient pas bonne presse à cette époque puisque le mouvement pour les droits civiques débutait. Le roman rappelle L’intrus (1948 de Faulkner en ce qu’il met en scène la recherche du coupable du meurtre d’un homme blanc. Cet article analyse la façon dont Spencer dépeint les manières du Sud en s’interrogeant sur les relations raciales. Le roman est également lu dans le contexte de sa publication puisque Spencer fut perçue comme une traîtresse par les Sudistes. Spencer utilise des sujets impopulaires pour révéler le paradoxe au cœur de la manière de vivre sudiste et montre combien le passé se rejoue constamment dans le présent.Elizabeth Spencer’s third novel, The Voice at the Back Door (1956, is part of her Mississippi cycle. It deals with race relations and southern violence, two highly controversial issues at the time since the Civil Rights Movements were beginning. The novel, reminiscent of William Faulkner’s Intruder in the Dust (1948, stages the search for a culprit after the murder of a white man. This paper focuses on Spencer’s portrait of southern manners and interracial relationships and analyzes the novel in the context of its publication. It will show that Spencer uses unpopular topics to expose the paradox at the core of the southern way of life and show that the past is constantly reenacted in the present.

  6. Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study

    Launonen Antti P


    Full Text Available Abstract Background Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. A comprehensive study by Palvanen et al. demonstrated an increase in the annual fracture rate of 13.7% per year over the past 33 years. Should this trend continue, the fracture rate would triple over the next three decades. The increasing incidence of low-energy fractures raises questions about the optimal treatment in terms of functional outcome, pain, and rehabilitation time, as well as the economical impact. Despite the high incidence and costs of proximal humerus fractures, there is currently no valid scientific evidence for the best treatment method. Several publications, including a Cochrane review outline the need for high-quality, well-designed randomized controlled trials. Methods/Design The study is a prospective, randomized, national multi-center trial. The hypothesis of the trial is that surgical treatment of displaced proximal humerus fractures achieves better functional outcome, pain relief, and patient satisfaction compared to conservative treatment. The trial is designed to compare conservative and surgical treatment of proximal humerus fractures in patients 60 years and older. The trial includes two strata. Stratum I compares surgical treatment with locking plates to conservative treatment for two-part fractures. Stratum II compares multi-fragmented fractures, including three- and four-part fractures. The aim of Stratum II is to compare conservative treatment, surgical treatment with the Philos locking plate, and hemiarthroplasty with an Epoca prosthesis. The primary outcome measure will be the Disabilities of the Arm, Shoulder and Hand (DASH score and the secondary outcome measures will be the EuroQol-5D (EQ-5D value, OSS, Constant-Murley Score, VAS, and 15D. Recruiting time will be 3 years. The results will be analyzed after the 2-year follow-up period. Discussion This publication

  7. Random fixed points and random differential inclusions

    Nikolaos S. Papageorgiou


    Full Text Available In this paper, first, we study random best approximations to random sets, using fixed point techniques, obtaining this way stochastic analogues of earlier deterministic results by Browder-Petryshyn, KyFan and Reich. Then we prove two fixed point theorems for random multifunctions with stochastic domain that satisfy certain tangential conditions. Finally we consider a random differential inclusion with upper semicontinuous orientor field and establish the existence of random solutions.

  8. Pioneering Strategies for Relieving Dental Anxiety in Hearing Impaired Children: a Randomized Controlled Clinical Study.

    Chandrasekhar, Shalini; Madu, Ghanashyam Prasad; Ambati, Naga Radhakrishna; Suravarapu, Pavani Reddy; Uppu, Kalyani; Bolla, Deepthi


    Hearing impaired children have a problem in understanding and comprehending with dental treatments. Visual language is the sensible answer of how to improve communication with them. To evaluate the applicability of dental sign language in Hearing impaired children in relieving anxiety during stressful dental treatment by improving their means of communication. This randomized clinical trial was carried out in the Department of Pedodontics and Preventive Dentistry which included 40 Hearing Impaired children meeting inclusion criteria. The selected children were randomly divided into the study and control group comprising of 20 each. In the control group, initial oral examination and dental treatment (oral prophylaxis and class I restoration) were performed without the use of dental sign language. In the study group, the dental sign language specific to dental treatment was educated and during their subsequent visit to the dental clinic after dental sign language reinforcement, oral prophylaxis and class I restoration were done. Subjective and objective measurements of anxiety were recorded for both groups using facial image scale (FIS), pulse oximeter and electronic blood pressure apparatus to compare for correlation. The obtained data were subjected to statistical analysis using unpaired t-test. There was a statistically significant reduction in the anxiety levels (pcontrol group. Dental sign language was effective in reducing the level of anxiety in children who are hard of hearing. Dental sign language was able to improve behavior positively during dental treatment and may also aid in developing a positive dental attitude among children who are hard of hearing.

  9. A Randomized, Head-to-Head Study of Virtual Reality Exposure Therapy for Posttraumatic Stress Disorder.

    McLay, Robert N; Baird, Alicia; Webb-Murphy, Jennifer; Deal, William; Tran, Lily; Anson, Heather; Klam, Warren; Johnston, Scott


    Virtual reality exposure therapy (VRET) is one of the few interventions supported by randomized controlled trials for the treatment of combat-related posttraumatic stress disorder (PTSD) in active duty service members. A comparative effectiveness study was conducted to determine if virtual reality technology itself improved outcomes, or if similar results could be achieved with a control exposure therapy (CET) condition. Service members with combat-related PTSD were randomly selected to receive nine weeks of VRET or CET. Assessors, but not therapists, were blinded. PTSD symptom improvement was assessed one week and 3 months after the conclusion of treatment using the clinician-administered PTSD scale (CAPS). A small crossover component was included. Results demonstrated that PTSD symptoms improved with both treatments, but there were no statistically significant differences between groups. Dropout rates were higher in VRET. Of those who received VRET, 13/42 (31%) showed >30% improvement on the CAPS, versus 16/43 (37%) who received CET. Three months after treatment, >30% improvement was seen in 10/33 (30%) of VRET participants and 12/33 (36%) in CET. Participants who crossed over (n = 11) showed no statistically significant improvements in a second round of treatment, regardless of condition. This study supported the utility of exposure therapy for PTSD, but did not support additional benefit by the inclusion of virtual reality.

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

    Nordin, Linda; Rorsman, Ia


    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.

  11. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study.

    Rosenson, Jonathan; Clements, Carter; Simon, Barry; Vieaux, Jules; Graffman, Sarah; Vahidnia, Farnaz; Cisse, Bitou; Lam, Joseph; Alter, Harrison


    Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management. We investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal. This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward). There were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4-32). There were no differences in adverse events. A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Microscope versus endoscope in root-end management: a randomized controlled study.

    Taschieri, S; Del Fabbro, M; Testori, T; Weinstein, R


    The purpose of this prospective, randomized, clinical study was to monitor the outcome of periradicular surgery, in which either a surgical microscope or an endoscope was used as a magnification device. A total of 113 teeth in 70 patients were included in the study, according to specific selection criteria. The choice of endoscope or surgical microscope was made using a randomized table. One hundred cases were followed for at least 2 years. Of these, 59 root-end management procedures were performed using a microscope and 41 using an endoscope. At the 2-year follow-up they were classified into three groups (success, uncertain healing and failure) according to radiographic and clinical criteria. After a 2-year follow-up, 91 teeth (91%) healed successfully. In the group using an endoscope 90% of successful healing was achieved, while 92% of success was recorded for the group using a microscope. No statistically significant difference was found in the treatment results relating to the type of magnification device. The type of magnification device used did not seem to affect the outcome of endodontic surgery.

  13. Acupuncture Antiarrhythmic Effects on Drug Refractory Persistent Atrial Fibrillation: Study Protocol for a Randomized, Controlled Trial

    Jimin Park


    Full Text Available Background. Atrial fibrillation (AF is the most common form of arrhythmia. Several trials have suggested that acupuncture may prevent AF. However, the efficacy of acupuncture for AF prevention has not been well investigated. Therefore, we designed a prospective, two-parallel-armed, participant and assessor blinded, randomized, sham-controlled clinical trial to investigate acupuncture in persistent AF (ACU-AF. Methods. A total of 80 participants will be randomly assigned to active acupuncture or sham acupuncture groups in a 1 : 1 ratio. Both groups will take the same antiarrhythmic medication during the study period. Patients will receive 10 sessions of acupuncture treatment once a week for 10 weeks. The primary endpoint is AF recurrence rate. Secondary endpoints are left atrium (LA and left atrial appendage (LAA changes in function and volume, and inflammatory biomarker changes. Ethics. This study protocol was approved by the institutional review boards (IRBs of Kyung Hee University Hospital (number 1335-04. This trial is registered with NCT02110537.

  14. Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: The PROMOTE Study A Randomized Controlled Trial

    HENSEL, Kendi L.; BUCHANAN, Steve; BROWN, Sarah K.; RODRIGUEZ, Mayra; CRUSER, des Anges


    Objective To evaluate the efficacy of Osteopathic Manipulative Treatment (OMT) to reduce low back pain and improve functioning during the third trimester in pregnancy and improve selected outcomes of labor and delivery. Study Design PROMOTE was a randomized, placebo-controlled trial of 400 women in their third trimester. Women were randomized to usual care only (UCO), usual care plus OMT (OMT), or usual care plus placebo ultrasound treatment (PUT). The study included seven treatments over nine weeks. The OMT protocol included specific techniques administered by board-certified OMT specialists. Outcomes were assessed using self-report measures for pain and back-related functioning, and medical records for delivery outcomes. Results There were 136 women in the OMT group, 131 in PUT, and 133 in UCO. Characteristics at baseline were similar across groups. Findings indicate significant treatment effects for pain and back related functioning (POMT group similar to that of the PUT, but both groups were significantly improved compared to UCO. For secondary outcome of meconium- stained amniotic fluid there were no differences between the groups. Conclusion OMT was effective for mitigating pain and functional deterioration compared to the UCO group; however OMT did not differ significantly from PUT. This may be attributed to PUT being a more active treatment than intended. There was no higher likelihood of conversion to high risk status based on treatment group. Therefore, OMT is a safe, effective adjunctive modality to improve pain and functioning during their third trimester. PMID:25068560

  15. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Chen, Tongyu; Xu, Jianjun; Ma, Wen; Zhou, Jia


    The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery. PMID:27073400

  16. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Tongyu Chen


    Full Text Available The aim of this study was to evaluate the effect of electroacupuncture (EA on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery.

  17. A comparison of two stretching programs for hamstring muscles: A randomized controlled assessor-blinded study.

    Demoulin, Christophe; Wolfs, Sébastien; Chevalier, Madeline; Granado, Caroline; Grosdent, Stéphanie; Depas, Yannick; Roussel, Nathalie; Hage, Renaud; Vanderthommen, Marc


    Most parameters regarding hamstring flexibility training programs have been investigated; however, the joint (i.e. hip or knee) on which the stretching should preferentially be focused needs to be further explored. This randomized controlled assessor-blinded study aimed to investigate the influence of this parameter. We randomly assigned 111 asymptomatic participants with tight hamstring muscles in three groups: a control group and two groups following a different home-based 8-week (five 10-minute sessions per week) hamstring stretching program (i.e. stretching performed by flexing the hip while keeping the knee extended [SH] or by first flexing the hip with a flexed knee and then extending the knee [SK]). Range of motion (ROM) of hip flexion and knee extension were measured before and after the stretching program by means of the straight leg raising test and the passive knee extension angle test, respectively. Eighty-nine participants completed the study. A significant increase in ROM was observed at post-test. Analyses showed significant group-by-time interactions for changes regarding all outcomes. Whereas the increase in hip flexion and knee extension ROM was higher in the stretching groups than in the CG (especially for the SH group p stretching groups were observed (p > 0.05). In conclusion, the fact that both stretching programs resulted in similar results suggests no influence of the joint at which the stretching is focused upon, as assessed by the straight leg raising and knee extension angle tests.

  18. Improved Bowel Preparation with Multimedia Education in a Predominantly African-American Population: A Randomized Study

    Garg, Shashank; Girotra, Mohit; Chandra, Lakshya; Verma, Vipin; Kaur, Sumanjit; Allawy, Allawy; Secco, Alessandra; Anand, Rohit; Dutta, Sudhir K.


    Background and Aim. Inadequate bowel preparation is a major impediment in colonoscopy quality outcomes. Aim of this study was to evaluate the role of multimedia education (MME) in improving bowel preparation quality and adenoma detection rate. Methods. This was an IRB-approved prospective randomized study that enrolled 111 adult patients undergoing outpatient screening or surveillance colonoscopy. After receiving standard colonoscopy instructions, the patients were randomized into MME group (n = 48) and control group (n = 46). The MME group received comprehensive multimedia education including an audio-visual program, a visual aid, and a brochure. Demographics, quality of bowel preparation, and colonoscopy findings were recorded. Results. MME group had a significantly better bowel preparation in the entire colon (OR 2.65, 95% CI 1.16–6.09) and on the right side of the colon (OR 2.74, 95% CI 1.12–6.71) as compared to control group (p 1 cm) were found more frequently in the MME group (11/31, 35.5% versus 0/13; p < 0.05). More polyps and adenomas were detected in MME group (57 versus 39 and 31 versus 13, resp.) but the difference failed to reach statistical significance. Conclusion. MME can lead to significant improvement in the quality of bowel preparation and large adenoma detection in a predominantly African-American population. PMID:27006590

  19. Teacher-Child Interaction Training: A Pilot Study With Random Assignment.

    Fernandez, Melanie A; Adelstein, Jonathan S; Miller, Samantha P; Areizaga, Margaret J; Gold, Dylann C; Sanchez, Amanda L; Rothschild, Sara A; Hirsch, Emily; Gudiño, Omar G


    Teacher-Child Interaction Training (TCIT), adapted from Parent-Child Interaction Therapy (PCIT), is a classroom-based program designed to provide teachers with behavior management skills that foster positive teacher-student relationships and to improve student behavior by creating a more constructive classroom environment. The purpose of this pilot study was to evaluate TCIT in more classrooms than previously reported in the literature, with older children than previously reported, using random assignment of classrooms to TCIT or to a no-TCIT control condition and conducting all but two sessions within the classroom to enhance feasibility. Participants included 11 kindergarten and first grade classroom teachers and their 118 students from three urban, public schools in Manhattan, with five classrooms randomly assigned to receive TCIT and six to the no-TCIT control condition. Observations of teacher skill acquisition were conducted before, during, and after TCIT for all 11 teachers, and teacher reports of student behavior were obtained at these same time points. Teacher satisfaction with TCIT was assessed following training. Results suggested that after receiving TCIT, teachers increased rates of positive attention to students' appropriate behavior, decreased rates of negative attention to misbehavior, reported significantly less distress related to student disruptive behavior, and reported high satisfaction with the training program. Our study supports the growing evidence-base suggesting that TCIT is a promising approach for training teachers in positive behavior management strategies and for improving student disruptive behavior in the classroom.

  20. Culturally-Tailored Smoking Cessation for American Indians: Study protocol for a randomized controlled trial

    Shireman Theresa I


    Full Text Available Abstract Background Cigarette smoking is the number one cause of preventable death among American Indian and Alaska Natives, AI/ANs. Two out of every five AI/AN will die from tobacco-related diseases if the current smoking rates of AI/ANs (40.8% persist. Currently, there is no proven, effective culturally-tailored smoking cessation program designed specifically for a heterogeneous population of AI. The primary aim of this group randomized clinical trial is to test the efficacy of "All Nations Breath of Life" (ANBL program compared to a non-tailored "Current Best Practices" smoking cessation program among AI smokers. Methods We will randomize 56 groups (8 smokers per group to the tailored program or non-tailored program for a total sample size of 448 American Indian smokers. All participants in the proposed study will be offered pharmacotherapy, regardless of group assignment. This study is the first controlled trial to examine the efficacy of a culturally-tailored smoking cessation program for American Indians. If the intervention is successful, the potential health impact is significant because the prevalence of smoking is the highest in this population. Trial Registration NCT01106456

  1. Acupuncture and Immune Function in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized, Controlled Study

    Lee, Shaun Wen Huey; Liong, Men Long; Yuen, Kah Hay; Krieger, John N


    Objective The immune system has been implicated as one mechanism underlying the benefits of acupuncture therapy. Evidence suggests that acupuncture can ameliorate symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but the association between clinical response and the immune system has not been investigated. Design/Setting We investigated 12 CP/CPPS patients participating in a prospective randomized clinical trial comparing acupuncture versus sham acupuncture for effects on cellular immunity. Blood samples were taken before the first needling and after the last of 20 treatment sessions (week 10). Patients also completed questionnaires examining their CP/CPPS symptoms and mood status at the baseline and end of study visits. Results At the end of study 8 of 12 participants (67%) were classified as treatment responders, 4 participants each from the acupuncture and sham groups. The acupuncture group averaged a 5% increase in natural killer cell levels compared to corresponding sham (-13%; p=0.03). Similarly, patients randomized to acupuncture reported a reduction in other white blood cell parameters examined, supporting the possibility that immunity might be important in the pathophysiology of CP/CPPS. Conclusions The specific effect of acupuncture on CP/CPPS remains unclear. Further research is warranted to examine the mechanisms by which acupuncture therapy may improve clinical symptoms in patients with CP/CPPS. PMID:25453515

  2. Optimization of random amplified polymorphic DNA techniques for use in genetic studies of Cuban Triatominae.

    Fraga, Jorge; Rodriguez, Jinnay; Fuentes, Omar; Fernandez-Calienes, Aymé; Castex, Mayda


    Random amplified polymorphic DNA (RAPD) technique is a simple and reliable method to detect DNA polymorphism. Several factors can affect the amplification profiles, thereby causing false bands and non-reproducibility of assay. In this study, we analyzed the effect of changing the concentration of primer, magnesium chloride, template DNA and Taq DNA polymerase with the objective of determining their optimum concentration for the standardization of RAPD technique for genetic studies of Cuban Triatominae. Reproducible amplification patterns were obtained using 5 pmoL of primer, 2.5 mM of MgCl2, 25 ng of template DNA and 2 U of Taq DNA polymerase in 25 microL of the reaction. A panel of five random primers was used to evaluate the genetic variability of T. flavida. Three of these (OPA-1, OPA-2 and OPA-4) generated reproducible and distinguishable fingerprinting patterns of Triatominae. Numerical analysis of 52 RAPD amplified bands generated for all five primers was carried out with unweighted pair group method analysis (UPGMA). Jaccard's Similarity Coefficient data were used to construct a dendrogram. Two groups could be distinguished by RAPD data and these groups coincided with geographic origin, i.e. the populations captured in areas from east and west of Guanahacabibes, Pinar del Río. T. flavida present low interpopulation variability that could result in greater susceptibility to pesticides in control programs. The RAPD protocol and the selected primers are useful for molecular characterization of Cuban Triatominae.

  3. Comparison of Levetiracetam and sodium Valproate in migraine prophylaxis: A randomized placebo-controlled study

    Homa Sadeghian


    Full Text Available Background: Migraine is a chronic and disabling disorder. Treatment of migraine often comprises of symptomatic (abortive and preventive (prophylactic treatment. The current drugs used in migraine prophylaxis include antidepressant drugs (Serotonin Reuptake Inhibitors, Tricyclic antidepressants, and anti-epileptic drugs (valproate, gabapentin, etc. Objective: The objective of our study was to assess the efficacy and tolerability of levetiracetam in adult migraine prophylaxis, compared to valproate and placebo. Materials and Methods: We conducted a prospective, randomized, placebo-controlled study. A total of 85 patients were randomized to receive levetiracetam 500 mg/d (n = 27, valproate 500 mg/d (n = 32 or placebo (n = 26. The patients were evaluated for treatment efficacy after 6 months. Efficacy was assessed as a more than 50% decrease in headache frequency. Results: In levetiracetam group, 17 (63.0% patients experienced a more than 50% decrease in headache frequency, while this efficacy number was 21 (65.6% for valproate group and 4 (15.4% for placebo group. The difference was not statistically significant between levetiracetam and valproate, while it was significant when comparing either levetiracetam or valproate to placebo. Conclusion: Compared to placebo, levetiracetam offers improvement in headache frequency in patients with migraine. The efficacy of levetiracetam in migraine prophylaxis is comparable to currently used drugs such as valproate.

  4. Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study.

    El-Awadi, Saleh; El-Nakeeb, Ayman; Youssef, Tamer; Fikry, Amir; Abd El-Hamed, Tito M; Ghazy, Hosam; Foda, Elyamany; Farid, Mohamed


    Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy (LC) feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy (OC) versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group (55 patients) and LC group (55 patients). There was no operative mortality. In LC group 4 (7.33%) patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group (96.13+17.35 min versus 76.13+15.12) P<0.05, associated with significantly higher intraoperative bleeding in OC group (P<0.01), necessitating blood transfusions to 7 (12.72%) patients in OC group. The time to resume diet was 18.36+8.18 h in LC group which is significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group (6+1.74 days versus 1.87+1.11 days) P<0.01 with low postoperative morbidity. LC in cirrhotics is still complicated and highly difficult which associates with significant morbidity compared with that of patients without cirrhosis. However, it offers lower morbidity, shorter operative time; early resume dieting with less need for blood transfusion and reducing hospital stay than OC.

  5. Lidocaine versus mepivacaine in sedated pediatric dental patients: randomized, prospective clinical study.

    Çalış, Aylin Sipahi; Cagiran, Esra; Efeoglu, Candan; Ak, Aslı Topaloglu; Koca, Huseyın


    Dental anxiety is usually seen in the pediatric patients. specially in the case of minor oral surgical procedures and exodontia, cooperation of the patients and their families with the dentist will lead to superior treatment outcomes. Pain control is important in dentistry. The aim of this randomized prospective clinical study is to compare the local anaesthetic and haemodynamic effects of 2% lidocaine (Group 1) and 3% mepivacaine (Group 2) in sedated pediatric patients undergoing primary tooth extraction. 60 pediatric patients undergoing sedation for elective primary tooth extraction was prospectively included in the study in a randomized fashion. Inclusion and exclusion criteria were assigned. Patients were given premedication via oral route. Local anesthesia was achieved before extraction(s). There were no significant differences between the groups in patient demographics, number of teeth extracted, duration of the operation and time from the end of the procedure to discharge (p ≥ 0.05). FLACC pain scale scores were not statistically significant between the groups, except at 20 minutes post-operatively when the score is significantly lower in Group 2 (p=0.029). Prevention of pain during dental procedures can nurture the relationship of the patient and dentist. Tooth extraction under sedation in pediatric patients could be safe with both local anesthetics.

  6. Prospective randomized clinical study of arterial pumps used for routine on pump coronary bypass grafting.

    Keyser, Andreas; Hilker, Michael K; Diez, Claudius; Philipp, Alois; Foltan, Maik; Schmid, Christof


    In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern.

  7. Hypertension with unsatisfactory sleep health (HUSH): study protocol for a randomized controlled trial.

    Levenson, Jessica C; Rollman, Bruce L; Ritterband, Lee M; Strollo, Patrick J; Smith, Kenneth J; Yabes, Jonathan G; Moore, Charity G; Harvey, Allison G; Buysse, Daniel J


    Insomnia is common in primary care medical practices. Although behavioral treatments for insomnia are safe, efficacious, and recommended in practice guidelines, they are not widely-available, and their effects on comorbid medical conditions remain uncertain. We are conducting a pragmatic clinical trial to test the efficacy of two cognitive behavioral treatments for insomnia (Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi)) versus an enhanced usual care condition (EUC). The study is a three-arm, parallel group, randomized controlled trial. Participants include 625 adults with hypertension and insomnia, recruited via electronic health records from primary care practices affiliated with a large academic medical center. After screening and baseline assessments, participants are randomized to treatment. BBTI is delivered individually with a live therapist via web-interface/telehealth sessions, while SHUTi is a self-guided, automated, interactive, web-based form of cognitive behavioral therapy for insomnia. Participants in EUC receive an individualized sleep report, educational resources, and an online educational video. Treatment outcomes are measured at 9 weeks, 6 months, and 12 months. The primary outcome is patient-reported sleep disturbances. Secondary outcomes include other self-reported sleep measures, home blood pressure, body mass index, quality of life, health functioning, healthcare utilization, and side effects. This randomized clinical trial compares two efficacious insomnia interventions to EUC, and provides a cost-effective and efficient examination of their similarities and differences. The pragmatic orientation of this trial may impact sleep treatment delivery in real world clinical settings and advance the dissemination and implementation of behavioral sleep interventions. (Identifier: NCT02508129 ; Date Registered: July 21, 2015).

  8. Comparison of random forest and parametric imputation models for imputing missing data using MICE: a CALIBER study.

    Shah, Anoop D; Bartlett, Jonathan W; Carpenter, James; Nicholas, Owen; Hemingway, Harry


    Multivariate imputation by chained equations (MICE) is commonly used for imputing missing data in epidemiologic research. The "true" imputation model may contain nonlinearities which are not included in default imputation models. Random forest imputation is a machine learning technique which can accommodate nonlinearities and interactions and does not require a particular regression model to be specified. We compared parametric MICE with a random forest-based MICE algorithm in 2 simulation studies. The first study used 1,000 random samples of 2,000 persons drawn from the 10,128 stable angina patients in the CALIBER database (Cardiovascular Disease Research using Linked Bespoke Studies and Electronic Records; 2001-2010) with complete data on all covariates. Variables were artificially made "missing at random," and the bias and efficiency of parameter estimates obtained using different imputation methods were compared. Both MICE methods produced unbiased estimates of (log) hazard ratios, but random forest was more efficient and produced narrower confidence intervals. The second study used simulated data in which the partially observed variable depended on the fully observed variables in a nonlinear way. Parameter estimates were less biased using random forest MICE, and confidence interval coverage was better. This suggests that random forest imputation may be useful for imputing complex epidemiologic data sets in which some patients have missing data.

  9. Context by treatment interactions as the primary object of study in cluster randomized controlled trials of population health interventions.

    Fuller, Daniel; Potvin, Louise


    Cluster randomized controlled trials are increasingly used in population health intervention research. Through randomization, researchers attempt to isolate the treatment effect and remove all other effects, including any effects of social context. In many cases, the constant effect assumption cannot be satisfied in cluster randomized controlled trials. We argue that when studying population health interventions, the effective mechanism of intervention lies in the interaction between the treatment and social context. Researchers should be cognizant that attempts to remove the effect of social context using CRTC may fail. The interaction between the treatment and social context should be the primary object of study in population health intervention research.

  10. Study of Electromagnetic Scattering From Material Object Doped Randomly With Thin Metallic Wires Using Finite Element Method

    Deshpande, Manohar D.


    A new numerical simulation method using the finite element methodology (FEM) is presented to study electromagnetic scattering due to an arbitrarily shaped material body doped randomly with thin and short metallic wires. The FEM approach described in many standard text books is appropriately modified to account for the presence of thin and short metallic wires distributed randomly inside an arbitrarily shaped material body. Using this modified FEM approach, the electromagnetic scattering due to cylindrical, spherical material body doped randomly with thin metallic wires is studied.

  11. Reducing depressive symptomatology with a smartphone app: study protocol for a randomized, placebo-controlled trial.

    Giosan, Cezar; Cobeanu, Oana; Mogoaşe, Cristina; Szentagotai, Aurora; Mureşan, Vlad; Boian, Rareș


    Depression has become one of the leading contributors to the global disease burden. Evidence-based treatments for depression are available, but access to them is still limited in some instances. As technology has become more integrated into mental health care, computerized cognitive behavioral therapy (CBT) protocols have become available and have been recently transposed to mobile environments (e.g., smartphones) in the form of "apps." Preliminary research on some depression apps has shown promising results in reducing subthreshold or mild to moderate depressive symptoms. However, this small number of studies reports a low statistical power and they have not yet been replicated. Moreover, none of them included an active placebo comparison group. This is problematic, as a "digital placebo effect" may explain some of the positive effects documented until now. The aim of this study is to test a newly developed mobile app firmly grounded in the CBT theory of depression to determine whether this app is clinically useful in decreasing moderate depressive symptoms when compared with an active placebo. Additionally, we are interested in the app's effect on emotional wellbeing and depressogenic cognitions. Romanian-speaking adults (18 years and older) with access to a computer and the Internet and owning a smartphone are included in the study. A randomized, three-arm clinical trial is being conducted (i.e., active intervention, placebo intervention and delayed intervention). Two hundred and twenty participants with moderate depressive symptoms (i.e., obtaining scores >9 and ≤16 on the Patient Health Questionnaire, PHQ-9) will be randomized to the three conditions. Participants undergoing therapy, presenting serious mental health problems, or legal or health issues that would prevent them from using the app, as well as participants reporting suicidal ideation are excluded. Participants randomized to the active and placebo interventions will use the smartphone app for 6

  12. Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study.

    Ahn, Rosa; Woodbridge, Alexandra; Abraham, Ann; Saba, Susan; Korenstein, Deborah; Madden, Erin; Boscardin, W John; Keyhani, Salomeh


     To examine the association between the presence of individual principal investigators' financial ties to the manufacturer of the study drug and the trial's outcomes after accounting for source of research funding.  Cross sectional study of randomized controlled trials (RCTs).  Studies published in "core clinical" journals, as identified by Medline, between 1 January 2013 and 31 December 2013.  Random sample of RCTs focused on drug efficacy.  Association between financial ties of principal investigators and study outcome.  A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers' fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1

  13. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: A randomized controlled pilot study

    Dronkers, J.J.; Lamberts, H.; Reutelingsperger, I.M.M.D.; Naber, R.H.; Dronkers-Landman, C.M.; Veldman, A.; Meeteren, N.L.U. van


    Objective: Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery. Design: Single-blind randomized controlled pilot study. Setting: Ordinary hospital in the Netherland

  14. Phase III Randomized Study of Bendamustine Compared With Chlorambucil in Previously Untreated Patients With Chronic Lymphocytic Leukemia

    Wolfgang U. Knauf; Toshko Lissichkov; Ali Aldaoud; Anna Liberati; Javier Loscertales; Raoul Herbrecht; Gunnar Juliusson; Gerhard Postner; Liana Gercheva; Stefan Goranov; Martin Becker; Hans-Joerg Fricke; Francoise Huguet; Ilaria Del Giudice; Peter Klein; Lothar Tremmel; Karlheinz Merkle; Marco Montillo


    This randomized, open-label, parallel-group, multicenter study was designed to compare the efficacy and safety of bendamustine and chlorambucil in previously untreated patients with advanced (Binet stage B or C...

  15. Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

    Rasmussen, S; Kehlet, H


    In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone...


    YANJun-Hong; PANJia-Xiang; ZHANGYa-Qin; KANGJin-Fang; LINGXiu-Ying


    This is a randomized comparative study of menstrual patterns between 30 cases of megestrol acetate IUD users and 30 cases using TCu220c IUD before and at the Ist, 3rd, 6th and 12th cycles after insertion.

  17. Does a mineral wristband affect balance? A randomized, controlled, double-blind study.

    Hansson, Eva Ekvall; Beckman, Anders; Persson, Liselott


    Having good balance is a facilitating factor in the performance of everyday activities. Good balance is also essential in various sport activities in order to both get results and prevent injury. A common measure of balance is postural sway, which can be measured both antero-posteriorly and medio-laterally. There are several companies marketing wristbands whose intended function is to improve balance, strength and flexibility. Randomized controlled trials have shown that wristbands with holograms have no effect on balance but studies on wristbands with minerals seem to be lacking. The aim of this study was to investigate if the mineral wristband had any effect on postural sway in a group of healthy individuals. Randomized, controlled, double-blind study. The study group consisted of 40 healthy persons. Postural sway was measured antero-posteriorly and medio-laterally on a force plate, to compare: the mineral wristband, a placebo wristband, and without any wristband. The measurements were performed for 30 s, in four situations: with open eyes and closed eyes, standing on a firm surface and on foam. Analyses were made with multilevel technique. The use of wristband with or without minerals did not alter postural sway. Closed eyes and standing on foam both prolonged the dependent measurement, irrespective if it was medio-lateral or antero-posterior. Wearing any wristband (mineral or placebo) gave a small (0.22-0.36 mm/s) but not statistically significant reduction of postural sway compared to not wearing wristband. This study showed no effect on postural sway by using the mineral wristband, compared with a placebo wristband or no wristband. Wearing any wristband at all (mineral or placebo) gave a small but not statistically significant reduction in postural sway, probably caused by sensory input.

  18. Numerical Modelling and Damage Assessment of Rotary Wing Aircraft Cabin Door Using Continuum Damage Mechanics Model

    Boyina, Gangadhara Rao T.; Rayavarapu, Vijaya Kumar; V. V., Subba Rao


    The prediction of ultimate strength remains the main challenge in the simulation of the mechanical response of composite structures. This paper examines continuum damage model to predict the strength and size effects for deformation and failure response of polymer composite laminates when subjected to complex state of stress. The paper also considers how the overall results of the exercise can be applied in design applications. The continuum damage model is described and the resulting prediction of size effects are compared against the standard benchmark solutions. The stress analysis for strength prediction of rotary wing aircraft cabin door is carried out. The goal of this study is to extend the proposed continuum damage model such that it can be accurately predict the failure around stress concentration regions. The finite element-based continuum damage mechanics model can be applied to the structures and components of arbitrary configurations where analytical solutions could not be developed.

  19. Risk of upper limb complaints due to computer use in older persons: a randomized study

    Jolles Jelle


    Full Text Available Abstract Background We studied whether the twelve-month use of a standard computer would induce complaints of upper limb pain or functional limitations in older novice computer users. Methods Participants between 64 and 76 of age were randomly assigned to an Intervention group (n = 62, whose members received a personal computer and fast Internet access at their homes, or a No Intervention control group (n = 61, whose members refrained from computer use during the twelve month study period. Results Difference scores between baseline and twelve months assessments on both complaint (SFS and functional health scales (SF-36 did not differ between groups (all p > .05. Conclusion Prolonged, self-paced use of a standard computer interface does not put older persons at a risk of upper limb complaints or reduce functional health in older adults.

  20. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study.

    Bauer, Brent A; Cutshall, Susanne M; Wentworth, Laura J; Engen, Deborah; Messner, Penny K; Wood, Christina M; Brekke, Karen M; Kelly, Ryan F; Sundt, Thoralf M


    Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery.

  1. Anterior cervical discectomy with or without fusion with ray titanium cage: a prospective randomized clinical study

    Hauerberg, J.; Kosteljanetz, M.; Bøge-Rasmussen, Torben;


    STUDY DESIGN: A prospective randomized clinical study. OBJECTIVE: To compare 2 surgical methods in the treatment of cervical radiculopathy caused by hard or soft disc herniation; namely, simple discectomy versus discectomy with an additional interbody fusion with a Ray titanium cage. SUMMARY...... by fusion with a Ray titanium cage (40 patients) or to discectomy alone (46 patients). Clinical and radiologic follow-up was performed 3, 12, and 24 months after surgery. RESULTS: There was no statistically significant difference between the 2 groups concerning self-reported satisfaction or severity of pain...... in the neck and arm. Two years after the operation, 86.1% of the patients treated with cage stated a good outcome versus 76.7% in the discectomy group (P = 0.44). The rate of fusion was 83.3% in the cage group versus 81.0% in the discectomy group (P = 0.30). Furthermore, after 2 years, also the rates of new...

  2. Conformation of Randomly Sulfonated Pentablock Ionomers in Dilute Solution: Molecular Dynamic Simulation Study

    Aryal, Dipak; Perahia, Dvora; Grest, Gary S.


    As part of our efforts to define the factors that control the structure and dynamics of structures ionic polymers, the conformation of a pentablock copolymer that consists of randomly sulfonated polystyrene, an ionomeric block, bound to poly-ethylene-r-propylene end caped by poly-t-butylstyrene has been studied in dilute solutions using molecular dynamic simulations. Multi-block copolymers offer a means to tailor several properties into one molecule, taking advantage of their rich phase diagram together with unique properties of specific blocks. We varied the solvent quality for the different blocks and followed the changes in conformation. The spatial configuration of the pentablock as well as the dynamics of the polymer was studied. We find that, independent on the solvent, the higher the sulfonation level, the lower Rg . The static and dynamic structure factors were calculated and compared in an implicit poor solvent, water and a common solvent. These data are compared with results obtained from neutron scattering.

  3. Exercise on prescription: a randomized study on the effect of counseling vs counseling and supervised exercise

    Kragstrup, J.; Skovgaard, T.; Puggaard, L.


    The aim of this study was to compare short- (0-4 months) and long-term (0-10 months) effects of high-intensive Exercise on Prescription (EoP) intervention (counseling and supervised exercise) implemented in primary healthcare in a number of Danish counties with a low-intensive intervention...... (counseling) using maximal oxygen uptake (VO(2max)) as the primary outcome. The study was conducted as a randomized trial in 2005-2006 with a high and a low-intensive group. All the patients referred to the EoP scheme by their GP in the counties of Vejle and Ribe, Denmark, were eligible for the trial....... The high-intensive EoP group received 4 months of group-based supervised training and attended five motivational counseling sessions. The low-intensive group only attended four motivational counseling sessions. Three hundred and twenty-seven patients entered the EoP scheme, and 52 (16%) volunteered...

  4. The value of including spirometry in health checks - a randomized controlled study in primary health care

    Ørts, Lene Maria; Ottesen, Anders Løkke; Bjerregaard, Anne-Louise

    studies in the Ph.D. project will evaluate whether early spirometry measurements can be used to predict future lung disease and describe the follow up of patients with abnormal spirometry measurements at the general practitioner. Disclosure of interest: None to declare. Key words: early spirometry......Background Lung diseases are among the most frequent and most serious ailments in Denmark. Preventive health checks including spirometry can be used to detect lung diseases earlier. Over time the attendance at preventive health checks has decreased and at present the response rate is approximately...... 50%. Little is known about initiatives that can influence the attendance rate. Objectives To examine whether focused information on spirometry in the invitation material will influence the attendance in preventive health checks. Materiel/Methods Design: A randomized controlled study on information...

  5. A randomized study of electronic mail versus telephone follow-up after emergency department visit.

    Ezenkwele, Ugo A; Sites, Frank D; Shofer, Frances S; Pritchett, Ellen N; Hollander, Judd E


    This study was conducted to determine whether electronic mail (e-mail) increases contact rates after patients are discharged from the emergency department (ED). Following discharge, patients were randomized to be contacted by telephone or e-mail. The main outcome was success of contact. Secondary outcome was the median time of response. There were 1561 patients initially screened. Of these, 444 had e-mail and were included in the study. Half were contacted by telephone and the rest via e-mail. Our telephone contact rate was 58% (129/222) after two calls in a 48-h period and our e-mail contact was 41% (90/222). The telephone was nearly two times better than e-mail. The median time of response was 48 h for e-mail and 18 h for telephone. It is concluded that the telephone is a better modality of contact than e-mail for patients discharged from the ED.

  6. A Randomized Clinical Trial of Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study

    Chao Hsing Yeh


    Full Text Available Objectives. This prospective, randomized clinical trial (RCT was designed to investigate the feasibility and effects of a 4-week auricular point acupressure (APA for chronic low back pain (CLBP. Methods. Participants were randomized to either true APA (true acupoints with taped seeds on the designated ear points for CLBP or sham APA (sham acupoints with taped seeds but on different locations than those designated for CLBP. The duration of treatment was four weeks. Participants were assessed before treatment, weekly during treatment, and 1 month following treatment. Results. Participants in the true APA group who completed the 4-week APA treatment had a 70% reduction in worst pain intensity, a 75% reduction in overall pain intensity, and a 42% improvement in disability due to back pain from baseline assessment. The reductions of worst pain and overall pain intensity in the true APA group were statistically greater than participants in the sham group (P<0.01 at the completion of a 4-week APA and 1 month followup. Discussion. The preliminary findings of this feasibility study showed a reduction in pain intensity and improvement in physical function suggesting that APA may be a promising treatment for patients with CLBP.

  7. Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior shoulder dislocations. A prospective randomized study.

    Matthews, D E; Roberts, T


    We performed a prospective, randomized study to evaluate the use of injected lidocaine as an anesthetic for closed reduction of acute anterior shoulder dislocations. Thirty consecutive patients who presented at the emergency department with acute anterior shoulder dislocations were randomly placed in one of two groups. One group received an intraarticular injection of 20 ml of 1% lidocaine and the other group, intravenous injections of morphine sulfate and midazolam. The groups were compared regarding time of reduction maneuver, difficulty of reduction, subjective pain, complications, and total time spent in the emergency department. The lidocaine provided adequate anesthesia and secondary relief of muscle spasm in 15 of 15 (100%) patients. When compared with the intravenous sedation group, the lidocaine group showed no statistically significant difference in time for reduction maneuver, difficulty of reduction, or subjective pain. The lidocaine group had no complications and had a statistically significant shorter emergency department visit when compared with the intravenous sedation group (mean, 78 minutes versus 186 minutes; P = 0.004). Lidocaine provides excellent anesthesia for patients with uncomplicated anterior shoulder dislocations and can be very beneficial when sedation is contraindicated. Lidocaine injections also proved to be cost effective in our institution, reducing total costs by as much as 62%.

  8. Is the Use of a Drain for Thyroid Surgery Realistic? A Prospective Randomized Interventional Study

    Ugur Deveci


    Full Text Available Background. The use of a suction drain in thyroid surgery is common practice in order to avoid hematomas or seromas. The aim of this study was to determine the efficacy of routine drainage after thyroid surgery. Methods. In this prospective randomized trial, 400 patients who underwent either a total thyroidectomy or lobectomy for thyroid disorders were randomly allocated to either the nondrainage (group 1 or the drainage (group 2 group. The volume of fluid collection in the operative bed, postoperative pain, complications, and length of hospital stay were then recorded. Results. Both groups were homogeneous according to age, gender, thyroid volume, type of procedure performed, and histopathological diagnosis. After assessment by USG, no significant difference was found between the groups in the fluid collection of the thyroid bed (, but the length of hospital stay was significantly reduced in group 1 (. Conclusions. In our experience, the use of drain for thyroid surgery is not a routine procedure. However, it should be used in the presence of extensive dead space, particularly when there is retrosternal or intrathoracic extension, or when the patient is on anticoagulant treatment. This trial was registered with clinical NCT01771523.

  9. Abdominal wound closure. A randomized prospective study of 571 patients comparing continuous vs. interrupted suture techniques.

    Richards, P C; Balch, C M; Aldrete, J S


    A randomized, prospective study was designed to compare a continuous with an interrupted technique for closing an abdominal incision. Five hundred seventy-one patients were randomized between the closure methods and stratified as to type of wound: clean, clean-contaminated, or contaminated. In mid-line incisions, the dehiscence rate was 2.0% (5/244) for the continuous group versus 0.9% (2/229) for the interrupted group. The difference was not statistically significant. Ventral hernias formed in 2.0% (4/201) of the continuous group vs. 0.5% (1/184) of the interrupted group. The type of wound had no influence on the results. In oblique incisions, 0% (0/39) of wounds closed continuously dehised while 2% (1/50) of incisions closed interruptedly dehised. No ventral hernias formed. Further analysis of the data indicated that dehiscence was more likely related to improper surgical technique than to the method of closure. An abdominal incision could be closed with a continuous suture in approximately half the time required for placing interrupted sutures (20 vs. 40 minutes). A continuous closure is preferred because it is more expedient and because it has the same incidence of wound disruption compared with an interrupted closure. PMID:6297417

  10. Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study

    Drumond Marra, Hellen Livia; Myczkowski, Martin Luiz; Maia Memória, Cláudia; Arnaut, Débora; Leite Ribeiro, Philip; Sardinha Mansur, Carlos Gustavo; Lancelote Alberto, Rodrigo; Boura Bellini, Bianca; Alves Fernandes da Silva, Adriano; Tortella, Gabriel; Ciampi de Andrade, Daniel; Teixeira, Manoel Jacobsen; Forlenza, Orestes Vicente; Marcolin, Marco Antonio


    Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersen's MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction (p = 0.05), favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration. PMID:26160997

  11. Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study

    Hellen Livia Drumond Marra


    Full Text Available Transcranial magnetic stimulation (TMS is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI, which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC. Thirty-four elderly outpatients meeting Petersen’s MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction p=0.05, favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration.

  12. Mirror therapy for distal radial fractures: A pilot randomized controlled study.

    Bayon-Calatayud, Manuel; Benavente-Valdepeñas, Ana Maria; Del Prado Vazquez-Muñoz, Maria


    To investigate the efficacy of mirror therapy in reducing pain and disability in patients with distal radial fractures. Pilot randomized controlled study. Twenty-two patients with closed distal radial fracture. Patients were randomly assigned to experimental (= 11) or control (= 11) groups. Researchers were blinded to group allocation. Both groups received conventional physiotherapy. In addition, the experimental group had 15 sessions of mirror therapy (a daily session, 30 min). The control group received the same amount of conventional occupational therapy. Assessment was made from baseline to post-treatment. Pain was measured on a visual analogue scale (VAS). Active wrist extension and Quick-DASH (Disabilities of Arm, Shoulder and Hand) were used to assess functional recovery. Pain, disability, and range of motion improved for both groups after intervention. No significant post-treatment differences were found between groups in Quick-DASH (= 0.409), active wrist extension (= 0.191) and VAS scores (= 0.807). There was no significant difference in active wrist extension between groups. Mirror therapy was not superior to conventional occupational therapy in reducing pain and disability.

  13. Transcutaneous Electrical Nerve Stimulation Reduces Post-Thoractomy Ipsilateral Shoulder Pain. A Prospective Randomized Study.

    Esteban González, Pedro; Novoa, Nuria M; Varela, Gonzalo


    The patient's position during an axillary thoracotomy can cause postoperative pain and decrease mobility of the ipsilateral shoulder. In this study, we assessed whether the implementation of a standardized analgesia program using transcutaneous electrical nerve stimulation (TENS) decreases local pain and improves ipsilateral shoulder mobility. Randomized, single-blind, single-center clinical trial of 50 patients who had undergone anatomical lung resection via axillary muscle-sparing thoracotomy. Patients were treated with TENS devices for 30 minutes every 8 hours, beginning on postoperative day 1. Pain and mobility of the affected limb were recorded at the same time on postoperative days 1 through 3. A visual analogue scale was used for pain assessment and shoulder mobility was assessed with a goniometer. Results were compared using a non-parametric test. Twenty-five patients were randomized to each group. Mean age of the control group was 62.7±9.3 years and 63.4±10.2 years in the experimental group. Shoulder mobility parameters were similar in both groups on all postoperative days. However, pain during flexion significantly decreased on day 2 (P=.03) and day 3 (P=.04) in the experimental group. The use of TENS decreases pain from shoulder flexion in patients undergoing axillary thoracotomy for pulmonary resection. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  14. Posterior bulk-filled resin composite restorations. A 5-year randomized controlled clinical study

    van Dijken, Jan WV; Pallesen, Ulla


    .4 years). Each patient received at least two, as similar as possible, extended Class I or Class II restorations. In all cavities, a 1-step self-etch adhesive (Xeno V+) was applied. Randomized, one of the cavities of each pair received the flowable bulk-filled resin composite (SDR), in increments up to 4mm......Objective: To evaluate in a randomized controlled study the 5-year clinical durability of a flowable resin composite bulk-fill technique in Class I and Class II restorations. Material and methods: 38 pairs Class I and 62 pairs Class II restorations were placed in 44 male and 42 female (mean age 52...... as needed to fill the cavity 2mm short of the occlusal cavosurface. The occlusal part was completed with the ormocer-based nano-hybrid resin composite (Ceram X mono+). In the other cavity, the resin composite-only (Ceram X mono+) was placed in 2mm increments. The restorations were evaluated using slightly...

  15. Comparing treatment fidelity between study arms of a randomized controlled clinical trial for stroke family caregivers.

    McLennon, Susan M; Hancock, Rebecca D; Redelman, Kathleen; Scarton, Lisa J; Riley, Elizabeth; Sweeney, Bobbie; Habermann, Barbara; Jessup, Nenette M; Bakas, Tamilyn


    To compare treatment fidelity among treatment arms in the Telephone Assessment and Skill-Building Kit study for stroke caregivers (TASK II) with respect to: 1) protocol adherence; 2) intervention dosage and 3) nurse intervener perspectives. A randomized controlled clinical trial design. Urban, community, midwestern United States. A total of 254 stroke caregivers (mean ±SD age, 54.4 ±11.8 years), 55 (22.0%) males and 199 (78.4%) females) randomized to the TASK II intervention (n=123) or an Information, Support, and Referral comparison group (n=131). TASK II participants received the TASK II Resource Guide; Information, Support, and Referral participants received a standard caregiver brochure. At approximately 8 weeks after discharge, both groups received 8 weekly calls from a nurse, with a booster call 4 weeks later. Protocol adherence was evaluated with the TASK II Checklist for Monitoring Adherence. Intervention dosage was measured by the number of minutes caregivers spent reading materials and talking with the nurse. Nurse intervener perspectives were obtained through focus groups. Protocol adherence was 80% for the TASK II and 92% for the Information, Support, and Referral. As expected, intervention dosage differed between TASK II and Information, Support, and Referral with respect to caregiver time spent reading materials (t=-6.49; Pstroke caregiver intervention trial (NIH R01NR010388; ClinicalTrials.govNCT01275495). © The Author(s) 2015.

  16. Exploiting SNP correlations within random forest for genome-wide association studies.

    Vincent Botta

    Full Text Available The primary goal of genome-wide association studies (GWAS is to discover variants that could lead, in isolation or in combination, to a particular trait or disease. Standard approaches to GWAS, however, are usually based on univariate hypothesis tests and therefore can account neither for correlations due to linkage disequilibrium nor for combinations of several markers. To discover and leverage such potential multivariate interactions, we propose in this work an extension of the Random Forest algorithm tailored for structured GWAS data. In terms of risk prediction, we show empirically on several GWAS datasets that the proposed T-Trees method significantly outperforms both the original Random Forest algorithm and standard linear models, thereby suggesting the actual existence of multivariate non-linear effects due to the combinations of several SNPs. We also demonstrate that variable importances as derived from our method can help identify relevant loci. Finally, we highlight the strong impact that quality control procedures may have, both in terms of predictive power and loci identification. Variable importance results and T-Trees source code are all available at and respectively.

  17. A double-blind, randomized, placebo-controlled study of nifedipine on early renal allograft function.

    Wilkie, M E; Beer, J C; Evans, S J; Raftery, M J; Lord, R H; Moore, R; Marsh, F P


    A double-blind, randomized, placebo-controlled study was conducted to determine the effect of nifedipine on early renal allograft function when added to a triple therapy immunosuppression regime comprising low-dose cyclosporin (CsA), prednisolone and azathioprine. Fifty adult cadaveric renal allograft recipients were randomized to placebo (group P n = 17), nifedipine 10 mg preoperatively and 20 mg b.d. postoperatively for 48 h, followed by matching placebo for 3 months (group NS n = 16) or nifedipine 10 mg preoperatively and 20 mg b.d. postoperatively for 3 months (group NL n = 17). Donor and recipient exclusion criteria included recent calcium antagonist treatment. At 3 months after transplantation mean GFR adjusted for graft loss was significantly higher in group NL than in NS (mean +/- SD 61 +/- 28 versus 34 +/- 25 ml/min/1.73 m2; P nifedipine commenced preoperatively and continued for 3 months following transplantation has beneficial effects on early renal allograft function when incorporated as part of an immunotherapy regimen based on cyclosporin.

  18. Tribulus terrestris versus placebo in the treatment of erectile dysfunction: A prospective, randomized, double blind study.

    Santos, C A; Reis, L O; Destro-Saade, R; Luiza-Reis, A; Fregonesi, A


    To evaluate the possible effects of Tribulus terrestris herbal medicine in the erectile dysfunction treatment and to quantify its potential impact on serum testosterone levels. Prospective, randomized, double-blind and placebo-controlled study including thirty healthy men selected from 100 patients who presented themselves spontaneously complaining of erectile dysfunction, ≥ 40 years of age, nonsmokers, not undergoing treatment for prostate cancer or erectile dysfunction, no dyslipidemia, no phosphodiesterase inhibitor use, no hormonal manipulation and, if present hypertension and/or diabetes mellitus should be controlled. International Index of Erectile Function (IIEF-5) and serum testosterone were obtained before randomization and after 30 days of study. Patients were randomized into two groups of fifteen subjects each. The study group received 800 mg of Tribulus terrestris, divided into two doses per day for thirty days and the control group received placebo administered in the same way. The groups were statistically equivalent in all aspects evaluated. The mean (SD) age was 60 (9.4) and 62.9 (7.9), P = .36 for intervention and placebo groups, respectively. Before treatment, the intervention group showed mean IIEF-5 of 13.2 (5-21) and mean total testosterone 417.1 ng/dl (270.7-548.4 ng/dl); the placebo group showed mean IIEF-5 of 11.6 (6-21) and mean total testosterone 442.7 ng/dl (301-609.1 ng/dl). After treatment, the intervention group showed mean IIEF-5 of 15.3 (5-21) and mean total testosterone 409.3 ng/dl (216.9-760.8 ng/dl); the placebo group showed mean IIEF-5 of 13.7 (6-21) and mean total testosterone 466.3 ng/dl (264.3-934.3 ng/dl). The time factor caused statistically significant changes in both groups for IIEF-5 only (P = .0004), however, there was no difference between the two groups (P = .7914). At the dose and interval studied, Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total


    Mahmoud Mohamed Ahmed Ewidea


    Full Text Available Background: Osteoarthritis is the most common cause of musculoskeletal pain and disability in the knee joint. This study investigated the efficacy of Dextrose iontophoresis versus Dextrose prolotherapy in case of knee osteoarthritis in a randomized, placebo-controlled, double-blinded study. Methods: sixty patients diagnosed mild to moderate osteoarthritis were included in the study. Their age's were45:65 years with mean age 51 ± 3.5 years. Patients were divided randomly into three equal groups, group (Areceived 50 % dextrose iontophoresis, group (B Each patient received three intra-articular injections of dextrose at 1-month intervals in weeks 0, 4, and 8 and group (C received sham iontophoresis. The outcome measurements were Western Ontario and McMaster Universities arthritis index (WOMAC values, knee ROM, and pain severity at rest (seated and in activity (after walking 6 m using the visual analogue scale (VAS were recorded. The patients were evaluated for these parameters before allocated in their groups then after 4, 8, and 24 weeks later. Results: compared to sham group (placebo there were significant improvement of VAS and ROM of iontophoresis group than sham (placebo group (p<0.000. Also there were significant improvement of prolotherapy group than placebo (p<0.006, and 0.02 respectively. Furthermore there was significant improve of iontophoresis group than prolotherapy where p was <0.000 for VAS, ROM and (WOMAC. Conclusion: The results of this study suggested that both dextrose iontophoresis and dextrose prolotherapy may be as useful modalities in treatment of osteoarthritis with better effects of dextrose iontophoresis than prolotherapy.

  20. Recombinant Bile Salt-Stimulated Lipase in Preterm Infant Feeding: A Randomized Phase 3 Study.

    Charlotte Casper

    Full Text Available Feeding strategies are critical for healthy growth in preterm infants. Bile salt-stimulated lipase (BSSL, present in human milk, is important for fat digestion and absorption but is inactivated during pasteurization and absent in formula. This study evaluated if recombinant human BSSL (rhBSSL improves growth in preterm infants when added to formula or pasteurized breast milk.LAIF (Lipase Added to Infant Feeding was a randomized, double-blind, placebo-controlled phase 3 study in infants born before 32 weeks of gestation. The primary efficacy variable was growth velocity (g/kg/day during 4 weeks intervention. Follow-up visits were at 3 and 12 months. The study was performed at 54 centers in 10 European countries.In total 415 patients were randomized (rhBSSL n = 207, placebo n = 208, 410 patients were analyzed (rhBSSL n = 206, placebo n = 204 and 365 patients were followed until 12 months. Overall, there was no significantly improved growth velocity during rhBSSL treatment compared to placebo (16.77 vs. 16.56 g/kg/day, estimated difference 0.21 g/kg/day, 95% CI [-0.40; 0.83], nor were secondary endpoints met. However, in a predefined subgroup, small for gestational age infants, there was a significant effect on growth in favor of rhBSSL during treatment. The incidence of adverse events was higher in the rhBSSL group during treatment.Although this study did not meet its primary endpoint, except in a subgroup of infants small for gestational age, and there was an imbalance in short-term safety, these data provide insights in nutrition, growth and development in preterm NCT01413581.

  1. On-Demand Treatment of Premature Ejaculation with Citalopram: A Randomized Double-Blind Study

    Ghafuri Zahra


    Full Text Available "nAs the most common male sexual disorder premature ejaculation (PE, also referred to as early ejaculation (EE or rapid ejaculation (RE, affects 30%-40% of sexually active men. Despite the limited number of available studies comparing the efficacy of selective serotonin re-uptake inhibitors (SSRI they have been thought to have beneficial effects for the treatment of patients with PE. In the present study, we assessed the efficacy of on-demand use of citalopram, in the treatment of premature ejaculation. A randomized double blind study of fixed dose on-demand use of citalopram was performed in Roozbeh Psychiatry Hospital, Tehran University of Medical Sciences. The sample was consisted of 80 married patients diagnosed with PE according to Diagnostic and Statistical Manual of Mental Disorders. The patients were randomly assigned to two groups: group 1 consisting of 42 patients received 20mg citalopram, and group 2 consisting of 38 patients received placebo four hours before intercourse for a 4-week treatment course. The effects of drug on the ejaculatory function in each group were assessed by the intravaginal ejaculation latency time (IELT, and the Chinese Index of Premature Ejaculation (CIPE before and at the end of treatment course. The mean IELT increased from 66.78±36.94 to 80.85±43.05 seconds in group 1 and from 63.44±33.16 to 65.71±34.26 seconds in group 2 (P = 0.000. Mean CIPE score increased 1.14±1.04 and 0.52±0.50 in group 1 and 2 respectively (P = 0.002. The patients treated with on demand citalopram showed significantly greater improvement in IELT and CIPE score compared to the patients receiving placebo. It seems that citalopram may be an effective treatment of premature ejaculation with on-demand usage. However further studies are warranted.

  2. Physical therapy after prophylactic mastectomy with breast reconstruction: a prospective randomized study.

    Unukovych, Dmytro; Johansson, Hemming; Johansson, Elizabeth; Arver, Brita; Liljegren, Annelie; Brandberg, Yvonne


    The rate of prophylactic mastectomies (PM) is increasing. Patients generally report high levels of health related quality of life and satisfaction after the procedure, whereas body image perception and sexuality may be negatively affected. The aim of the study was to evaluate the interest in physical therapy as a means of improving body image and sexuality in women after PM. Patients undergoing PM at Karolinska University Hospital between 2006 and 2010 were eligible. The following patient-reported outcome measures were used at study baseline and 2 years postoperatively: the body image scale (BIS), the sexual activity questionnaire (SAQ), the short-form health survey (SF-36), the hospital anxiety and depression scale (HAD), and a study specific "pain/motion/sensation scale". Out of 125 patients invited to participate in this prospective randomized study, 43 (34%) consented and were randomized into the intervention (n = 24, 56%) or control (n = 19, 44%) groups. There were no statistically significant between-group differences found with respect to BIS, SAQ, SF-36, HAD, and "pain/motion/sensation". Two years postoperatively, more than half of the patients in both groups reported problems like feeling less attractive, less sexually attractive, their body feeling less whole, and being dissatisfied with their body. A majority marked a decreased sensation in breast area. The interest in a physiotherapy intervention was limited among women who had undergone PM. The intervention did not show any substantial effects. A large proportion of patients reported specific body image related and pain/motion/sensation problems postoperatively. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Early embryo development in a sequential versus single medium: a randomized study

    D'Hooghe Thomas M


    Full Text Available Abstract Background The success of in vitro fertilization techniques is defined by multiple factors including embryo culture conditions, related to the composition of the culture medium. In view of the lack of solid scientific data and in view of the current general belief that sequential media are superior to single media, the aim of this randomized study was to compare the embryo quality in two types of culture media. Methods In this study, the embryo quality on day 3 was measured as primary outcome. In total, 147 patients younger than 36 years treated with IVF/ICSI during the first or second cycle were included in this study. Embryos were randomly cultured in a sequential (group A or a single medium (group B to compare the embryo quality on day 1, day 2 and day 3. The embryo quality was compared in both groups using a Chi-square test with a significance level of 0.05. Results At day 1, the percentage of embryos with a cytoplasmic halo was higher in group B (46% than in group A (32%. At day 2, number of blastomeres, degree of fragmentation and the percentage of unequally sized blastomeres were higher in group B than in group A. At day 3, a higher percentage of embryos had a higher number of blastomeres and unequally sized blastomeres in group B. The number of good quality embryos (GQE was comparable in both groups. The embryo utilization rate was higher in group B (56% compared to group A (49%. Conclusions Although, no significant difference in the number of GQE was found in both media, the utilization rate was significantly higher when the embryos were cultured in the single medium compared to the sequential medium. The results of this study have a possible positive effect on the cumulative cryo-augmented pregnancy rate. Trial registration number NCT01094314

  4. Multicenter randomized trial of cell therapy in cardiopathies – MiHeart Study

    Oliveira Sérgio A


    Full Text Available Abstract Background Cardiovascular diseases are the major cause of death in the world. Current treatments have not been able to reverse this scenario, creating the need for the development of new therapies. Cell therapies have emerged as an alternative for cardiac diseases of distinct causes in experimental animal studies and more recently in clinical trials. Method/Design We have designed clinical trials to test for the efficacy of autologous bone marrow derived mononuclear cell therapies in four different cardiopathies: acute and chronic ischemic heart disease, and Chagasic and dilated cardiomyopathy. All trials are multicenter, randomized, double-blind and placebo controlled. In each trial 300 patients will be enrolled and receive optimized therapy for their specific condition. Additionally, half of the patients will receive the autologous bone marrow cells while the other half will receive placebo (saline with 5% autologous serum. For each trial there are specific inclusion and exclusion criteria and the method for cell delivery is intramyocardial for the chronic ischemic heart disease and intracoronary for all others. Primary endpoint for all studies will be the difference in ejection fraction (determined by Simpson's rule six and twelve months after intervention in relation to the basal ejection fraction. The main hypothesis of this study is that the patients who receive the autologous bone-marrow stem cell implant will have after a 6 month follow-up a mean increase of 5% in absolute left ventricular ejection fraction in comparison with the control group. Discussion Many phase I clinical trials using cell therapy for cardiac diseases have already been performed. The few randomized studies have yielded conflicting results, rendering necessary larger well controlled trials to test for efficacy of cell therapies in cardiopathies. The trials registration numbers at the NIH registry are the following: Chagasic cardiomyopathy (NCT00349271

  5. Comprehensive genotyping in dyslipidemia: mendelian dyslipidemias caused by rare variants and Mendelian randomization studies using common variants.

    Tada, Hayato; Kawashiri, Masa-Aki; Yamagishi, Masakazu


    Dyslipidemias, especially hyper-low-density lipoprotein cholesterolemia and hypertriglyceridemia, are important causal risk factors for coronary artery disease. Comprehensive genotyping using the 'next-generation sequencing' technique has facilitated the investigation of Mendelian dyslipidemias, in addition to Mendelian randomization studies using common genetic variants associated with plasma lipids and coronary artery disease. The beneficial effects of low-density lipoprotein cholesterol-lowering therapies on coronary artery disease have been verified by many randomized controlled trials over the years, and subsequent genetic studies have supported these findings. More recently, Mendelian randomization studies have preceded randomized controlled trials. When the on-target/off-target effects of rare variants and common variants exhibit the same direction, novel drugs targeting molecules identified by investigations of rare Mendelian lipid disorders could be promising. Such a strategy could aid in the search for drug discovery seeds other than those for dyslipidemias.

  6. Prednisolone and acupuncture in Bell's palsy: study protocol for a randomized, controlled trial

    Wang Kangjun


    Full Text Available Abstract Background There are a variety of treatment options for Bell's palsy. Evidence from randomized controlled trials indicates corticosteroids can be used as a proven therapy for Bell's palsy. Acupuncture is one of the most commonly used methods to treat Bell's palsy in China. Recent studies suggest that staging treatment is more suitable for Bell's palsy, according to different path-stages of this disease. The aim of this study is to compare the effects of prednisolone and staging acupuncture in the recovery of the affected facial nerve, and to verify whether prednisolone in combination with staging acupuncture is more effective than prednisolone alone for Bell's palsy in a large number of patients. Methods/Design In this article, we report the design and protocol of a large sample multi-center randomized controlled trial to treat Bell's palsy with prednisolone and/or acupuncture. In total, 1200 patients aged 18 to 75 years within 72 h of onset of acute, unilateral, peripheral facial palsy will be assessed. There are six treatment groups, with four treated according to different path-stages and two not. These patients are randomly assigned to be in one of the following six treatment groups, i.e. 1 placebo prednisolone group, 2 prednisolone group, 3 placebo prednisolone plus acute stage acupuncture group, 4 prednisolone plus acute stage acupuncture group, 5 placebo prednisolone plus resting stage acupuncture group, 6 prednisolone plus resting stage acupuncture group. The primary outcome is the time to complete recovery of facial function, assessed by Sunnybrook system and House-Brackmann scale. The secondary outcomes include the incidence of ipsilateral pain in the early stage of palsy (and the duration of this pain, the proportion of patients with severe pain, the occurrence of synkinesis, facial spasm or contracture, and the severity of residual facial symptoms during the study period. Discussion The result of this trial will assess the

  7. The Cessation in Pregnancy Incentives Trial (CPIT: study protocol for a randomized controlled trial

    Tappin David M


    Full Text Available Abstract Background Seventy percent of women in Scotland have at least one baby, making pregnancy an opportunity to help most young women quit smoking before their own health is irreparably compromised. By quitting during pregnancy their infants will be protected from miscarriage and still birth as well as low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. In the UK, the NICE guidelines: ‘How to stop smoking in pregnancy and following childbirth’ (June 2010 highlighted that little evidence exists in the literature to confirm the efficacy of financial incentives to help pregnant smokers to quit. Its first research recommendation was to determine: Within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit? Design and methods This study is a phase II exploratory individually randomized controlled trial comparing standard care for pregnant smokers with standard care plus the additional offer of financial voucher incentives to engage with specialist cessation services and/or to quit smoking during pregnancy. Participants (n = 600 will be pregnant smokers identified at maternity booking who, when contacted by specialist cessation services, agree to having their details passed to the NHS Smokefree Pregnancy Study Helpline to discuss the trial. The NHS Smokefree Pregnancy Study Helpline will be responsible for telephone consent and follow-up in late pregnancy. The primary outcome will be self reported smoking in late pregnancy verified by cotinine measurement. An economic evaluation will refine cost data collection and assess potential cost-effectiveness while qualitative research interviews with clients and health professionals will assess the level of acceptance of this form of incentive payment. The research questions are: What is the likely therapeutic efficacy? Are incentives potentially cost-effective? Is individual randomization an

  8. The effects of experimentally manipulated social status on acute eating behavior: A randomized, crossover pilot study.

    Cardel, M I; Johnson, S L; Beck, J; Dhurandhar, E; Keita, A D; Tomczik, A C; Pavela, G; Huo, T; Janicke, D M; Muller, K; Piff, P K; Peters, J C; Hill, J O; Allison, D B


    Both subjective and objectively measured social status has been associated with multiple health outcomes, including weight status, but the mechanism for this relationship remains unclear. Experimental studies may help identify the causal mechanisms underlying low social standing as a pathway for obesity. Our objective was to investigate the effects of experimentally manipulated social status on ad libitum acute dietary intakes and stress-related outcomes as potential mechanisms relating social status and weight. This was a pilot feasibility, randomized, crossover study in Hispanic young adults (n=9; age 19-25; 67% female; BMI ≥18.5 and ≤30kg/m(2)). At visit 1, participants consumed a standardized breakfast and were randomized to a high social status position (HIGH) or low social status position (LOW) in a rigged game of Monopoly™. The rules for the game differed substantially in terms of degree of 'privilege' depending on randomization to HIGH or LOW. Following Monopoly™, participants were given an ad libitum buffet meal and energy intakes (kcal) were estimated by pre- and post-weighing foods consumed. Stress-related markers were measured at baseline, after the game of Monopoly™, and after lunch. Visit 2 used the same standardized protocol; however, participants were exposed to the opposite social status condition. When compared to HIGH, participants in LOW consumed 130 more calories (p=0.07) and a significantly higher proportion of their daily calorie needs in the ad libitum buffet meal (39% in LOW versus 31% in HIGH; p=0.04). In LOW, participants reported decreased feelings of pride and powerfulness following Monopoly™ (p=0.05) and after their lunch meal (p=0.08). Relative to HIGH, participants in LOW demonstrated higher heart rates following Monopoly™ (p=0.06), but this relationship was not significant once lunch was consumed (p=0.31). Our pilot data suggest a possible causal relationship between experimentally manipulated low social status and

  9. Height and Breast Cancer Risk: Evidence From Prospective Studies and Mendelian Randomization

    Zhang, Ben; Shu, Xiao-Ou; Delahanty, Ryan J.; Zeng, Chenjie; Michailidou, Kyriaki; Bolla, Manjeet K.; Wang, Qin; Dennis, Joe; Wen, Wanqing; Long, Jirong; Li, Chun; Dunning, Alison M.; Chang-Claude, Jenny; Shah, Mitul; Perkins, Barbara J.; Czene, Kamila; Darabi, Hatef; Eriksson, Mikael; Bojesen, Stig E.; Nordestgaard, Børge G.; Nielsen, Sune F.; Flyger, Henrik; Lambrechts, Diether; Neven, Patrick; Wildiers, Hans; Floris, Giuseppe; Schmidt, Marjanka K.; Rookus, Matti A.; van den Hurk, Katja; de Kort, Wim L. A. M.; Couch, Fergus J.; Olson, Janet E.; Hallberg, Emily; Vachon, Celine; Rudolph, Anja; Seibold, Petra; Flesch-Janys, Dieter; Peto, Julian; dos-Santos-Silva, Isabel; Fletcher, Olivia; Johnson, Nichola; Nevanlinna, Heli; Muranen, Taru A.; Aittomäki, Kristiina; Blomqvist, Carl; Li, Jingmei; Humphreys, Keith; Brand, Judith; Guénel, Pascal; Truong, Thérèse; Cordina-Duverger, Emilie; Menegaux, Florence; Burwinkel, Barbara; Marme, Frederik; Yang, Rongxi; Surowy, Harald; Benitez, Javier; Zamora, M. Pilar; Perez, Jose I. A.; Cox, Angela; Cross, Simon S.; Reed, Malcolm W. R.; Andrulis, Irene L.; Knight, Julia A.; Glendon, Gord; Tchatchou, Sandrine; Sawyer, Elinor J.; Tomlinson, Ian; Kerin, Michael J.; Miller, Nicola; Chenevix-Trench, Georgia; Haiman, Christopher A.; Henderson, Brian E.; Schumacher, Fredrick; Marchand, Loic Le; Lindblom, Annika; Margolin, Sara; Hooning, Maartje J.; Martens, John W. M.; Tilanus-Linthorst, Madeleine M. A.; Collée, J. Margriet; Hopper, John L.; Southey, Melissa C.; Tsimiklis, Helen; Apicella, Carmel; Slager, Susan; Toland, Amanda E.; Ambrosone, Christine B.; Yannoukakos, Drakoulis; Giles, Graham G.; Milne, Roger L.; McLean, Catriona; Fasching, Peter A.; Haeberle, Lothar; Ekici, Arif B.; Beckmann, Matthias W.; Brenner, Hermann; Dieffenbach, Aida Karina; Arndt, Volker; Stegmaier, Christa; Swerdlow, Anthony J.; Ashworth, Alan; Orr, Nick; Jones, Michael; Figueroa, Jonine; Garcia-Closas, Montserrat; Brinton, Louise; Lissowska, Jolanta; Dumont, Martine; Winqvist, Robert; Pylkäs, Katri; Jukkola-Vuorinen, Arja; Grip, Mervi; Brauch, Hiltrud; Brüning, Thomas; Ko, Yon-Dschun; Peterlongo, Paolo; Manoukian, Siranoush; Bonanni, Bernardo; Radice, Paolo; Bogdanova, Natalia; Antonenkova, Natalia; Dörk, Thilo; Mannermaa, Arto; Kataja, Vesa; Kosma, Veli-Matti; Hartikainen, Jaana M.; Devilee, Peter; Seynaeve, Caroline; Van Asperen, Christi J.; Jakubowska, Anna; Lubiński, Jan; Jaworska-Bieniek, Katarzyna; Durda, Katarzyna; Hamann, Ute; Torres, Diana; Schmutzler, Rita K.; Neuhausen, Susan L.; Anton-Culver, Hoda; Kristensen, Vessela N.; Grenaker Alnæs, Grethe I.; Pierce, Brandon L.; Kraft, Peter; Peters, Ulrike; Lindstrom, Sara; Seminara, Daniela; Burgess, Stephen; Ahsan, Habibul; Whittemore, Alice S.; John, Esther M.; Gammon, Marilie D.; Malone, Kathleen E.; Tessier, Daniel C.; Vincent, Daniel; Bacot, Francois; Luccarini, Craig; Baynes, Caroline; Ahmed, Shahana; Maranian, Mel; Healey, Catherine S.; González-Neira, Anna; Pita, Guillermo; Alonso, M. Rosario; Álvarez, Nuria; Herrero, Daniel; Pharoah, Paul D. P.; Simard, Jacques; Hall, Per; Hunter, David J.; Easton, Douglas F.


    Background: Epidemiological studies have linked adult height with breast cancer risk in women. However, the magnitude of the association, particularly by subtypes of breast cancer, has not been established. Furthermore, the mechanisms of the association remain unclear. Methods: We performed a meta-analysis to investigate associations between height and breast cancer risk using data from 159 prospective cohorts totaling 5216302 women, including 113178 events. In a consortium with individual-level data from 46325 case patients and 42482 control subjects, we conducted a Mendelian randomization analysis using a genetic score that comprised 168 height-associated variants as an instrument. This association was further evaluated in a second consortium using summary statistics data from 16003 case patients and 41335 control subjects. Results: The pooled relative risk of breast cancer was 1.17 (95% confidence interval [CI] = 1.15 to 1.19) per 10cm increase in height in the meta-analysis of prospective studies. In Mendelian randomization analysis, the odds ratio of breast cancer per 10cm increase in genetically predicted height was 1.22 (95% CI = 1.13 to 1.32) in the first consortium and 1.21 (95% CI = 1.05 to 1.39) in the second consortium. The association was found in both premenopausal and postmenopausal women but restricted to hormone receptor–positive breast cancer. Analyses of height-associated variants identified eight new loci associated with breast cancer risk after adjusting for multiple comparisons, including three loci at 1q21.2, DNAJC27, and CCDC91 at genome-wide significance level P < 5×10–8. Conclusions: Our study provides strong evidence that adult height is a risk factor for breast cancer in women and certain genetic factors and biological pathways affecting adult height have an important role in the etiology of breast cancer. PMID:26296642

  10. Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC).

    Warschburger, Petra; Kröller, Katja


    Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting. Five hundred twenty-three parents and their 7-13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses. Objective weight data were available for 49.6 (67.0) % of the children 6 (12) months after the end of treatment. Completers and non-completers at the 6- and 12-month follow-up differed in the amount of weight loss during their inpatient stay, their initial BMI-SDS, educational level of the parents, and child's quality of life and well-being. Additionally, completers supported their child more than non-completers, and at the 12-month follow-up, families with a more structured eating environment were less likely to drop out. On a multivariate level, only educational background and structure of the eating environment remained significant. The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background. Current Controlled Trials ISRCTN24655766 . Registered 06 September 2008, updated 16 May 2012.

  11. Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study.

    Padmanabhan, Anantha; Frangopoulos, Christoforos; Shaffer, Lynn E T


    Previous literature has shown that propofol has ideal anesthetic properties for patients undergoing colonoscopy, a common procedure at outpatient surgery centers. However, there is a paucity of information regarding patient satisfaction with propofol. The aim of this study was to evaluate patient satisfaction with propofol compared with nonpropofol (fentanyl/midazolam) anesthesia for outpatient colonoscopies. Safety and complications were secondary end points. This study was a double-blind, randomized, parallel-group controlled clinical trial (NCT 02937506). This study was conducted at a single ambulatory surgery center at an urban teaching community health system. Patients were scheduled for outpatient colonoscopy. Those with high-risk cardiac or pulmonary disease were excluded. Anesthesia personnel administered either fentanyl/midazolam (n = 300) or propofol (n = 300) for sedation during outpatient colonoscopy. A single, highly experienced endoscopist performed all colonoscopies. The primary outcomes measured were patient satisfaction (5-point Likert scale) and procedure complications. Data were collected on the day of endoscopy by the nursing staff of the postanesthesia care unit. A subinvestigator blinded to the randomization called patients 24 to 72 hours after discharge to obtain data on postprocedure problems and status of resumption of normal activities. Analysis was intention-to-treat. Fewer patients who received propofol remembered being awake during the procedure (2% vs 17% for fentanyl, p propofol (p propofol group (2.7% vs 11.7%, p propofol over a combination of fentanyl/midazolam as their anesthetic for outpatient colonoscopies. From a patient and provider perspective, propofol appears to be superior to fentanyl/midazolam for outpatient colonoscopy. See Video Abstract at

  12. Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery: A randomized, double-blind study

    Shio Priye


    Full Text Available Objectives: The purpose of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in postcardiac surgery patients. Settings and Design: A prospective, randomized, double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass. Interventions: Sixty-four patients who underwent elective cardiac surgery under general anesthesia were shifted to intensive care unit (ICU and randomly divided into two groups. Group A (n = 32 received a 12 h infusion of normal saline and group B (n = 32 received a 12 h infusion of dexmedetomidine 0.4 μg/kg/h. Postoperative pain was managed with bolus intravenous fentanyl. Total fentanyl consumption, hemodynamic monitoring, Visual Analogue Scale (VAS pain ratings, Ramsay Sedation Scale were charted every 6 th hourly for 24 h postoperatively and followed-up till recovery from ICU. Student′s t-test, Chi-square/Fisher′s exact test has been used to find the significance of study parameters between the groups. Results: Dexmedetomidine treated patients had significantly less VAS score at each level (P < 0.001. Total fentanyl consumption in dexmedetomidine group was 128.13 ± 35.78 μg versus 201.56 ± 36.99 μg in saline group (P < 0.001. A statistically significant but clinically unimportant sedation was noted at 6 and 12 h (P < 0.001, and P = 0.046 respectively. Incidence of delirium was less in dexmedetomidine group (P = 0.086+. Hemodynamic parameters were statistically insignificant. Conclusions: Dexmedetomidine infusion even without loading dose provides safe, effective adjunct analgesia, reduces narcotic consumption, and showed a reduced trend of delirium incidence without undesirable hemodynamic effects in the cardiac surgery patients.

  13. Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial.

    Achey, Meredith A; Beck, Christopher A; Beran, Denise B; Boyd, Cynthia M; Schmidt, Peter N; Willis, Allison W; Riggare, Sara S; Simone, Richard B; Biglan, Kevin M; Dorsey, E Ray


    Interest in improving care for the growing number of individuals with chronic conditions is rising. However, access to care is limited by distance, disability, and distribution of doctors. Small-scale studies in Parkinson disease, a prototypical chronic condition, have suggested that delivering care using video house calls is feasible, offers similar clinical outcomes to in-person care, and reduces travel burden. We are conducting a randomized comparative effectiveness study (Connect.Parkinson) comparing usual care in the community to usual care augmented by virtual house calls with a Parkinson disease specialist. Recruitment is completed centrally using online advertisements and emails and by contacting physicians, support groups, and allied health professionals. Efforts target areas with a high proportion of individuals not receiving care from neurologists. Approximately 200 individuals with Parkinson disease and their care partners will be enrolled at 20 centers throughout the United States and followed for one year. Participants receive educational materials, then are randomized in a 1:1 ratio to continue their usual care (control arm) or usual care and specialty care delivered virtually (intervention arm). Care partners are surveyed about their time and travel burden and their perceived caregiver burden. Participants are evaluated via electronic survey forms and videoconferencing with a blinded independent rater at baseline and at 12 months. All study activities are completed remotely.The primary outcomes are: (1) feasibility, as measured by the proportion of visits completed, and (2) quality of life, as measured by the 39-item Parkinson's Disease Questionnaire. Secondary outcomes include measures of clinical benefit, quality of care, time and travel burden, and caregiver burden. Connect.Parkinson will evaluate the feasibility and effectiveness of using technology to deliver care into the homes of individuals with Parkinson disease. The trial may serve as a

  14. Control of Intraoperative Shivering Under Spinal Anaesthesia- A Prospective Randomized Comparative Study of Butorphanol with Tramadol

    Astha Palan


    Full Text Available Background: Shivering is very uncomfortable and distressing for the patient, anaesthesiologist and the surgeon, especially when the patient is under regional anaesthesia. Aim and Objectives: The present study was designed to evaluate the efficacy of butorphanol and tramadol in the control of shivering under spinal anaesthesia and to compare their side effects. To compare the efficacy, potency, response time, hemodynamic alterations, and adverse effects of intravenously administered tramadol and butorphanol for relief of shivering occurring during spinal anaesthesia. Material and Methods: This randomized prospective study was conducted in 100 patients who developed shivering under spinal anaesthesia during various abdominal, orthopaedic, urological and gynaecological procedures. Patients with fever, acute infections, drug allergy and compromised cardiorespiratory functions were not included in the study. On shivering, patients were randomly allocated in two groups of 50 patients each who received intravenously 1mg of butorphanol or 50 mg of tramadol in a double blinded manner. Control of shivering, time taken for cessation, recurrence, hemodynamic changes, axillary temperatures and side effects were noted and compared for both the groups. Collected data were analysed using Chi square test and Student's unpaired t test. Results: All patients were relieved of shivering after butorphanol, 58% within 1 min, 82% within 3min and 100% within 5 min. Tramadol relieved shivering in 98% of patients, 32% within 1 min, 60% within 3 min, 98% within 5 mins (p<0.05. There was higher incidence of side effects like nausea and vomiting with tramadol (16% and 12% respectively as compared to butorphanol. Conclusion: Both the drugs, tramadol and butorphanol are effective to control shivering after spinal anaesthesia. Butorphanol is better as compared to tramadol in treating shivering under spinal anaesthesia because of its quicker onset of action, higher success rate

  15. Effects of acupuncture treatment on depression insomnia: a study protocol of a multicenter randomized controlled trial

    Chen Yuan-Fang


    Full Text Available Abstract Background More than 70% of patients with depression who see their doctors experience insomnia. Insomnia treatment is a very important link for depression treatment. Furthermore, antidepression treatment is also important for depression insomnia. In acupuncture, LU-7 (Lie Que and KID-6 (Zhao Hai, which are two of the eight confluence points in meridian theory, are used as main points. An embedded needle technique is used, alternately, at two groups of points to consolidate the treatment effect. These two groups of points are BL-15 (Xin Shu with BL-23 (Shen Shu and BL-19 (Dan Shu with N-HN-54 (An Mian. The effectiveness of these optimized acupuncture formulas is well proven in the practice by our senior acupuncturists in Guangdong Provincial Hospital of TCM. This study has been designed to examine whether this set of optimized clinical formulas is able to increase the clinical efficacy of depression insomnia treatment. Methods/design In this randomized controlled multicenter trial, all the eligible participants are diagnosed with depression insomnia. All participants are randomly assigned to one of two groups in a ratio of 1:1 and receive either conventional acupuncture treatment or optimized acupuncture treatment. Patients are evaluated using the Pittsburgh Sleep Quality Index(PSQIand the Hamilton rating scale(HAMD for depression. The use of antidepression and hypnotics drugs is also considered. Results are obtained at the start of treatment, 1 and 2 months after treatment has begun, and at the end of treatment. The entire duration of the study will be approximately 36 months. Discussion A high quality of trial methodologies is utilized in the study, and the results may provide better evidence for the effectiveness of acupuncture as a treatment for depression insomnia. The optimized acupuncture formula has potential benefits in increasing the efficacy of treating depression insomnia. Trial registration The trial was registered in

  16. Effect of Intravenous Iron Supplementation on Acute Mountain Sickness: A Preliminary Randomized Controlled Study.

    Ren, Xuewen; Zhang, Qiuying; Wang, Hao; Man, Chunyan; Hong, Heng; Chen, Li; Li, Tanshi; Ye, Ping


    The aim of this study was to assess the role of intravenous iron supplementation in the prevention of AMS. This was a randomized, double-blinded, placebo-controlled study. Forty-one (n=41) healthy Chinese low-altitude inhabitants living in Beijing, China (altitude of about 50 meters) were randomly assigned into intravenous iron supplementation (ISS group; n=21) and placebo (CON group; n=20) groups. Participants in the ISS group received iron sucrose supplement (200 mg) before flying to Lhasa, China (altitude of 4300 meters). Acute mountain sickness (AMS) severity was assessed with the Lake Louise scoring (LLS) system within 5 days after landing on the plateau (at high altitude). Routine check-ups, clinical biochemistry, and blood tests were performed before departure and 24 h after arrival. A total of 38 participants completed the study (ISS group: n=19; CON group: n=19). The rate of subjects with AMS (LLS>3) was lower in the ISS group compared with the CON group, but no significant differences were obtained (P>0.05). There were no differences in patients' baseline characteristics. The physiological indices were similar in both groups except for serum iron concentrations (19.44±10.02 vs. 85.10±26.78 μmol/L) and transferrin saturation rates (28.20±12.14 vs. 68.34±33.12%), which were significantly higher in the ISS group (Piron supplementation has no significant protective effect on AMS in healthy Chinese low-altitude inhabitants.

  17. [Laparoscopic inguinal hernia repair "IPOM" vs "open tension free". Preliminary results of a prospective randomized study].

    Catani, M; De Milito, R; Spaziani, E; Chiaretti, M; Manili, G; Capitano, S; Di Filippo, A; Simi, M


    The authors report the preliminary results of a prospective comparison of IPOM (group A) and "open tension free" (group B) hernioplasty in 50 patients having a mono or bilateral primitive hernia. In group A (26 patients) hernia repair was performed using "Gore-Tex DualMesh Plus biomaterial with holes Corduroy" and in group B (24 patients) using the patch and plug technique with Marlex prosthesis. No intraoperative complications occurred and, in group A, no conversion was necessary. Four minor complications were obser-ved in group A (10.8%): 3 seromas and 1 transient paresthesia; 5 in group B (16%): 4 hematomas and 1 wound infection (p=n.s.). In group A only 2 patients (7.6%) needed analgesics after the first 24 hours and 12 patients (50%) in group B (p<0.001). Mean resumption of normal activity was 8 days in group A and 17 days in group B (p<0.001). At a 12-month-follow-up, no recurrence was reported in both groups. The results of this prospective randomized study show that IPOM may be not only a feasible and effective procedure in the treatment of recurrent and bilateral hernia or when hernia repair is performed during other laparoscopic procedures, but also in particular cases of primitive hernia such as in very active young males or heavy duty workers. However it is necessary to definitely ascertain the true incidence of recurrence in non limited series and in longer follow-up and the preliminary results of this study encourage the authors to complete the randomized study.

  18. Effects of acupuncture on patients with fibromyalgia: study protocol of a multicentre randomized controlled trial

    Santos-Rey Koldo


    Full Text Available Abstract Background Fibromyalgia is a multidimensional disorder for which treatment as yet remains unsatisfactory. Studies of an acupuncture-based approach, despite its broad acceptance among patients and healthcare staff, have not produced sufficient evidence of its effectiveness in treating this syndrome. The present study aims to evaluate the effectiveness of individualized acupuncture for patients with fibromyalgia, with respect to reducing their pain and level of incapacity, and improving their quality of life. Methods/design Randomized controlled multicentre study, with 156 outpatients, aged over 17 years, diagnosed with fibromyalgia according to American College of Rheumatology criteria, either alone or associated with severe depression, according to the criteria of the Diagnostic and Statistical Manual for Mental Disorders. The participants will be randomly assigned to receive either "True acupuncture" or "Sham acupuncture". They will be evaluated using a specific measurement system, constituted of the Fibromyalgia Impact Questionnaire and the Hamilton rating scale for depression. Also taken into consideration will be the clinical and subjective pain intensity, the patient's family structure and relationships, psychological aspects, quality of life, the duration of previous temporary disability, the consumption of antidepressant, analgesic and anti-inflammatory medication, and the potential effect of factors considered to be predictors of a poor prognosis. All these aspects will be examined by questionnaires and other suitably-validated instruments. The results obtained will be analysed at 10 weeks, and 6 and 12 months from the start of treatment. Discussion This trial will utilize high quality trial methodologies in accordance with CONSORT guidelines. It may provide evidence for the effectiveness of acupuncture as a treatment for fibromyalgia either alone or associated with severe depression. Trial registration ISRCTN trial number

  19. Nutrients, foods, dietary patterns and telomere length: Update of epidemiological studies and randomized trials.

    Freitas-Simoes, Tania-Marisa; Ros, Emilio; Sala-Vila, Aleix


    Identifying simple strategies to prevent or delay age-associated pathologies is a major public health concern. Attrition of telomeres, chromatin structures that help maintain genome stability, leads to cell death or senescence. Thus telomere length is a reliable hallmark of biological aging and the risk of developing age-related chronic diseases through common oxidation and inflammation mechanisms. Variability in telomere shortening that is independent of chronological age suggests that it is a modifiable factor, which may be explained in part by lifestyle variables such as smoking, adiposity, physical exercise, and diet. Here we summarize data from published studies focused on nutrition (nutrients, foods, and dietary patterns) and telomere length. Research on the topic is incipient and most data comes from epidemiologic studies, often cross-sectional in design. Consistent with well-known evidence of benefit or harm for chronic age-related diseases, dietary antioxidants and consumption of antioxidant-rich, plant-derived foods help maintain telomere length. In contrast, total and saturated fat intake and consumption of refined flour cereals, meat and meat products, and sugar-sweetened beverages relate to shorter telomeres. Data on alcohol and dairy products is controversial. There is evidence that adherence to the Mediterranean diet is associated with longer telomeres. Randomized clinical trials are limited to seafood-derived long-chain n-3 polyunsaturated fatty acids, with promising results. To fill the many gaps in our knowledge of the aging process and confirm nutrition as a useful tool to counteract biological aging more research is warranted, particularly observational studies using repeated measurements of telomere length and randomized trials of foods and dietary patterns with sequential telomere analyses.

  20. Strategies for improving postpartum contraceptive use: evidence from non-randomized studies.

    Lopez, Laureen M; Grey, Thomas W; Chen, Mario; Hiller, Janet E


    Nearly two-thirds of women in their first postpartum year have an unmet need for family planning. Adolescents often have repeat pregnancies within a year of giving birth. Women may receive counseling on family planning both antepartum and postpartum. Decisions about contraceptive use made right after counseling may differ considerably from actual postpartum use. In earlier work, we found limited evidence of effectiveness from randomized trials on postpartum contraceptive counseling. For educational interventions, non-randomized studies may be conducted more often than randomized trials. We reviewed non-randomized studies of educational strategies to improve postpartum contraceptive use. Our intent was to examine associations between specific interventions and postpartum contraceptive use or subsequent pregnancy. We searched for eligible non-randomized studies until 3 November 2014. Sources included CENTRAL, PubMed, POPLINE, and Web of Science. We also sought current trials via and ICTRP. For additional citations, we examined reference lists of relevant reports and reviews. The studies had to be comparative, i.e., have intervention and comparison groups. The educational component could be counseling or another behavioral strategy to improve contraceptive use among postpartum women. The intervention had to include contact within six weeks postpartum. The comparison condition could be another behavioral strategy to improve contraceptive use, usual care, other health education, or no intervention. Our primary outcomes were postpartum contraceptive use and subsequent pregnancy. Two authors evaluated abstracts for eligibility and extracted data from included studies. We computed the Mantel-Haenszel odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous measures, both with 95% Confidence Intervals (CI). Where studies used adjusted analyses for continuous outcomes, we presented the results as reported by the investigators

  1. Zero Distribution of System with Unknown Random Variables Case Study: Avoiding Collision Path

    Parman Setyamartana


    Full Text Available This paper presents the stochastic analysis of finding the feasible trajectories of robotics arm motion at obstacle surrounding. Unknown variables are coefficients of polynomials joint angle so that the collision-free motion is achieved. ãk is matrix consisting of these unknown feasible polynomial coefficients. The pattern of feasible polynomial in the obstacle environment shows as random. This paper proposes to model the pattern of this randomness values using random polynomial with unknown variables as coefficients. The behavior of the system will be obtained from zero distribution as the characteristic of such random polynomial. Results show that the pattern of random polynomial of avoiding collision can be constructed from zero distribution. Zero distribution is like building block of the system with obstacles as uncertainty factor. By scale factor k, which has range, the random coefficient pattern can be predicted.

  2. Assessment of Neonatal Pain During Heel Prick: Lancet vs Needle-A Randomized Controlled Study.

    Britto, Carl; P N Rao, Suman


    Heel prick is a frequent painful procedure in newborns. A lancet or a 26-gauge needle is used for a heel prick in India. To compare the pain caused by heel prick with a lancet or a 26-gauge needle in newborns admitted in the neonatal intensive care unit (NICU) using the preterm infant pain profile (PIPP). This randomized controlled trial was conducted over 2 months in a Level III NICU with a sample size of 40 subjects (20 in each group), which was required for the study to have a power of 80% with an alpha error of 0.05. Hemodynamically stable newborns on at least those on partial oral feeds undergoing heel prick for routine glucose monitoring were randomized into two groups within 48 h of NICU admission after informed parental consent: heel prick with a lancet or with a 26-gauge needle using computer-generated random numbers. Two milliliters of expressed breast milk was given 2 min before the heel prick. Pain before, during and after (1 and 5 min) was assessed using the PIPP score. The primary outcome measure was the PIPP score. The secondary outcome measures were the duration of audible cry and the number of pricks needed for an adequate sample. Statistical analysis was done using the Mann Whitney U test and Friedman's test on SPSS v.21. A p value of < 0.05 was significant. There were 40 neonates, 24 males and 16 females included in the study with a median age of 7 days. The mean birth weight was 2441 g (SD: 699) at a mean gestation of 34.4 weeks (SD: 3.2). The median PIPP scores at 0-30 s after heel prick were 7.05 ± 3.57 with a lancet vs. 9.35 ± 3.68 a needle (p = 0.052). There was a significantly lower duration of audible cry with use of lancet (10.5 ± 18.5 s vs. 75.2 ± 12.0 s with needle; p = 0.03). All heel pricks resulted in adequate sampling. Heel prick with a lancet causes less crying than a 26-gauge needle, though the PIPP scores are not significantly different. © The Author [2017]. Published by Oxford

  3. The effectiveness of platform screen doors for the prevention of subway suicides in South Korea.

    Chung, Yong Woon; Kang, Sung Jin; Matsubayashi, Tetsuya; Sawada, Yasuyuki; Ueda, Michiko


    Subway suicide can significantly impact the general public. Platform Screen Doors (PSDs) are considered to be an effective strategy to prevent suicides at subway stations, but the evidence on their effectiveness is limited. We assessed the effectiveness of installing half- and full-height platform screen doors in reducing subway suicides using Poisson regression analysis. Ten-year monthly panel data for 121 subway stations between 2003 and 2012 in the Seoul metropolitan area were used for the analysis. We found that installing PSDs decreases fatal suicide cases by 89% (95% CI: 57-97%). We also found that the installation of full-height PSDs resulted in the elimination of subway suicides by completely blocking access to the track area; however, half-height PSDs, which do not extend to the ceiling of the platform, were not as effective as full-height ones. Our findings were based on the data from a single subway operator for a limited period of time. Accordingly, we did not consider the possibility that some passengers choose to die at a station run by other operators. Our study did not examine the potential substitution effects of other suicide methods. Installing physical barriers at subway stations can be an effective strategy to reduce the number of subway suicides; however, half-height PSDs are not as effective as full-height ones, even when they are as high as the height of an adult. Thus, these barriers should be made high enough so that nobody can climb over them. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Effect of topical tetracycline on seroma formation in the Lichtenstein technique: a prospective randomized study.

    Turk, Emin; Karagulle, Erdal; Coban, Gokcen; Yildirim, Erkan; Moray, Gokhan


    We sought to investigate whether application of topical tetracycline has a limiting effect on seroma formation in patients undergoing hernia repair using a polypropylene mesh. This study was conducted in 96 patients undergoing an elective groin hernia repair. Patients were randomized and divided into 2 groups. After the graft was placed, and before external oblique muscle aponeurosis was closed, 5 mL tetracycline was administered on the graft in the tetracycline group (tetra group, n = 50), and 5 mL isotonic saline was administered in the control group (n = 46) without putting in a drain. Seroma checks via surface ultrasonography were done. Seroma amounts measured on the first day were significantly higher in the tetra group (P = 0.04). There were no significant differences regarding seroma measurements on the seventh day or in the first and second months. Topical tetracycline application has no limiting effect on seroma formation after a groin hernia operation.

  5. Simulation study of localization of electromagnetic waves in two-dimensional random dipolar systems.

    Wang, Ken Kang-Hsin; Ye, Zhen


    We study the propagation and scattering of electromagnetic waves by random arrays of dipolar cylinders in a uniform medium. A set of self-consistent equations, incorporating all orders of multiple scattering of the electromagnetic waves, is derived from first principles and then solved numerically for electromagnetic fields. For certain ranges of frequencies, spatially localized electromagnetic waves appear in such a simple but realistic disordered system. Dependence of localization on the frequency, radiation damping, and filling factor is shown. The spatial behavior of the total, coherent, and diffusive waves is explored in detail, and found to comply with a physical intuitive picture. A phase diagram characterizing localization is presented, in agreement with previous investigations on other systems.

  6. Delta-Bar-Delta and directed random search algorithms to study capacitor banks switching overvoltages

    Sadeghkhani Iman


    Full Text Available This paper introduces an approach to analyse transient overvoltages during capacitor banks switching based on artificial neural networks (ANN. Three learning algorithms, delta-bar-delta (DBD, extended delta-bar-delta (EDBD and directed random search (DRS were used to train the ANNs. The ANN training is based on equivalent parameters of the network and therefore, a trained ANN is applicable to every studied system. The developed ANN is trained with extensive simulated results and tested for typical cases. The new algorithms are presented and demonstrated for a partial 39-bus New England test system. The simulated results show the proposed technique can accurately estimate the peak values of switching overvoltages.




    The Accumulator Ring for the proposed Spallation Neutron Source (SNS) [l] is to accept a 1 ms beam pulse from a 1 GeV Proton Linac at a repetition rate of 60 Hz. For each beam pulse, 10{sup 14} protons (some 1,000 turns) are to be accumulated via charge-exchange injection and then promptly extracted to an external target for the production of neutrons by spallation. At this very high intensity, stringent limits (less than two parts in 10,000 per pulse) on beam loss during accumulation must be imposed in order to keep activation of ring components at an acceptable level. To stay within the desired limit, the effects of random and systematic field errors in the ring require careful attention. This paper describes the authors studies of these effects and the magnetic corrector schemes for their compensation.

  8. Kinetic study of CO2 reaction with CaO by a modified random pore model

    Nouri S.M.M.


    Full Text Available In this work, a modified random pore model was developed to study the kinetics of the carbonation reaction of CaO. Pore size distributions of the CaO pellets were measured by nitrogen adsorption and mercury porosimetry methods. The experiments were carried out in a thermogravimeter at different isothermal temperatures and CO2 partial pressures. A fractional concentration dependency function showed the best accuracy for predicting the intrinsic rate of reaction. The activation energy was determined as 11 kcal/mole between 550–700°C. The effect of product layer formation was also taken into account by using the variable product layer diffusivity. Also, the model was successfully predicted the natural lime carbonation reaction data extracted from the literature.

  9. Topical symphytum herb concentrate cream against myalgia: a randomized controlled double-blind clinical study.

    Kucera, Miroslav; Barna, Milos; Horàcek, Ondrej; Kàlal, Jan; Kucera, Alexander; Hladìkova, Marie


    The effectiveness and tolerability of the topical Symphytum product Traumaplant (Harras Pharma Curarina, München, Germany) (10% active ingredient of a 2.5:1 aqueous-ethanolic pressed concentrate of freshly harvested, cultivated comfrey herb [Symphytum uplandicum Nyman], corresponding to 25 g of fresh herb per 100 g of cream) in the treatment of patients with myalgia (n=104) were tested against a 1% reference product (corresponding to 2.5 g of fresh comfrey herb in 100 g of cream; n=111). The primary efficacy parameter in this double-blind, reference- controlled, randomized, multicenter study of 215 patients with pain in the lower and upper back was pain in motion, assessed with the aid of a visual analogue scale. Secondary efficacy parameters included pain at rest, pain on palpation, and functional impairment. With high concentrations of the treatment product, amelioration of pain on active motion (Pback pain can be concluded.

  10. Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth


    .05. Satisfaction with the medical procedure was inversely correlated with GA and the intensity of pain, nausea, vomiting and dizziness, while satisfaction with the surgical procedure was unaffected by these side effects. Fewer women with a failed medical than a failed surgical abortion were satisfied (17% vs 62......) or a surgical abortion (vacuum aspiration in general anaesthesia). The procedure was determined either by randomization (n = 111) or by choice (n = 922). Data on satisfaction, side effects and expectations were collected from questionnaires 2 and 8 weeks after termination. RESULTS: More women were very......BACKGROUND: The aim of the study was to compare satisfaction with medical and surgical abortion and to identify potential confounders affecting satisfaction. METHODS: 1033 women with gestational age (GA) medical (600 mg mifepristone followed by 1 mg gemeprost...

  11. Comparison of the effectiveness of two different interventions to reduce preoperative anxiety: A randomized controlled study.

    Ertuğ, Nurcan; Ulusoylu, Özge; Bal, Ayça; Özgür, Hazal


    This study was conducted to determine and compare the effectiveness of nature sounds and relaxation exercises for reducing preoperative anxiety. A repeated measures randomized controlled trial design was used. We divided 159 preoperative patients into three groups: nature sounds (n = 53), relaxation exercises (n = 53), and control groups (n = 53). We evaluated anxiety using the visual analog scale and state anxiety inventory scores immediately before, immediately after, and 30 min after interventions in nature sounds and relaxation exercises groups, and silent rest in the control. We found no differences between the measurement values in the intervention groups, but we did observe a difference between the intervention and control groups. The two interventions were similarly effective in reducing preoperative anxiety. These simple and low-cost interventions can be used to reduce preoperative anxiety in surgical clinics. © 2017 John Wiley & Sons Australia, Ltd.

  12. Randomized study of coagulation and fibrinolysis during and after gasless and conventional laparoscopic cholecystectomy

    Larsen, J F; Ejstrud, P; Svendsen, F


    , after insufflation or traction, 30 min after introduction of the laparoscope, 10 min after exsufflation of carbon dioxide or traction, 4 h after extubation and 24 h after operation. RESULTS: The two groups were comparable with respect to age, sex, body mass index and duration of operation. Plasma levels......BACKGROUND: Carbon dioxide pneumoperitoneum may be an important pathophysiological factor stimulating the coagulation system during conventional laparoscopic cholecystectomy. The aim of this study was to test the hypothesis that gasless laparoscopy produces smaller changes in the coagulation...... and fibrinolytic system than carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty patients were allocated randomly to conventional (n = 26) or gasless (n = 24) laparoscopic cholecystectomy. Blood samples were obtained on admission, after induction of anaesthesia...

  13. Internal gallbladder drainage prevents development of acute cholecystitis in a pig model: a randomized study

    Kjaer, Daniel W; Mortensen, Frank V; Møller, Jens K;


    BACKGROUND: Acute cholecystitis can be the result of retention of bile in the gallbladder with possible secondary infection and ischaemia. The aim of the present study was to investigate whether internal drainage of the gallbladder could protect against the development of acute cholecystitis...... in a pig model. MATERIALS AND METHODS: Twenty pigs were randomized to either internal drainage (drained) or not (undrained). Day 0 acute cholecystitis was induced by ligation of the cystic artery and duct together with inoculation of bacteria. Four days later the pigs were killed and the gallbladders were...... removed and histologically scored for the presence of cholecystitis. Bile and blood samples were collected for bacterial culturing and biochemical analyses. RESULTS: The histological examination demonstrated statistical significant differences in acute cholecystitis development between groups, the degree...

  14. Calcipotriol versus coal tar: a prospective randomized study in stable plaque psoriasis

    Sharma, V.; Kaur, I.; Kumar, B. [Postgraduate Institute of Medicinal Education & Research, Chandigarh (India)


    Topical therapies are the first line of treatment for patients with stable plaque psoriasis (SPP) affecting a limited body surface area. Very few trials comparing newer agents, such as 0.005% topical calcipotriol, with conventional modes of therapy, such as coal tar ointment, have been reported. A prospective, right-left randomized, investigator-blinded study with a 12-week treatment period and an 8-week follow-up period was performed. It was found that 0.005% calcipotriol ointment produced a faster initial response and had better cosmetic acceptability in patients, although after a long period of treatment, i.e. 12 weeks, 5% coal tar ointment had comparable efficacy. There was no statistically significant difference in the relapse rates between the two modalities.

  15. Effectiveness of exercise at workplace in physical fitness: uncontrolled randomized study.

    Grande, Antônio José; Silva, Valter; Parra, Sérgio Alencar


    To investigate the effectiveness of workplace exercise for employee health by means of health-related physical activity components. A randomized uncontrolled study with 20 workers was carried out during three months to evaluate a workplace exercise program. The selected outcomes were flexibility, body mass, fat percentage, lean mass, blood pressure, and heart rate. For statistical analysis, the paired t test and the intent-to-treat analysis were used. There was a significant increase in weight, fat percentage, blood pressure, and heart rate. However the clinical significance was 10% in the size of the effect. The changes verified in the outcomes analyzed were not significant; the variables are within normality ranges proposed by academic organizations.

  16. Study protocol: effect of playful training on functional abilities of older adults - a randomized controlled trial

    Jessen, Jari Due; Lund, Henrik Hautop


    paired t-test, otherwise using Wilcoxon signed-rank test. "Intention to treat" analysis will be done.Discussion: The trial tests for increased mobility, agility, balancing and general fitness of community-dwelling elderly as a result of playing, in this case on modular interactive tiles. A positive...... of community dwelling elderly as a result of short-term playing with an exergame system in the form of interactive modular tiles. Such playful training may be motivational to perform and viewed by the subjects to offer life-fulfilling quality, while providing improvement in physical abilities, e.g. related...... to prevent fall accidents. The RCT will test for a variety of health parameters of community-dwelling elderly playing on interactive modular tiles.Methods: The study will be a single blinded, randomized controlled trial with 60 community-dwelling adults 70+ years. The trial will consist an intervention group...

  17. Intra-uterine insemination with prepared sperm vs. unprepared first split ejaculates. A randomized study.

    Goldenberg, M; Rabinovici, J; Bider, D; Lunenfeld, B; Blankstein, J; Weissenberg, R


    In this randomized prospective study, we determined the conception rate following intra-uterine insemination with washed and prepared sperm, or with the first portion of a split ejaculate, in couples with longstanding male (n = 27, 70 treatment cycles) or cervical infertility (n = 14, 29 treatment cycles). Folliculogenesis and ovulation were induced by human menopausal gonadotropin and human chorionic gonadotropin. Significantly more couples conceived in the male infertility group following intra-uterine insemination with washed sperm, than after intra-uterine insemination with split ejaculate (9 vs. 2; P less than 0.05), while no difference in pregnancy rate (2 vs. 2) was found by the two intra-uterine insemination methods in the cervical infertility group.

  18. Molecular motion in cell membranes: analytic study of fence-hindered random walks

    Kenkre, V M; Kalay, Z


    A theoretical calculation is presented to describe the confined motion of transmembrane molecules in cell membranes. The study is analytic, based on Master equations for the probability of the molecules moving as random walkers, and leads to explicit usable solutions including expressions for the molecular mean square displacement and effective diffusion constants. One outcome is a detailed understanding of the dependence of the time variation of the mean square displacement on the initial placement of the molecule within the confined region. How to use the calculations is illustrated by extracting (confinement) compartment sizes from experimentally reported published observations from single particle tracking experiments on the diffusion of gold-tagged G-protein coupled mu-opioid receptors in the normal rat kidney cell membrane, and by further comparing the analytical results to observations on the diffusion of phospholipids, also in normal rat kidney cells.

  19. Low Nonfasting Triglycerides and Reduced All-Cause Mortality: A Mendelian Randomization Study

    Thomsen, Mette; Varbo, Anette; Tybjærg-Hansen, Anne;


    Increased nonfasting plasma triglycerides marking increased amounts of cholesterol in remnant lipoproteins are important risk factors for cardiovascular disease, but whether lifelong reduced concentrations of triglycerides on a genetic basis ultimately lead to reduced all-cause mortality is unknown....... We tested this hypothesis.METHODS: Using individuals from the Copenhagen City Heart Study in a Mendelian randomization design, we first tested whether low concentrations of nonfasting triglycerides were associated with reduced all-cause mortality in observational analyses (n = 13 957); second......, whether genetic variants in the triglyceride-degrading enzyme lipoprotein lipase, resulting in reduced nonfasting triglycerides and remnant cholesterol, were causally associated with reduced all-cause mortality (n = 10 208).RESULTS: During a median 24 and 17 years of 100% complete follow-up, 9991 and 4005...

  20. Concepts for a theoretical and experimental study of lifting rotor random loads and vibrations, Phase 2

    Hohenemser, K. H.; Gaonkar, G. H.


    A comparison with NASA conducted simulator studies has shown that the approximate digital method for computing rotor blade flapping responses to random inputs, tentatively suggested in Phase I Report, gives with increasing rotor advance ratio the wrong trend. Consequently, three alternative methods of solution have been considered and are described: (1) an approximate method based on the functional relation between input and output double frequency spectra, (2) a numerical method based on the system responses to deterministic inputs and (3) a perturbation approach. Among these the perturbation method requires the least amount of computation and has been developed in two forms - the first form to obtain the response correlation function and the second for the time averaged spectra of flapping oscillations.