Stroke prevention in atrial fibrillation: re-defining 'real-world data' within the broader data universe.

Science.gov (United States)

Fanaroff, Alexander C; Steffel, Jan; Alexander, John H; Lip, Gregory Y H; Califf, Robert M; Lopes, Renato D

2018-04-23

Real-world data (RWD) has been defined as data generated outside of traditional randomized clinical trials (RCTs). Though RWD has received increasing attention from regulatory authorities and professional societies, dividing evidence into that derived from 'real-world' vs. 'non-real-world' sources provides only one element of a much larger framework for evidence evaluation. Evidence should be evaluated on the source of the data, the method of treatment allocation (whether any intervention being evaluated was assigned or simply observed as used in practice) and the context in which the evidence was generated (overall study design). Under this framework, RWD refers only to data source, and a study incorporates RWD when it primarily uses data collected for non-research purposes, such as insurance claims data or the electronic health record, regardless of study design. Separation of study design, data source, and context enables parallel evaluation of two critical elements: (i) whether a study can support claims of causal inference, which can be assured with a high degree of confidence only in studies where patients are assigned treatments by protocol; and (ii) whether the study population and clinical context mirror clinical practice, a strength of observational studies using data from clinical practice or administrative claims. In this review, we describe the strengths and weaknesses of observational and non-observational studies, and studies involving RWD and non-RWD, through the lens of anticoagulation for atrial fibrillation (AF). Observational studies employing RWD are useful for describing how oral anticoagulants are used in clinical practice, but generally cannot be used to make claims regarding comparative treatment effects. Questions regarding treatment effect generally are best answered through an RCT, and additional pragmatic RCTs are needed to compare different antithrombotic agents for the prevention of thrombotic events in AF.

Clinical Practicability of a Newly Developed Real-time Digital Kymographic System.

Science.gov (United States)

Lee, Jin-Choon; Wang, Soo-Geun; Sung, Eui-Suk; Bae, In-Ho; Kim, Seong-Tae; Lee, Yeon-Woo

2017-12-22

A digital kymogram shows real images of vocal fold vibration. However, DKG is difficult to use in clinical practice because the recorded image cannot be seen instantaneously after examination, as considerable encoding time is required to visualize a digital kymogram. In addition, frame-by frame analysis should be implemented to evaluate high-speed videoendoscopy data, but is time- and labor-intensive. The purpose of the study was to validate the clinical practicability of a real-time multislice digital kymographic system developed by the authors. We analyzed the promptness and accuracy of the examination before and after intracordal injections in patients with unilateral vocal fold paralysis. To assess the clinical applicability of this system, six patients with unilateral vocal fold paralysis were selected. Real-time DKG was performed before and immediately after intracordal injection. We observed changes in the digital kymogram after the intracordal injection. Using this system, 10 scanning lines and up to five vertical pixel row could be obtained in real time, and the maximum acquisition time for the DKG image was 10 seconds. A digital kymogram of the patients could be instantaneously acquired, and whether the intracordal injection was appropriate or not. This article is the first validation study after the development of the real-time multislice digital kymographic system. Our system may be a promising tool in clinical practice for immediate assessment of the vibratory patterns of the vocal cords. More research is necessary for further clinical validation. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Real-life effectiveness of smoking-cessation treatments in general practice clinics in Denmark. The Escape Smoke project

DEFF Research Database (Denmark)

Poulsen, Peter Bo; Spillemose, Heidi; Nielsen, Gerda

2015-01-01

BACKGROUND: The smoking prevalence has not decreased in the last years in Denmark. General practice (GP) offers smoking cessation (SC) treatment. Studies of real-life effectiveness of daily practice SC-activities from the GP-setting opposed to efficacy results from randomized clinical trials...... are few. The study aim was to evaluate the real-life effectiveness of SC-treatments for daily smokers among Danish GP-clinics. METHODS: In a multi-centre-based observational study design Danish GP-clinics with prior SC-activity recruited daily smokers motivated for quitting. As per usual clinical practice...

Clinical profile of patients with type 2 diabetes mellitus treated with sodium- glucose cotransporter-2 inhibitors and experience in real-world clinical practice in Spain.

Science.gov (United States)

Cuatrecasas, Gabriel; Goñi-Goicoechea, Fernando

2016-11-01

The main aim of the treatment of type 2 diabetes is overall control of cardiovascular risk factors. Almost 50% of patients with type 2 diabetes do not achieve glycaemic targets, and a much higher percentage do not achieve weight and blood pressure targets, despite the therapeutic arsenal that has appeared in the last decade for the treatment of this disease. In addition, antidiabetic secretatogues and insulin are associated with weight gain and an increased risk of hyperglycaemic episodes. Clinical practice guidelines recommend sodium-glucose cotransporter-2 inhibitors (SGLT2i) as an alternative in the same therapeutic step as the other options after initiation of metformin therapy. The present study reviews the most appropriate patient profile for SGLT2i therapy, based on their safety and efficacy demonstrated in controlled clinical trials. The article discusses which patients are at risk of experiencing the possible secondary effects due to the mechanism of action of this new therapeutic class, in whom SGLT2i should be used with caution. These considerations on the profile of patients suitable for SGLT2i therapy are contrasted with the results obtained in daily clinical practice, both in retrospective studies from other countries and from real-world experiences in Spain. This article presents a selection of studies performed in distinct centres with a minimum follow-up of 6 months and compares their results with those from clinical trials. SGLT2i are used in clinical practice in any therapeutic step and the efficacy results are very similar to those reported by controlled clinical trials, with a slightly higher proportion of genitourinary infections and a low dropout rate. Half the reported patients are diabetics receiving insulin therapy plus a gliflozin, showing the wide uptake of this therapeutic strategy by clinicians. SGLT2i are especially attractive due to their additional effectiveness in weight and blood pressure control and the possibility of using them

Efficacy and Tolerability of Intravenous Ferric Carboxymaltose in Patients with Iron Deficiency at a Hospital Outpatient Clinic: A Retrospective Cohort Study of Real-World Clinical Practice

Directory of Open Access Journals (Sweden)

António Robalo Nunes

2017-01-01

Full Text Available Ferric carboxymaltose (FCM is an intravenous iron formulation to correct iron deficiency. Although its use has been extensively studied in clinical trials, real-world evidence regarding FCM treatment is scarce. Our aim was to evaluate the efficacy and tolerability of FCM treatment in patients with iron deficiency, with or without anemia, at a hospital outpatient clinic. Data was collected retrospectively from medical records. During this 2-year study, 459 patients were included. Mean age was 58.6 ± 17.5 years and most patients received cumulative FCM doses of 501–1000 mg (63.2%. Six weeks after administration of FCM, efficacy endpoints hemoglobin increase ≥2 g/dL, hemoglobin increase ≥3 g/dL, and transferrin saturation > 20% were attained by 41%, 20%, and 63% of patients, respectively. Patients who received higher FCM doses showed significant reduced odds of not achieving hemoglobin increase ≥2 g/dL (501–1000 mg, adjusted odds ratio [OR]: 0.34, 95% confidence interval [CI] 0.18–0.62; 1001–3000 mg, OR: 0.19, 95% CI 0.07–0.49, compared to 500 mg doses. Treatment-emergent adverse events were documented in <4% of patients. In conclusion, FCM treatment was effective and well-tolerated by outpatients with iron deficiency at a hospital clinic, and its dosage should be adjusted to improve iron deficiency management in clinical practice.

Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population.

Science.gov (United States)

Qvist, Ina; Hendriks, Jeroen M L; Møller, Dorthe S; Albertsen, Andi E; Mogensen, Helle M; Oddershede, Gitte D; Odgaard, Annette; Mortensen, Leif Spange; Johnsen, Søren Paaske; Frost, Lars

2016-01-01

A previous randomised trial showed that structured, nurse-led atrial fibrillation (AF) care is superior to conventional AF care, although further research is needed to determine the outcomes of such care in a real-world setting. We compared the outcomes of patients in real-world, nurse-led, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death. All patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist provided patient education, risk-factor control and stimulated empowerment and compliance. During follow-up, treatment was adjusted according to clinical guidelines. Patient education was repeated, and compliance with medical treatment was controlled. The study size was powered as a non-inferiority study. Outcome measures were adjudicated by the same principles in both cohorts. A total of 596 patients from the real world and 356 patients from a clinical trial were included in this study. No significant difference between groups with respect to age, type of AF or CHA2DS2VASc score was found. The composite primary end point occurred with an incidence rate of 8.0 (95% CI 6.1 to 10.4) per 100 person-years in the real-world population and 8.3 (95% CI 6.3 to 10.9) per 100 person-years in the clinical trial, with a crude HR of 0.83 (95% CI 0.56 to 1.23). Structured, nurse-led, hospital-based AF care appears to be effective, and patient outcomes in an actual, hospital-based, structured AF care are as least as good as those in trial settings.

Overall safety profile and effectiveness of tramadol hydrochloride/acetaminophen in patients with chronic noncancer pain in Japanese real-world practice.

Science.gov (United States)

Yoshizawa, K; Kawai, K; Fujie, M; Suzuki, J; Ogawa, Y; Yajima, T; Yokomori, J

2015-11-01

To evaluate the overall safety profile and clinical effectiveness of tramadol hydrochloride/acetaminophen (TA) combination tablets in Japanese patients with chronic noncancer pain unrelieved by non-opioid drugs for up to 12 weeks in real-world practice. This survey was a multicenter, prospective, longitudinal registry on the use of TA as a newly initiated pain treatment for chronic noncancer pain incurable by non-opioid analgesics that was conducted under the Good Post Marketing Study Practice regulation controlled by the Japan Ministry of Health, Labor and Welfare. Collected data included socio-demographics, treatment information, incidence of adverse drug reactions (ADRs), numerical rating scale for intensity of pain, EuroQol-5D (EQ-5D) scale, and physician's global impression (PGI) during the 12 week observation period. A total of 1316 patients were registered. ADRs were reported in 259 patients (20.5%); most events were nonserious (99.4%), including nausea (n = 87 [6.9%]), constipation (n = 63 [5.0%]), dizziness and somnolence (n = 29 [2.3%] each), and vomiting (n = 21 [1.7%]). No event related to drug dependence or respiratory depression was reported. In addition, 82.8% of patients showed acceptable effectiveness based on PGI at Week 4. Numerical rating scale for intensity of pain and EQ-5D utility scores were improved by -2.7 (SD 2.3) and 0.16 (SD 0.20) at Week 4, respectively, and the improvement was maintained until Week 12. This is a first report to evaluate the risk-benefit profile of TA in Japanese real-world practice using large size registry data. It is suggested that the favorable risk-benefit balance of TA was confirmed for patients with chronic noncancer pain unrelieved by non-opioid drugs in real-world practice. Limitations of this study were those inherent to open-label and non-interventional study designs. This registry survey is registered at umin.ac.jp (identifier: UMIN000015901).

Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice: A Retrospective Study.

Science.gov (United States)

Feng, Ru; Liu, Lu; Zhang, Yuan-Yuan; Yuan, Zhong-Shang; Gao, Ling; Zuo, Chang-Ting

2018-05-05

Facing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes. The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses. The average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ 2 = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001). Management of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.

Implementing Peer Learning in Clinical Education: A Framework to Address Challenges In the "Real World".

Science.gov (United States)

Tai, Joanna Hong Meng; Canny, Benedict J; Haines, Terry P; Molloy, Elizabeth K

2017-01-01

Phenomenon: Peer learning has many benefits and can assist students in gaining the educational skills required in future years when they become teachers themselves. Peer learning may be particularly useful in clinical learning environments, where students report feeling marginalized, overwhelmed, and unsupported. Educational interventions often fail in the workplace environment, as they are often conceived in the "ideal" rather than the complex, messy real world. This work sought to explore barriers and facilitators to implementing peer learning activities in a clinical curriculum. Previous peer learning research results and a matrix of empirically derived peer learning activities were presented to local clinical education experts to generate discussion around the realities of implementing such activities. Potential barriers and limitations of and strategies for implementing peer learning in clinical education were the focus of the individual interviews. Thematic analysis of the data identified three key considerations for real-world implementation of peer learning: culture, epistemic authority, and the primacy of patient-centered care. Strategies for peer learning implementation were also developed from themes within the data, focusing on developing a culture of safety in which peer learning could be undertaken, engaging both educators and students, and establishing expectations for the use of peer learning. Insights: This study identified considerations and strategies for the implementation of peer learning activities, which took into account both educator and student roles. Reported challenges were reflective of those identified within the literature. The resultant framework may aid others in anticipating implementation challenges. Further work is required to test the framework's application in other contexts and its effect on learner outcomes.

Health care provider experience with canagliflozin in real-world clinical practice: favorability, treatment patterns, and patient outcomes

Directory of Open Access Journals (Sweden)

Bolge SC

2017-06-01

Full Text Available Susan C Bolge,1 Natalia M Flores,2 Shu Huang,3 Jennifer Cai1 1Janssen Scientific Affairs, LLC, Titusville, NJ, 2Kantar Health, Foster City, CA, 3Kantar Health, New York, NY, USA Purpose: This study describes how health care providers approach canagliflozin for the treatment of patients with type 2 diabetes mellitus (T2DM in the real world.Patients and methods: An Internet-based questionnaire was completed by 101 endocrinologists, 101 primary care physicians, and 100 nurse practitioners/physician assistants (NP/PAs. Health care providers were required to have experience prescribing or managing patients using canagliflozin to be included in the study. Health care providers compared canagliflozin with other T2DM medication classes on clinical characteristics, costs, and patient satisfaction. Confidence in canagliflozin was also measured. Health care providers reported their canagliflozin prescribing experience and good candidate characteristics for treatment. Finally, providers reported on patient outcomes among those receiving canagliflozin. All variables were compared across provider type.Results: Health care providers reported higher favorability for canagliflozin for blood pressure and body weight compared with dipeptidyl peptidase-4 (DPP-4 inhibitors and higher favorability for effect on blood pressure, body weight, treatment satisfaction, and glycosylated hemoglobin (HbA1c compared with sulfonylureas (SUs, with differences observed for effect on blood pressure. Health care providers reported being very/extremely confident (55%–74% with canagliflozin as a second- to fourth-line treatment. The top 3 characteristics reported by the providers, in terms of describing a good candidate for canagliflozin, include those concerned about their weight, insurance coverage/affordability, and avoiding injectable treatments. Finally, providers reported often/always observing patients’ lowering or controlling HbA1c (82%–88% and improvement in overall

Network Coding Designs Suited for the Real World

DEFF Research Database (Denmark)

Pedersen, Morten Videbæk; Roetter, Daniel Enrique Lucani; Fitzek, Frank

2013-01-01

design have produced a large influx of new ideas and approaches to harness the power of NC. But, which of these designs are truly successful in practice? and which designs will not live up to their promised theoretical gains due to real-world constraints? Without attempting a comprehensive view of all...

The Salford Lung Study protocol: a pragmatic, randomised phase III real-world effectiveness trial in asthma

OpenAIRE

Woodcock, Ashley; Bakerly, Nawar Diar; New, John P.; Gibson, J. Martin; Wu, Wei; Vestbo, J?rgen; Leather, David

2015-01-01

Background Novel therapies need to be evaluated in normal clinical practice to allow a true representation of the treatment effectiveness in real-world settings. Methods/design The Salford Lung Study is a pragmatic randomised controlled trial in adult asthma, evaluating the clinical effectiveness and safety of once-daily fluticasone furoate (100??g or 200??g)/vilanterol 25??g in a novel dry-powder inhaler, versus existing asthma maintenance therapy. The study was initiated before this investi...

Assessing the Value of Real-life Brands in Virtual Worlds

DEFF Research Database (Denmark)

Mattsson, Jan; Barnes, Stuart; Hartley, Nicole

2015-01-01

World. A key finding is the difficulty in creating emotional brand value in Second Life which has serious implications for the sustainability of current real-life brands in Virtual Worlds. The paper rounds off with conclusions and implications for future research and practice in this very new area.......Virtual Worlds are a significant new market environment for brand-building through experiential customer service interactions. Using value theory, this paper aims to assess the experiential brand value of real-life brands that have moved to the Virtual World of Second Life. A key premise...... is that current brand offerings in Virtual Worlds do not offer consumers adequate experiential value. The results demonstrate both the validity of an axiological approach to examining brand value, and highlight significant problems in consumer perceptions of the experiential value of brands within the Virtual...

"Real-World" use of cinacalcet for managing SHPT in different European countries: analysis of data from the ECHO observational study

DEFF Research Database (Denmark)

Vervloet, M; Bencova, V; Malberti, F

2010-01-01

The pan-European ECHO observational study evaluated cinacalcet in adult dialysis patients with secondary hyperparathyroidism (SHPT) in "real-world" clinical practice. A sub-analysis compared data for 7 European countries/country clusters: Austria, CEE (Czech Republic and Slovakia), France, Italy,...

Real world evidence (RWE - Are we (RWE ready?

Directory of Open Access Journals (Sweden)

Viraj Ramesh Suvarna

2018-01-01

Full Text Available Real world evidence is important as it complements data from randomised controlled trials (RCTs. Both have limitations in design, interpretation, and extrapolatability. It is imperative one designs real world studies in the right way, else it can be misleading. An RCT is always considered higher in the evidence ladder and when there is discordance between a real world study and an RCT, it is the latter which is always considered pristine because of the way it is conducted, e.g., randomization, prospective, double-blind, etc. A real world study can also be done prospectively, and propensity score matching can be used to construct comparable cohorts but may not be able to account for certain biases or confounding factors the way an RCT can do. Nevertheless, comparative effectiveness research in the real world is being resorted to, especially for efficiency studies or pharmacoeconomic analyses, and with the advent of machine learning, the electronic healthcare database mining can result in algorithms that help doctors identify clinical characteristics that correlate with optimal response of a patient to a drug/regimen, thus helping him/her select the right patient for the right drug.

Quantitative and qualitative assessment of real world data comparative effectiveness research of systemic therapies in lung oncology: A systematic review

NARCIS (Netherlands)

Peters, Bas J.M.; Janssen, Vivi E.M.T.; Schramel, Franz M.; van de Garde, Ewoudt M.W.

2016-01-01

Introduction The growing interest in comparative effectiveness research (CER) based on data from routine clinical practice also extends towards lung oncology. Although CER studies using real world data (RWD) have the potential to assist clinical decision-making, concerns about the quality and

Real-world usage and clinical outcomes of alectinib among post-crizotinib progression anaplastic lymphoma kinase positive non-small-cell lung cancer patients in the USA

Science.gov (United States)

DiBonaventura, Marco D; Wong, William; Shah-Manek, Bijal; Schulz, Mathias

2018-01-01

Background Alectinib is an approved treatment for anaplastic lymphoma kinase (ALK)-positive patients with advanced non-small-cell lung cancer. Despite positive supporting clinical data, there is a lack of real-world information on the usage and patient outcomes of those treated with alectinib post-crizotinib progression. Methods Participating oncologists (N=95) in the USA were recruited from an online physician panel to participate in a retrospective patient chart review. Physicians randomly selected eligible patients (ie, patients who progressed on crizotinib as their first ALK inhibitor and were treated with alectinib as their second ALK inhibitor), collected demographics and clinical history from their medical charts, and entered the data into an online data collection form. Results A total of N=207 patient charts were included (age: 60.1±10.4 years; 53.6% male). The patients in our sample were older (median age of 60 vs 53 years), were more likely to be current smokers (12% vs 1%), had better performance status (45% vs 33% had an Eastern Cooperative Oncology Group [ECOG] of 0), and were less likely to have an adenocarcinoma histology (83% vs 96%) relative to published clinical trials. The objective response rate was higher than in clinical trials (67.1% vs 51.3%, respectively) as was the disease control rate (89.9% vs 78.8%, respectively), though it varied by race/ethnicity, ECOG, and prior treatment history. Discontinuation (0.0%) and dose reductions (3.4%) due to adverse events were uncommon in alectinib. Conclusion Patients using alectinib post-crizotinib in clinical practice are older, more racially/ethnically and histologically diverse than patients in published trials. Real-world response rates were high and similar to those reported in clinical studies, though there is some variation by patient characteristics. Alectinib was well tolerated in clinical practice as reflected by the rates of discontinuation, dose reductions, and dose interruptions. PMID

Post-Marketing Safety Surveillance of the Salvia Miltiorrhiza Depside Salt for Infusion: A Real World Study.

Directory of Open Access Journals (Sweden)

Ying-Ying Yan

Full Text Available Salvia Miltiorrhiza Depside Salt for Infusion (SMDS is made of a group of highly purified listed drugs. However, its safety data is still reported limitedly. Compared with the clinical trials, its safety in the real world setting is barely assessed.To investigate the safety issues, including adverse events (AEs, adverse events related to SMDS (ADEs, and adverse drug reactions (ADRs of the SMDS in the real world clinical practice.This is a prospective, multicenter, pharmacist-led, cohort study in the real world setting. Consecutive patients prescribed with SMDS were all included in 36 sites. Pharmacists were well trained to standardized collect the patients information, including demographics, medical history, prescribing patterns of SMDS, combined medications, adverse events, laboratory investigations, outcomes of the treatment when discharge, and interventions by pharmacists. Adverse events and adverse drug reactions were collected in details. Multivariate possion regression analysis was applied to identify risk factors associated with ADEs using the significance level (α 0.05. ClinicalTrials.gov Identifier: NCT01872520.Thirty six hospitals were participated in the study and 30180 consecutive inpatients were included. The median age was 62 (interquartile range [IQR], 50-73 years, and male was 17384 (57.60% among the 30180 patients. The incidences of the AEs, ADEs and ADRs were 6.40%, 1.57% and 0.79%, respectively. There were 9 kinds of new ADEs which were not on the approved label found in the present study. According to the multivariate analysis, male (RR = 1.381, P = 0.009, 95%CI [1.085~1.759], more concomitant medications (RR = 1.049, P<0.001, 95%CI [1.041~1.057], longer duration of SMDS therapy (RR = 1.027, P<0.001, 95%CI [1.013~1.041], higher drug concentration (RR = 1.003, P = 0.014, 95%CI [1.001~1.006], and resolvent unapproved (RR = 1.900, P = 0.002, 95%CI [1.260~2.866] were the independent risk factors of the ADEs. Moreover, following

International perspectives on education, training, and practice in clinical neuropsychology: comparison across 14 countries around the world.

Science.gov (United States)

Grote, Christopher L; Novitski, Julia I

2016-11-01

To review and summarize data provided by special issue authors regarding the education, training, and practice of neuropsychologists from 14 surveyed countries. A table was constructed to present an overview of variables of interest. There is considerable diversity among surveyed countries regarding the education and training required to enter practice as a clinical neuropsychologist. Clinical neuropsychologists are typically well compensated, at least in comparison to what constitutes an average salary in each country. Despite substantial variations in education and training pathways, and availability of neuropsychologists from country to country, two common areas for future development are suggested. First, identification, development, and measurement of core competencies for neuropsychological education and practice are needed that can serve as a unifying element for the world's clinical neuropsychologists. Second, greater emphasis on recognizing and addressing the need for assessment and treatment of diverse populations is needed if the world's citizens can hope to benefit from the expertise of practitioners in our field.

Real-world use, safety, and survival of ipilimumab in metastatic cutaneous melanoma in The Netherlands.

Science.gov (United States)

Jochems, Anouk; Leeneman, Brenda; Franken, Margreet G; Schouwenburg, Maartje G; Aarts, Maureen J B; van Akkooi, Alexander C J; van den Berkmortel, Franchette W P J; van den Eertwegh, Alfonsus J M; Groenewegen, Gerard; de Groot, Jan Willem B; Haanen, John B A G; Hospers, Geke A P; Kapiteijn, Ellen; Koornstra, Rutger H; Kruit, Wim H J; Louwman, Marieke W J; Piersma, Djura; van Rijn, Rozemarijn S; Ten Tije, Albert J; Vreugdenhil, Gerard; Wouters, Michel W J M; Uyl-de Groot, Carin A; van der Hoeven, Koos J M

2018-07-01

Phase III trials with ipilimumab showed an improved survival in patients with metastatic melanoma. We evaluated the use and safety of ipilimumab, and the survival of all patients with metastatic cutaneous melanoma (N=807) receiving ipilimumab in real-world clinical practice in The Netherlands using data from the Dutch Melanoma Treatment Registry. Patients who were registered between July 2012 and July 2015 were included and analyzed according to their treatment status: treatment-naive (N=344) versus previously-treated (N=463). Overall, 70% of treatment-naive patients and 62% of previously-treated patients received all four planned doses of ipilimumab. Grade 3 and 4 immune-related adverse events occurred in 29% of treatment-naive patients and 21% of previously-treated patients. No treatment-related deaths occurred. Median time to first event was 5.4 months [95% confidence interval (CI): 4.7-6.5 months] in treatment-naive patients and 4.4 months (95% CI: 4.0-4.7 months) in previously-treated patients. Median overall survival was 14.3 months (95% CI: 11.6-16.7 months) in treatment-naive patients and 8.7 months (95% CI: 7.6-9.6 months) in previously-treated patients. In both patient groups, an elevated lactate dehydrogenase level (hazard ratio: 2.25 and 1.70 in treatment-naive and previously-treated patients, respectively) and American Joint Committee on Cancer M1c-stage disease (hazard ratio: 1.81 and 1.83, respectively) were negatively associated with overall survival. These real-world outcomes of ipilimumab slightly differed from outcomes in phase III trials. Although phase III trials are crucial for establishing efficacy, real-world data are of great added value enhancing the generalizability of outcomes of ipilimumab in clinical practice.

Infusing Real World Experiences into Engineering Education

Science.gov (United States)

National Academies Press, 2012

2012-01-01

The aim of this report is to encourage enhanced richness and relevance of the undergraduate engineering education experience, and thus produce better-prepared and more globally competitive graduates, by providing practical guidance for incorporating real world experience in US engineering programs. The report, a collaborative effort of the…

The Salford Lung Study protocol: a pragmatic, randomised phase III real-world effectiveness trial in chronic obstructive pulmonary disease.

Science.gov (United States)

Bakerly, Nawar Diar; Woodcock, Ashley; New, John P; Gibson, J Martin; Wu, Wei; Leather, David; Vestbo, Jørgen

2015-09-04

New treatments need to be evaluated in real-world clinical practice to account for co-morbidities, adherence and polypharmacy. Patients with chronic obstructive pulmonary disease (COPD), ≥ 40 years old, with exacerbation in the previous 3 years are randomised 1:1 to once-daily fluticasone furoate 100 μg/vilanterol 25 μg in a novel dry-powder inhaler versus continuing their existing therapy. The primary endpoint is the mean annual rate of COPD exacerbations; an electronic medical record allows real-time collection and monitoring of endpoint and safety data. The Salford Lung Study is the world's first pragmatic randomised controlled trial of a pre-licensed medication in COPD. Clinicaltrials.gov identifier NCT01551758.

Processing speed and executive functions predict real-world everyday living skills in adolescents with early-onset schizophrenia.

Science.gov (United States)

Puig, O; Penadés, R; Baeza, I; Sánchez-Gistau, V; De la Serna, E; Fonrodona, L; Andrés-Perpiñá, S; Bernardo, M; Castro-Fornieles, J

2012-06-01

Cognition and clinical variables are known to be among the most predictive factors of real-world social functioning and daily living skills in adult-onset schizophrenia. Fewer studies have focused on their impact in adolescents with early-onset schizophrenia (EOS). The aim of this study is to examine the relationships and the predictive value of cognition and clinical variables on real-world daily living skills in a sample of adolescents with EOS. Cognitive, clinical and real-world everyday living skills measures were administered to 45 clinically and pharmacologically stabilized adolescent outpatients with EOS and 45 healthy control subjects matched by age and sex. Multi-variant analyses to compare cognitive and real-world functioning profiles between patients and controls and regression analysis to identify predictors of real-world functioning scores in patients were used. Adolescents with EOS showed a generalized cognitive and real-world daily living skills dysfunction. Several cognitive and clinical variables significantly correlated with real-world daily living skills functioning but only the processing speed and executive functions emerged as independent predictors of everyday living skills scores, explaining 25.1% of the variance. Slowness in processing information and executive dysfunction showed a significant impact on real-world daily living skills in EOS, independently from clinical symptoms and other cognitive variables. Nevertheless, much of the variance in the daily living skills measure remained unaccounted for, suggesting that other factors were involved as well in this young population.

Data Modeling for Mobile Services in the Real World

DEFF Research Database (Denmark)

Jensen, Christian Søndergaard; Pedersen, Torben Bach; Speicys, L.

2003-01-01

Research contributions on data modeling, data structures, query processing, and indexing for mobile services may have an impact in the longer term, but each contribution typically offers an isolated solution to one small part of the practical problem of delivering mobile services in the real world....... In contrast, this paper describes holistic concepts and techniques for mobile data modeling that are readily applicable in practice. Focus is on services to be delivered to mobile users, such as route guidance, point-of-interest search, road pricing, parking payment, traffic monitoring, etc. While geo...

Studying Real-World Perceptual Expertise

Directory of Open Access Journals (Sweden)

Jianhong eShen

2014-08-01

Full Text Available Significant insights into visual cognition have come from studying real-world perceptual expertise. Many have previously reviewed empirical findings and theoretical developments from this work. Here we instead provide a brief perspective on approaches, considerations, and challenges to studying real-world perceptual expertise. We discuss factors like choosing to use real-world versus artificial object domains of expertise, selecting a target domain of real-world perceptual expertise, recruiting experts, evaluating their level of expertise, and experimentally testing experts in the lab and online. Throughout our perspective, we highlight expert birding (also called birdwatching as an example, as it has been used as a target domain for over two decades in the perceptual expertise literature.

Practical Implications of Using Real-World Evidence (RWE) in Comparative Effectiveness Research : Learnings from IMI-GetReal

NARCIS (Netherlands)

Makady, Amr; Stegenga, Heather; Ciaglia, Antonio; Debray, Thomas Pa; Lees, Michael; Happich, Michael; Ryll, Bettina; Abrams, Keith; Thwaites, Rob; Garner, Sarah; Jonsson, Páll; Goettsch, Wim G.

In light of increasing attention towards the use of real-world evidence (RWE) in decision making in recent years, this commentary aims to reflect on the experiences gained in accessing and using RWE for comparative effectiveness research as a part of the Innovative Medicines Initiative GetReal

The interdisciplinary team in type 2 diabetes management: Challenges and best practice solutions from real-world scenarios

Directory of Open Access Journals (Sweden)

Margaret McGill

2017-03-01

Full Text Available The Global Partnership for Effective Diabetes Management has previously recommended the implementation of an interdisciplinary team (IDT approach to type 2 diabetes (T2DM management as one of 10 practical steps for health care professionals to help more people achieve their glycaemic goal. This article discusses some of the key contributors to success and also the challenges faced when applying IDT care, by examining case studies and examples from around the world. The real-world practices discussed show that implementing successful interdisciplinary care in diabetes is possible despite significant barriers such as established hierarchal structures and financial resource constraints. Instituting collaborative, integrated working relationships among multiple disciplines under strong leadership, together with enhanced and active communication and improved patient access to appropriate specialties is essential. Patients have a crucial role in the management of their own disease and including them as part of the treatment team is also critical. IDTs in diabetes care improve patient outcomes in terms of control of glycaemia and cardiometabolic risk factors, and decreased risk of diabetes complications. Ensuring access to an appropriate IDT, in whatever form, is paramount to enable the best care to be delivered.

Treatment of allergic rhinitis using mobile technology with real world data

DEFF Research Database (Denmark)

Bousquet, J; Arnavielhe, S; Bedbrook, A

2018-01-01

BACKGROUND: Large observational implementation studies are needed to triangulate the findings from randomized control trials (RCTs) as they reflect "real world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real life treatment of allergi...

Regorafenib in the Real-Life Clinical Practice: Data from the Czech Registry.

Science.gov (United States)

Kopeckova, Katerina; Buchler, Tomas; Bortlicek, Zbynek; Hejduk, Karel; Chloupkova, Renata; Melichar, Bohuslav; Pokorna, Petra; Tomasek, Jiri; Linke, Zdenek; Petruzelka, Lubos; Kiss, Igor; Prausova, Jana

2017-02-01

To describe the use of regorafenib for the treatment of metastatic colorectal cancer (mCRC) in clinical practice in the Czech Republic, and to describe the clinical outcomes of patients in terms of safety and survival. The data of patients treated with regorafenib were extracted from the national CORECT registry. The CORECT registry is a non-interventional post-marketing database, gathering information about patients with CRC and treated with targeted agents. Twenty oncology centres in the Czech Republic contributed to this registry. Collected data included patients' characteristics, disease history, cancer treatments, response to treatments and safety. A total of 148 patients treated with regorafenib in clinical practice were analysed. At regorafenib initiation, almost all patients were fully active or slightly restricted in physical activity. Regorafenib was not administered as first-line treatment in any patient. Median progression-free survival was 3.5 months and median overall survival was 9.3 months. One-year survival rate was 44.6 %. Four partial responses were observed and 51 stable diseases. Progression was observed in 66 patients (44.6 %). The main reported adverse events were skin toxicity (5.4 %) and fatigue (2.0 %). Regorafenib is a well-established treatment for pretreated patients with mCRC, however real-life data are scarce. Our results demonstrated slightly better efficacy of regorafenib and better safety profile in patients with mCRC compared to the randomised trials.

Bringing real-world problems into the classroom

NARCIS (Netherlands)

Enserink, B.; De Haan, A.R.C.; Hermans, L.M.

2012-01-01

Real world problems are a challenge and a motivator for students to learn understanding and using the concepts of systems and actors. But using real world problems in the classroom is not without challenges and dilemmas. In the paper we explicitly address the issue of the need for quite intense

Partnering for Real World Learning, Sustainability, Tourism Education

Science.gov (United States)

Jennings, Gayle; Cater, Carl I.; Hales, Rob; Kensbock, Sandra; Hornby, Glen

2015-01-01

Purpose: The purpose of this article is to study how real world learning was used to engender and enhance sustainability principles and practices with 11 micro-, small- and medium-tourism business enterprises and 101 university tourism students enrolled across three university courses. Design/methodology/approach: Action research processes were…

Alice in the Real World

Science.gov (United States)

Parker, Tom

2012-01-01

As a fifth-grade mathematics teacher, the author tries to create authentic problem-solving activities that connect to the world in which his students live. He discovered a natural connection to his students' real world at a computer camp. A friend introduced him to Alice, a computer application developed at Carnegie Mellon, under the leadership of…

Real-world outcomes

DEFF Research Database (Denmark)

Holmgreen, Lise-Lotte

-down model of feeding back research findings to subjects” (Roberts and Sarangi 2003, 340) although, arguably, making results applicable to a real-world context ought to be an essential goal of researcher-practitioner studies. This issue forms the background of the presentation, in which it will be discussed...... how the dissemination of research findings may take place to ensure the creation of real-world outcomes for practitioners (cf. e.g. Nørreklit et al. 1987; Puchta & Potter 2004). The presentation will be centered around the interview study of the discursive constructions of culture in a Danish cross...

Does health intervention research have real world policy and practice impacts: testing a new impact assessment tool.

Science.gov (United States)

Cohen, Gillian; Schroeder, Jacqueline; Newson, Robyn; King, Lesley; Rychetnik, Lucie; Milat, Andrew J; Bauman, Adrian E; Redman, Sally; Chapman, Simon

2015-01-01

There is a growing emphasis on the importance of research having demonstrable public benefit. Measurements of the impacts of research are therefore needed. We applied a modified impact assessment process that builds on best practice to 5 years (2003-2007) of intervention research funded by Australia's National Health and Medical Research Council to determine if these studies had post-research real-world policy and practice impacts. We used a mixed method sequential methodology whereby chief investigators of eligible intervention studies who completed two surveys and an interview were included in our final sample (n = 50), on which we conducted post-research impact assessments. Data from the surveys and interviews were triangulated with additional information obtained from documentary analysis to develop comprehensive case studies. These case studies were then summarized and the reported impacts were scored by an expert panel using criteria for four impact dimensions: corroboration; attribution, reach, and importance. Nineteen (38%) of the cases in our final sample were found to have had policy and practice impacts, with an even distribution of high, medium, and low impact scores. While the tool facilitated a rigorous and explicit criterion-based assessment of post-research impacts, it was not always possible to obtain evidence using documentary analysis to corroborate the impacts reported in chief investigator interviews. While policy and practice is ideally informed by reviews of evidence, some intervention research can and does have real world impacts that can be attributed to single studies. We recommend impact assessments apply explicit criteria to consider the corroboration, attribution, reach, and importance of reported impacts on policy and practice. Impact assessments should also allow sufficient time between impact data collection and completion of the original research and include mechanisms to obtain end-user input to corroborate claims and reduce biases

Using mathematics to solve real world problems: the role of enablers

Science.gov (United States)

Geiger, Vincent; Stillman, Gloria; Brown, Jill; Galbriath, Peter; Niss, Mogens

2018-03-01

The purpose of this article is to report on a newly funded research project in which we will investigate how secondary students apply mathematical modelling to effectively address real world situations. Through this study, we will identify factors, mathematical, cognitive, social and environmental that "enable" year 10/11 students to successfully begin the modelling process, that is, formulate and mathematise a real world problem. The 3-year study will take a design research approach in working intensively with six schools across two educational jurisdictions. It is anticipated that this research will generate new theoretical and practical insights into the role of "enablers" within the process of mathematisation, leading to the development of principles for the design and implementation for tasks that support students' development as modellers.

Cardioversion of atrial fibrillation in a real-world setting

DEFF Research Database (Denmark)

Frederiksen, Anne Sofie; Albertsen, Andi Eie; Christesen, Amanda Marie Somer

2017-01-01

.10-11.81). Major bleeding events occurred in four patients (0.58%) in the NOAC group and 11 patients (0.75%) in the warfarin group (RR 0.78; 95% CI 0.25-2.43). Conclusion: In a real-world clinical setting with anticoagulation handled in a structured multidisciplinary AF clinic, the waiting time to cardioversion...

Effect of agomelatine treatment on C-reactive protein levels in patients with major depressive disorder: an exploratory study in "real-world," everyday clinical practice.

Science.gov (United States)

De Berardis, Domenico; Fornaro, Michele; Orsolini, Laura; Iasevoli, Felice; Tomasetti, Carmine; de Bartolomeis, Andrea; Serroni, Nicola; De Lauretis, Ida; Girinelli, Gabriella; Mazza, Monica; Valchera, Alessandro; Carano, Alessandro; Vellante, Federica; Matarazzo, Ilaria; Perna, Giampaolo; Martinotti, Giovanni; Di Giannantonio, Massimo

2017-08-01

Agomelatine is a newer antidepressant but, to date, no studies have been carried out investigating its effects on C-reactive protein (CRP) levels in major depressive disorder (MDD) before and after treatment. The present study aimed (i) to investigate the effects of agomelatine treatment on CRP levels in a sample of patients with MDD and (ii) to investigate if CRP variations were correlated with clinical improvement in such patients. 30 adult outpatients (12 males, 18 females) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of MDD were recruited in "real-world," everyday clinical practice and treated with a flexible dose of agomelatine for 12 weeks. The Hamilton Rating Scale for Depression (HAM-D) and the Snaith-Hamilton Pleasure Scale (SHAPS) were used to evaluate depressive symptoms and anhedonia, respectively. Moreover, serum CRP was measured at baseline and after 12 weeks of treatment. Agomelatine was effective in the treatment of MDD, with a significant reduction in HAM-D and SHAPS scores from baseline to endpoint. CRP levels were reduced in the whole sample, with remitters showing a significant difference in CRP levels after 12 weeks of agomelatine. A multivariate stepwise linear regression analysis showed that higher CRP level variation was associated with higher baseline HAM-D scores, controlling for age, gender, smoking, BMI, and agomelatine dose. Agomelatine's antidepressant properties were associated with a reduction in circulating CRP levels in MDD patients who achieved remission after 12 weeks of treatment. Moreover, more prominent CRP level variation was associated with more severe depressive symptoms at baseline.

Real-world usage and clinical outcomes of alectinib among post-crizotinib progression anaplastic lymphoma kinase positive non-small-cell lung cancer patients in the USA

Directory of Open Access Journals (Sweden)

DiBonaventura MD

2017-12-01

Full Text Available Marco D DiBonaventura,1 William Wong,2 Bijal Shah-Manek,3,4 Mathias Schulz2 1Ipsos Healthcare, Global Evidence, Value & Access, New York, NY, 2Genentech, US Medical Affairs, San Francisco, CA, 3Ipsos Healthcare, Global Evidence, Value & Access, San Francisco, CA, 4College of Pharmacy, Touro University California, CA, USA Background: Alectinib is an approved treatment for anaplastic lymphoma kinase (ALK-positive patients with advanced non-small-cell lung cancer. Despite positive supporting clinical data, there is a lack of real-world information on the usage and patient outcomes of those treated with alectinib post-crizotinib progression. Methods: Participating oncologists (N=95 in the USA were recruited from an online physician panel to participate in a retrospective patient chart review. Physicians randomly selected eligible patients (ie, patients who progressed on crizotinib as their first ALK inhibitor and were treated with alectinib as their second ALK inhibitor, collected demographics and clinical history from their medical charts, and entered the data into an online data collection form. Results: A total of N=207 patient charts were included (age: 60.1±10.4 years; 53.6% male. The patients in our sample were older (median age of 60 vs 53 years, were more likely to be current smokers (12% vs 1%, had better performance status (45% vs 33% had an Eastern Cooperative Oncology Group [ECOG] of 0, and were less likely to have an adenocarcinoma histology (83% vs 96% relative to published clinical trials. The objective response rate was higher than in clinical trials (67.1% vs 51.3%, respectively as was the disease control rate (89.9% vs 78.8%, respectively, though it varied by race/ethnicity, ECOG, and prior treatment history. Discontinuation (0.0% and dose reductions (3.4% due to adverse events were uncommon in alectinib.Conclusion: Patients using alectinib post-crizotinib in clinical practice are older, more racially/ethnically and histologically

Usefulness of the CAD System for Detecting Pulmonary Nodule in Real Clinical Practice

International Nuclear Information System (INIS)

Song, Kyoung Doo; Chung, Myung Jin; Kim, Hee Cheol; Lee, Kyung Soo; Jeong, Sun Young

2011-01-01

We wanted to evaluate the usefulness of the computer-aided detection (CAD) system for detecting pulmonary nodules in real clinical practice by using the CT images. Our Institutional Review Board approved our retrospective study with a waiver of informed consent. This study included 166 CT examinations that were performed for the evaluation of pulmonary metastasis in 166 patients with colorectal cancer. All the CT examinations were interpreted by radiologists and they were also evaluated by the CAD system. All the nodules detected by the CAD system were evaluated with regard to whether or not they were true nodules, and they were classified into micro nodules (MN, diameter < 4 mm) and significant nodules (SN, 4 ≤ diameter ≤ 10 mm). The radiologic reports and CAD results were compared. The CAD system helped detect 426 nodules: 115 (27%) of the 426 nodules were classified as true nodules and 35 (30%) of the 115 nodules were SNs, and 83 (72%) of the 115 were not mentioned in the radiologists' reports and three (4%) of the 83 nodules were non-calcified SNs. One of three non-calcified SNs was confirmed as a metastatic nodule. According to the radiologists' reports, 60 true nodules were detected, and 28 of the 60 were not detected by the CAD system. Although the CAD system missed many SNs that are detected by radiologists, it helps detect additional nodules that are missed by the radiologists in real clinical practice. Therefore, the CAD system can be useful to support a radiologist's detection performance

Agile science: creating useful products for behavior change in the real world.

Science.gov (United States)

Hekler, Eric B; Klasnja, Predrag; Riley, William T; Buman, Matthew P; Huberty, Jennifer; Rivera, Daniel E; Martin, Cesar A

2016-06-01

Evidence-based practice is important for behavioral interventions but there is debate on how best to support real-world behavior change. The purpose of this paper is to define products and a preliminary process for efficiently and adaptively creating and curating a knowledge base for behavior change for real-world implementation. We look to evidence-based practice suggestions and draw parallels to software development. We argue to target three products: (1) the smallest, meaningful, self-contained, and repurposable behavior change modules of an intervention; (2) "computational models" that define the interaction between modules, individuals, and context; and (3) "personalization" algorithms, which are decision rules for intervention adaptation. The "agile science" process includes a generation phase whereby contender operational definitions and constructs of the three products are created and assessed for feasibility and an evaluation phase, whereby effect size estimates/casual inferences are created. The process emphasizes early-and-often sharing. If correct, agile science could enable a more robust knowledge base for behavior change.

Real-world Outcomes of Multiple Myeloma: Retrospective Analysis of the Czech Registry of Monoclonal Gammopathies.

Science.gov (United States)

Hájek, Roman; Jarkovsky, Jiri; Maisnar, Vladimír; Pour, Ludek; Špička, Ivan; Minařík, Jiri; Gregora, Evžen; Kessler, Petr; Sýkora, Michal; Fraňková, Hana; Campioni, Marco; DeCosta, Lucy; Treur, Maarten; Gonzalez-McQuire, Sebastian; Bouwmeester, Walter

2018-06-01

Real-world data on patient outcomes and treatment patterns in multiple myeloma (MM) are limited. The present noninterventional, observational, retrospective analysis of prospectively collected Czech patient medical record data from the Registry of Monoclonal Gammopathies estimated real-world outcomes in adults with a diagnosis of symptomatic MM made between May 2007 and June 2014. In total, 2446 patients had initiated first-line treatment. The median overall survival since the diagnosis (primary endpoint) was 50.3 months (95% confidence interval, 46.1-54.5 months) and decreased with each successive treatment line. A similar trend was observed for progression-free survival and the depth of response. In line with European guidelines and clinical practice, bortezomib-, thalidomide-, and lenalidomide-based regimens were most commonly used across all treatment lines (42.3%, 28.9%, and 18.4%, respectively). In the first line, bortezomib and thalidomide were used most often, with lenalidomide the most commonly used agent in the relapse setting (second to fourth lines). Exploratory analyses revealed that younger age (≤ 65 years), lower international staging system stage, and previous stem cell transplantation were associated with significant improvements in overall and progression-free survival, especially in the early treatment lines. The present study is the first analysis of Czech data from the Registry of Monoclonal Gammopathies, and it provides important insights into the real-world management of MM for physicians and healthcare providers. Copyright © 2018 Elsevier Inc. All rights reserved.

How to do Research in the Real world: What is to know and Who is to gain?

DEFF Research Database (Denmark)

Villumsen, Anne Marie Anker

2016-01-01

a specific line of research. This, again, requires time. In the presentation, I will propose new concepts concerning real world research and knowledge production. The presentation will be based on data from a collaborative organizational field study. The aim of the study was establish a coherent practice...... of multidisciplinary collaboration between day-care and social services to support and aid children and families at risk. First, I propose the concepts of a) Development through Research and b) Research through Development. Both concepts are inter-dependent. They share development as a goal and both require applying......Real world research: The need for different types of knowledge requires two knowledge production processes In real world research, there are dilemmas. One significant dilemma is time. The field of practice needs a type of knowledge that is produced quickly and can be applied immediately...

The patient-physician partnership in asthma: real-world observations associated with clinical and patient-reported outcomes.

Science.gov (United States)

Small, M; Vickers, A; Anderson, P; Kay, S

2010-09-01

It is hypothesized that a good partnership between asthma patients and their physicians has a direct and positive influence on the patients' clinical and patient-reported outcomes. Conversely, poor partnership has a detrimental effect on clinical and patient-reported outcomes. This paper uses data from a real-world observational study to define partnership through matched physician and patient data and correlate the quality of partnership with observed clinical and patient-reported outcomes. Data were drawn from Adelphi's Respiratory Disease Specific Programme, a cross-sectional study of consulting patients in five European countries undertaken between June and September 2009. A range of clinical and patient-reported outcomes were observed allowing analysis of the partnership between 2251 asthma patients and their physicians. Analysis demonstrates that the better the partnership between patient and physician, the more likely the patient is to have their asthma condition controlled (PPartnership is also associated with lower impact on lifestyle (Ppartnership is a contributory factor in the improvement of asthma treatment, and patient education may lead to improvement in a patient's ability to contribute to this. Device satisfaction is one of the markers of good partnership.

Assessing acupuncture effect in the real world study

Directory of Open Access Journals (Sweden)

Qi-Wen Zhang

2017-04-01

Full Text Available Acupuncture, with its unique set of theories and its evident results in clinical practice is an important part of traditional Chinese medicine (TCM, and gaining recognition worldwide for the past few years. Although acupuncture treatment is generally accepted by the public, a few western researchers believe that sufficient evidence of its efficiency is still currently lacking, therefore creating a challenge of its acceptance on a wider scale. This article suggests the concepts of acupuncture behind clinical researches by reviewing the clinical researches done, analyzing the existing problems, and integrating real life acupuncture into the research process. By increasing the credibility of acupuncture, its reach can be extended globally and to more countries and regions.

Efficacy and Safety of Drug-Eluting Stents in the Real World: 8-Year Follow-Up

Energy Technology Data Exchange (ETDEWEB)

Pellegrini, Denise Oliveira, E-mail: dennizmo@yahoo.com.br; Gomes, Vitor Osório; Lasevitch, Ricardo; Smidt, Luis; Azeredo, Marco Aurélio; Ledur, Priscila; Bodanese, Rodrigo; Sinnott, Leonardo; Moriguchi, Emílio; Caramori, Paulo [Hospital São Lucas PUC, Porto Alegre, RS (Brazil)

2014-09-15

Drug-eluting stents have been used in daily practice since 2002, with the clear advantages of reducing the risk of target vessel revascularization and an impressive reduction in restenosis rate by 50%-70%. However, the occurrence of a late thrombosis can compromise long-term results, particularly if the risks of this event were sustained. In this context, a registry of clinical cases gains special value. To evaluate the efficacy and safety of drug-eluting stents in the real world. We report on the clinical findings and 8-year follow-up parameters of all patients that underwent percutaneous coronary intervention with a drug-eluting stent from January 2002 to April 2007. Drug-eluting stents were used in accordance with the clinical and interventional cardiologist decision and availability of the stent. A total of 611 patients were included, and clinical follow-up of up to 8 years was obtained for 96.2% of the patients. Total mortality was 8.7% and nonfatal infarctions occurred in 4.3% of the cases. Target vessel revascularization occurred in 12.4% of the cases, and target lesion revascularization occurred in 8% of the cases. The rate of stent thrombosis was 2.1%. There were no new episodes of stent thrombosis after the fifth year of follow-up. Comparative subanalysis showed no outcome differences between the different types of stents used, including Cypher®, Taxus®, and Endeavor®. These findings indicate that drug-eluting stents remain safe and effective at very long-term follow-up. Patients in the 'real world' may benefit from drug-eluting stenting with excellent, long-term results.

Creating and using real-world evidence to answer questions about clinical effectiveness

Directory of Open Access Journals (Sweden)

Simon de Lusignan

2015-11-01

Full Text Available New forms of evidence are needed to complement evidence generated from randomised controlled trials (RCTs. Real-World Evidence (RWE is a potential new form of evidence, but remains undefined.This paper sets to fill that gap by defining RWE as the output from a rigorous research process which: (1 includes a clear a priori statement of a hypothesis to be tested or research question to be answered; (2 defines the data sources that will be used and critically appraises their strengths and weaknesses; and (3 applies appropriate methods, including advanced analytics. These elements should be set out in advance of the study commencing, ideally in a published protocol.The strengths of RWE studies are that they are more inclusive than RCTs and can enable an evidence base to be developed around real-world effectiveness and to start to address the complications of managing other real-world problems such as multimorbidity. Computerised medical record systems and big data provide a rich source of data for RWE studies.However, guidance is needed to help assess the rigour of RWE studies so that the strength of recommendations based on their output can be determined. Additionally, RWE advanced analytics methods need better categorisation and validation.We predict that the core role of RCTs will shift towards assessing safety and achieving regulatory compliance. RWE studies, notwithstanding their limitations, may become established as the best vehicle to assess efficacy. 

Rufinamide from clinical trials to clinical practice in the United States and Europe.

Science.gov (United States)

Resnick, Trevor; Arzimanoglou, Alexis; Brown, Lawrence W; Flamini, Robert; Kerr, Michael; Kluger, Gerhard; Kothare, Sanjeev; Philip, Sunny; Harrison, Miranda; Narurkar, Milind

2011-05-01

Rufinamide is a triazole derivative structurally unrelated to other antiepileptic drugs that is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients aged ≥4 years. Originally granted orphan drug status, marketing authorisation was obtained on the basis of a randomised, double-blind, placebo-controlled trial conducted in 138 LGS patients. An open-label extension study subsequently demonstrated that rufinamide's efficacy and tolerability were maintained over the longer term (median duration of treatment, 432 days). Recently published reports from Europe and the United States have described the use of adjunctive rufinamide to treat LGS in clinical practice. These data complement the clinical trial results, by providing information on the efficacy and tolerability of rufinamide when used on an individualised basis in real-world practice, under less tightly restricted conditions in terms of patient population and dosing strategies. A comparison of the data reveals that a "lower and slower" dosing strategy tends to be adopted in clinical practice, in comparison with the clinical trial, which does not appear to compromise efficacy, but may provide improvements in tolerability. Individual case reports provide additional valuable information on how rufinamide is being used to treat different seizure types associated with LGS. Since clinical experience with rufinamide is currently at an early stage, there are still unanswered questions relating to its use, and it is likely that its place in the adjunctive treatment of LGS will evolve as further data emerge.

Mathematics in the Real World.

Science.gov (United States)

Borenstein, Matt

1997-01-01

The abstract nature of algebra causes difficulties for many students. Describes "Real-World Data," an algebra course designed for students with low grades in algebra and provides multidisciplinary experiments (linear functions and variations; quadratic, square-root, and inverse relations; and exponential and periodic variation)…

Primary care clinicians' recognition and management of depression: a model of depression care in real-world primary care practice.

Science.gov (United States)

Baik, Seong-Yi; Crabtree, Benjamin F; Gonzales, Junius J

2013-11-01

Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered. This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions. Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n = 24, 2 h each), two surveys per clinician, and investigators' field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data. Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners. A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians' interactions with patients, practice, and the local community. A clinician's interactional familiarity ("familiarity capital") was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression. The clinician's ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

OCA Oracle Database 11g database administration I : a real-world certification guide

CERN Document Server

Ries, Steve

2013-01-01

Developed as a practical book, ""Oracle Database 11g Administration I Certification Guide"" will show you all you need to know to effectively excel at being an Oracle DBA, for both examinations and the real world. This book is for anyone who needs the essential skills to become an Oracle DBA, pass the Oracle Database Administration I exam, and use those skills in the real world to manage secure, high performance, and highly available Oracle databases.

Collaborative adaptations in social work intervention research in real-world settings: lessons learned from the field.

Science.gov (United States)

Blank Wilson, Amy; Farkas, Kathleen

2014-01-01

Social work research has identified the crucial role that service practitioners play in the implementation of evidence-based practices. This has led some researchers to suggest that intervention research needs to incorporate collaborative adaptation strategies in the design and implementation of studies focused on adapting evidence-based practices to real-world practice settings. This article describes a collaborative approach to service adaptations that was used in an intervention study that integrated evidence-based mental health and correctional services in a jail reentry program for people with serious mental illness. This description includes a discussion of the nature of the collaboration engaged in this study, the implementation strategies that were used to support this collaboration, and the lessons that the research team has learned about engaging a collaborative approach to implementing interventions in research projects being conducted in real-world social service delivery settings.

Designing and Using Projects with Real World Application in a MBA Managerial Accounting Class: The Case of The Balanced Scorecard

Science.gov (United States)

Houke, Charlotte

2017-01-01

This paper explores the purpose of designing and using projects with real world application in a M.B.A. managerial accounting class. Included is a discussion of how and why the Balanced Scorecard (BSC) Project has been used in classes to link theory with practice by providing real world application of the BSC framework. M.B.A. students represent a…

The LIBERTY study: Design of a prospective, observational, multicenter trial to evaluate the acute and long-term clinical and economic outcomes of real-world endovascular device interventions in treating peripheral artery disease.

Science.gov (United States)

Adams, George L; Mustapha, Jihad; Gray, William; Hargus, Nick J; Martinsen, Brad J; Ansel, Gary; Jaff, Michael R

2016-04-01

Most peripheral artery disease (PAD) clinical device trials are supported by commercial manufacturers and designed for regulatory device approval, with extensive inclusion/exclusion criteria to support homogeneous patient populations. High-risk patients with advanced disease, including critical limb ischemia (CLI), are often excluded leading to difficulty in translating trial results into real-world clinical practice. As a result, physicians have no direct guidance regarding the use of endovascular devices. There is a need for objectively assessed studies to evaluate clinical, functional, and economic outcomes in PAD patient populations. LIBERTY is a prospective, observational, multicenter study sponsored by Cardiovascular Systems Inc (St Paul, MN) to evaluate procedural and long-term clinical and economic outcomes of endovascular device interventions in patients with symptomatic lower extremity PAD. Approximately 1,200 patients will be enrolled and followed up to 5 years: 500 patients in the "Claudicant Rutherford 2-3" arm, 600 in the "CLI Rutherford 4-5" arm, and 100 in the "CLI Rutherford 6" arm. The study will use 4 core laboratories for independent analysis and will evaluate the following: procedural and lesion success, rates of major adverse events, duplex ultrasound interpretations, wound status, quality of life, 6-minute walk test, and economic analysis. The LIBERTY Patient Risk Score(s) will be developed as a clinical predictor of outcomes to provide guidance for interventions in this patient population. LIBERTY will investigate real-world PAD patients treated with endovascular revascularization with rigorous study guidelines and independent oversight of outcomes. This study will provide observational, all-comer patient clinical data to guide future endovascular therapy. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Real-world experimentation of distributed DSA network algorithms

DEFF Research Database (Denmark)

Tonelli, Oscar; Berardinelli, Gilberto; Tavares, Fernando Menezes Leitão

2013-01-01

such as a dynamic propagation environment, human presence impact and terminals mobility. This chapter focuses on the practical aspects related to the real world-experimentation with distributed DSA network algorithms over a testbed network. Challenges and solutions are extensively discussed, from the testbed design......The problem of spectrum scarcity in uncoordinated and/or heterogeneous wireless networks is the key aspect driving the research in the field of flexible management of frequency resources. In particular, distributed dynamic spectrum access (DSA) algorithms enable an efficient sharing...... to the setup of experiments. A practical example of experimentation process with a DSA algorithm is also provided....

Reflections on "Real-World" Community Psychology

Science.gov (United States)

Wolff, Tom; Swift, Carolyn

2008-01-01

Reflections on the history of real-world (applied) community psychologists trace their participation in the field's official guild, the Society for Community Research and Action (SCRA), beginning with the Swampscott Conference in 1965 through the current date. Four benchmarks are examined. The issues these real-world psychologists bring to the…

Properties of four real world collaboration--competition networks

Science.gov (United States)

Fu, Chun-Hua; Xu, Xiu-Lian; He, Da-Ren

2009-03-01

Our research group has empirically investigated 9 real world collaboration networks and 25 real world cooperation-competition networks. Among the 34 real world systems, all the 9 real world collaboration networks and 6 real world cooperation-competition networks show the unimodal act-size distribution and the shifted power law distribution of degree and act-degree. We have proposed a collaboration network evolution model for an explanation of the rules [1]. The other 14 real world cooperation-competition networks show that the act-size distributions are not unimodal; instead, they take qualitatively the same shifted power law forms as the degree and act-degree distributions. The properties of four systems (the main land movie film network, Beijing restaurant network, 2004 Olympic network, and Tao-Bao notebook computer sale network) are reported in detail as examples. Via a numerical simulation, we show that the new rule can still be explained by the above-mentioned model. [1] H. Chang, B. B. Su, et al. Phsica A, 2007, 383: 687-702.

The real meaning of complex Minkowski-space world-lines

Energy Technology Data Exchange (ETDEWEB)

Adamo, T M [University of Oxford, Mathematical Institute, 24-29 St Giles, Oxford, OX1 3LB (United Kingdom); Newman, E T, E-mail: newman@pitt.ed [University of Pittsburgh, Department of Physics and Astronomy, Pittsburgh, PA 15213 (United States)

2010-04-07

In connection with the study of shear-free null geodesics in Minkowski space, we investigate the real geometric effects in real Minkowski space that are induced by and associated with complex world-lines in complex Minkowski space. It was already known, in a formal manner, that complex analytic curves in complex Minkowski space induce shear-free null geodesic congruences. Here we look at the direct geometric connections of the complex line and the real structures. Among other items, we show, in particular, how a complex world-line projects into the real Minkowski space in the form of a real shear-free null geodesic congruence.

The real meaning of complex Minkowski-space world-lines

International Nuclear Information System (INIS)

Adamo, T M; Newman, E T

2010-01-01

In connection with the study of shear-free null geodesics in Minkowski space, we investigate the real geometric effects in real Minkowski space that are induced by and associated with complex world-lines in complex Minkowski space. It was already known, in a formal manner, that complex analytic curves in complex Minkowski space induce shear-free null geodesic congruences. Here we look at the direct geometric connections of the complex line and the real structures. Among other items, we show, in particular, how a complex world-line projects into the real Minkowski space in the form of a real shear-free null geodesic congruence.

A real life clinical practice of neurologists in the ambulatory setting in Thailand: a pragmatic study

Directory of Open Access Journals (Sweden)

Kannikar Kongbunkiat

2015-06-01

Full Text Available The burden of neurological disorders is high in developing countries. Real life data from neurologists as to how they practice in Thailand are limited in literature. Practices of neurologists in a university hospital clinical setting in Thailand were studied. A prospective study was performed at the ambulatory neurology clinic, Khon Kaen University Hospital, between 1 February and 31 October 2009. The following data were recorded: numbers of patients, characteristics of patients, consultation notes, and time spent for each patient. There were three neurologists, each of whom ran one afternoon clinic, once a week. There were 6137 visits during the 9 months, with an average of 681 visits per month. The total number of patients was 2834. The three most common diseases were cerebrovascular diseases (33%, epilepsy (16%, and movement disorders (non-Parkinson’s disease, 12%. Neurologists spent an average of 6.34 minutes per patient. In conclusion, neurologists in medical schools have limited time to take care of each patient. Several strategies are needed in medical education and neurology training to improve the quality of care.

TRAX - Real-World Tracking of Moving Objects

DEFF Research Database (Denmark)

Jensen, Christian Søndergaard; Pakalnis, Stardas

2007-01-01

accuracy. This paper presents the TRAX tracking system that supports several techniques capable of tracking the current positions of moving objects with guaranteed accuracies at low update and communication costs in real-world settings. The techniques are readily relevant for practical applications......, but they also have implications for continued research. The tracking techniques offer a realistic setting for existing query processing techniques that assume that it is possible to always know the exact positions of moving objects. The techniques enable studies of trade-offs between querying and update...

Uncertainty in the Real World

Indian Academy of Sciences (India)

Home; Journals; Resonance – Journal of Science Education; Volume 4; Issue 2. Uncertainty in the Real World - Fuzzy Sets. Satish Kumar. General Article Volume 4 Issue 2 February 1999 pp 37-47. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/004/02/0037-0047 ...

Real-World Evidence In Support Of Precision Medicine: Clinico-Genomic Cancer Data As A Case Study.

Science.gov (United States)

Agarwala, Vineeta; Khozin, Sean; Singal, Gaurav; O'Connell, Claire; Kuk, Deborah; Li, Gerald; Gossai, Anala; Miller, Vincent; Abernethy, Amy P

2018-05-01

The majority of US adult cancer patients today are diagnosed and treated outside the context of any clinical trial (that is, in the real world). Although these patients are not part of a research study, their clinical data are still recorded. Indeed, data captured in electronic health records form an ever-growing, rich digital repository of longitudinal patient experiences, treatments, and outcomes. Likewise, genomic data from tumor molecular profiling are increasingly guiding oncology care. Linking real-world clinical and genomic data, as well as information from other co-occurring data sets, could create study populations that provide generalizable evidence for precision medicine interventions. However, the infrastructure required to link, ensure quality, and rapidly learn from such composite data is complex. We outline the challenges and describe a novel approach to building a real-world clinico-genomic database of patients with cancer. This work represents a case study in how data collected during routine patient care can inform precision medicine efforts for the population at large. We suggest that health policies can promote innovation by defining appropriate uses of real-world evidence, establishing data standards, and incentivizing data sharing.

Handbook of Research on Technology Tools for Real-World Skill Development (2 Volumes)

Science.gov (United States)

Rosen, Yigel, Ed.; Ferrara, Steve, Ed.; Mosharraf, Maryam, Ed.

2016-01-01

Education is expanding to include a stronger focus on the practical application of classroom lessons in an effort to prepare the next generation of scholars for a changing world economy centered on collaborative and problem-solving skills for the digital age. "The Handbook of Research on Technology Tools for Real-World Skill Development"…

Argus developer in practice real estate development modeling in the real world

CERN Document Server

Havard, Tim M

2014-01-01

First ""missing manual"" for Argus Developer--case studies show readers how to analyze a development, something Argus manuals don't do. Argus Developer is by far the leading program for real estate developers worldwide The book is an education in real estate finance as well as the program Author teaches seminars and consults with people using the program--back of room sales likely Author has three other books on real estate development Possibility that Argus gets behind the project The book will contain dozens of screenshots

Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population

DEFF Research Database (Denmark)

Banerjee, A; Lane, D A; Torp-Pedersen, C

2012-01-01

The concept of net clinical benefit has been used to quantify the balance between risk of ischaemic stroke (IS) and risk of intracranial haemorrhage (ICH) with the use oral anticoagulant therapy (OAC) in the setting of non-valvular atrial fibrillation (AF), and has shown that patients at highest ...... in AF. Using 'real world' data, our modelling analysis has shown that when the risk of bleeding and stroke are both high, all three new drugs appear to have a greater net clinical benefit compared to warfarin....

Project Manager Street Smarts A Real World Guide to PMP Skills

CERN Document Server

Zaval, Linda Kretz

2011-01-01

The perfect workbook for project managers and PMP exam candidates seeking practical experience New project managers and students pursuing the Project Management Professional certification are looking for practical experience to solidify their skills. The step-by-step tasks presented in this book offer them an opportunity to practice the common tasks project managers face in the real world. The authors, both expert project management trainers and consultants, explore each phase of project management: initiation, planning, execution, monitoring and control, and closing the project, with in-depth

Managing Uncertainty in the Real World

Indian Academy of Sciences (India)

Home; Journals; Resonance – Journal of Science Education; Volume 4; Issue 4. Managing Uncertainty in the Real World - Fuzzy Systems. Satish Kumar. General Article ... Author Affiliations. Satish Kumar1. Department of Physics and Computer Science, Dayalbagh Educational Institute Dayalbagh, Agra 282005, India.

StoryTrek: Experiencing Stories in the Real World

DEFF Research Database (Denmark)

Khaled, Rilla; Barr, Pippin James; Greenspan, Brian

2011-01-01

world experience. In early tests we observed the emergence of a number of recurrent themes in participants’ experiences which are characteristic of the StoryTrek system, but which also help us to understand locative media storytelling affordances more generally. In this paper we present the system......In this paper we introduce StoryTrek, a locative hypernarrative system developed to generate stories based on a reader’s location and specific movements in the real world. This creates, for readers, an interplay between navigation, narrative, and agency, as well as between the fictional and real...

StoryTrek: Experiencing Stories in the Real World

DEFF Research Database (Denmark)

Khaled, Rilla; Barr, Pippin James; Greenspan, Brian

2011-01-01

In this paper we introduce StoryTrek, a locative hypernarrative system developed to generate stories based on a reader’s location and specific movements in the real world. This creates, for readers, an interplay between navigation, narrative, and agency, as well as between the fictional and real...... world experience. In early tests we observed the emergence of a number of recurrent themes in participants’ experiences which are characteristic of the StoryTrek system, but which also help us to understand locative media storytelling affordances more generally. In this paper we present the system...

Real World Connections in High School Mathematics Curriculum and Teaching

Directory of Open Access Journals (Sweden)

Gökhan Karakoç

2015-04-01

Full Text Available Making real world connections in mathematics curricula and in teaching mathematics is generally viewed favorably within the educational community, however, little empirical research has examined how and why to use real world connections in mathematics education based on the views of experts. This study describes the feasibility of the use of real world connections according to high school mathematics teachers and academicians of mathematics education. Opinions of high school mathematics teachers (n=16 and academicians (n=8 about advantages, disadvantages, and examples of real world connections are elicited and reported. Teachers and academicians report several advantages of the use of real world connections in teaching mathematics as well as its disadvantages and limitations. Suggestions about dealing with limiting factors for using real world connections are also reported. Keywords: Mathematics curriculum, real world connections, mathematics teaching

Real-World Assessment of Clinical Outcomes in Patients with Lower-Risk Myelofibrosis Receiving Treatment with Ruxolitinib

Directory of Open Access Journals (Sweden)

Keith L. Davis

2015-01-01

Full Text Available Few trial-based assessments of ruxolitinib in patients with lower-risk myelofibrosis (MF have been conducted, and no studies have made such assessments in a real-world population. We assessed changes in spleen size and constitutional symptoms during ruxolitinib treatment using a retrospective, observational review of anonymized US medical record data of patients diagnosed with IPSS low-risk (n=25 or intermediate-1-risk (n=83 MF. The majority of patients were male (low risk, 60%; intermediate-1 risk, 69%. Most patients (92% and 77% were still receiving ruxolitinib at the medical record abstraction date (median observation/exposure time, 8 months. The proportion of patients with moderate or severe palpable splenomegaly (≥10 cm decreased from diagnosis (56% to best response (12%. Fatigue was reported in 47% of patients and was the most common constitutional symptom. For most symptoms in both risk groups, shifts in the distribution of severity from more to less severe from diagnosis to best response were observed. Both patients with low-risk and intermediate-1-risk MF experienced a substantial decrease in spleen size with ruxolitinib treatment in real-world settings. For most symptoms examined, there were distinct improvements in the distribution of severity during ruxolitinib treatment. These findings suggest that patients with lower-risk MF may benefit clinically from ruxolitinib treatment.

Good Practices for Real-World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making.

Science.gov (United States)

Berger, Marc L; Sox, Harold; Willke, Richard J; Brixner, Diana L; Eichler, Hans-Georg; Goettsch, Wim; Madigan, David; Makady, Amr; Schneeweiss, Sebastian; Tarricone, Rosanna; Wang, Shirley V; Watkins, John; Mullins, C Daniel

2017-09-01

Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders. Copyright © 2017. Published by Elsevier Inc.

Real change in the real world: an achievable goal.

Science.gov (United States)

Friedman, Robert M

2010-03-01

This commentary builds on the papers presented at the Vanderbilt Conference by emphasizing the importance of better understanding the process of change-making if real change in the real world is to be achieved. The commentary reviews several frameworks and research findings related to achieving large-scale sustainable change that benefits children and families. It calls for the application of systems thinking as a complement to the more micro-level research that was presented at the Vanderbilt conference. Such an approach would have implications for framing of the issue, for the strategies that are taken to try to achieve change, and for research/evaluation methods for studying complex, dynamic, nonlinear systems.

Learning from Dealing with Real World Problems

Science.gov (United States)

Akcay, Hakan

2017-01-01

The purpose of this article is to provide an example of using real world issues as tools for science teaching and learning. Using real world issues provides students with experiences in learning in problem-based environments and encourages them to apply their content knowledge to solving current and local problems.

Glyphosate and AMPA, "pseudo-persistent" pollutants under real-world agricultural management practices in the Mesopotamic Pampas agroecosystem, Argentina.

Science.gov (United States)

Primost, Jezabel E; Marino, Damián J G; Aparicio, Virginia C; Costa, José Luis; Carriquiriborde, Pedro

2017-10-01

In the Pampas, public concern has strongly risen because of the intensive use of glyphosate for weed control and fallow associated with biotech crops. The present study was aimed to evaluate the occurrence and concentration of the herbicide and its main metabolite (AMPA) in soil and other environmental compartments of the mentioned agroecosystem, including groundwater, in relation to real-world agricultural management practices in the region. Occurrence was almost ubiquitous in solid matrices (83-100%) with maximum concentrations among the higher reported in the world (soil: 8105 and 38939; sediment: 3294 and 7219; suspended particulate matter (SPM): 584 and 475 μg/kg of glyphosate and AMPA). Lower detection frequency was observed in surface water (27-55%) with maximum concentrations in whole water of 1.80 and 1.90 μg/L of glyphosate and AMPA, indicating that SPM analysis would be more sensitive for detection in the aquatic ecosystem. No detectable concentrations of glyphosate or AMPA were observed in groundwater. Glyphosate soil concentrations were better correlated with the total cumulative dose and total number of applications than the last spraying event dose, and an increment of 1 mg glyphosate/kg soil every 5 spraying events was estimated. Findings allow to infer that, under current practices, application rates are higher than dissipation rates. Hence, glyphosate and AMPA should be considered "pseudo-persistent" pollutants and a revisions of management procedures, monitoring programs, and ecological risk for soil and sediments should be also recommended. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fairer machine learning in the real world: Mitigating discrimination without collecting sensitive data

OpenAIRE

Veale, M; Binns, RDP

2017-01-01

Decisions based on algorithmic, machine learning models can be unfair, reproducing biases in historical data used to train them. While computational techniques are emerging to address aspects of these concerns through communities such as discrimination-aware data mining (DADM) and fairness, accountability and transparency machine learning (FATML), their practical implementation faces real-world challenges. For legal, institutional or commercial reasons, organisations might not hold the data o...

TREATMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS IN THE REAL CLINICAL PRACTICE OF A RHEUMATOLOGIST IN RUSSIA

Directory of Open Access Journals (Sweden)

Sh F Erdes

2013-01-01

Full Text Available Objective: to analyze the treatment of ankylosing spondylitis (AS in the real practice of a rheumatologist in Russia. Subjects and methods. The cross-sectional study included 330 AS patients who had been actively seeking medical advice from rheumatologists during 4 months in 24 cities and towns of the Russian Federation. The therapy performed was studied using the medical history data recorded by physicians in the specially designed clinical chart. Drug intake, its regularity, reasons for discontinuation of medications, and their clinical effect were elucidated in all the patients. The need to intensify the therapy and to use genetically engineered biological agents was determined by disease activity at the time of examination. Results. The medical histories indicated that 62% of the patients received nonsteroidal anti-inflammatory drugs (NSAIDs regularly, 34% had them periodically, and 4% were not treated; two thirds of the patients took diclofenac, nimesulide, or meloxicam. 33, 14, and 9% of the patients used sulfasalazine, methotrexate, and oral glucocorticosteroids, respectively. Sixty (18% patients received tumor necrosis factor-α (TNF-α inhibitors. Different physiotherapeutic methods were used in 30% of cases; only 46% did exercises regularly; as high as 4% of the patients had sanatorium-and-spa treatment. In the physicians' opinion, 81% of the patients needed intensified therapy and 62% did therapy with TNF-α inhibitors. At the same time TNF-α inhibitors were indicated in 38% of the patients according to the ASAS recommendations. Conclusion. In real clinical practice, AS treatment does not always meet the current recommendations: only 62% of the patients received continuous NSAID therapy; disease-modifying antirheumatic drugs were frequently used without any indications. 18% of the patients took TNF-α inhibitors and 38% really needed them.

The realism project reconciling nuclear power and radiation policies with the real world

International Nuclear Information System (INIS)

Theodore Rockwell

2006-01-01

Let's get real. It is crazy to fear that one's health and life are threatened by entities known to be harmless, whether those entities are goblins under the bed or trivial levels of radiation from non-existent radiological catastrophes. The nuclear community is in that paranoid state, and no advice from public relations experts can cure it. Some people claim that overstating risk is a prudent thing to do, but in practice it may do harm. Let us recall what we have said and done to create this situation. Then let us look at what the real world tells us about those risks. And then we will consider what might be done to return to reason. (author)

Understanding Use Situated in Real-world Mobile Contexts

DEFF Research Database (Denmark)

Korn, Matthias

where the activity is happening) by leveraging three keyenablers: (1) the high penetration of smart phones, (2) their easy programmability and (3) the large-scale distribution channels for mobile applications that come with the platforms. My approach suggests a triggered response solicitation, which......  Our understanding of users' everyday practices in their natural contexts is still very limited. Insights are often only available from studies conducted outside of the context itself. I propose a new approach to study use situated in real-world everyday mobile contexts (at the time and place...

The Robobo Project: Bringing Educational Robotics Closer to Real-World Applications

DEFF Research Database (Denmark)

Bellas, Francisco; Naya, Martin; Varela, Gervasio

2017-01-01

The Robobo Project is a STEM-based project that aims to bring educational robotics, in primary and high school, closer to real-world applications. It is based on the use of a smartphone-based robotic platform called Robobo, a very flexible programming environment, and a set of lessons to integrate...... them. The smartphone provides high-level hardware capabilities in terms of sensors, communications and processing capabilities that allow to create more practical and realistic lessons that exploit human-robot interaction, with a small investment. In this paper, we present the main elements...

Real World SharePoint 2010 Indispensable Experiences from 22 MVPs

CERN Document Server

Hillier, Scot; Bishop, Darrin; Bleeker, Todd; Bogue, Robert; Bosch, Karine; Brotto, Claudio; Buenz, Adam; Connell, Andrew; Drisgill, Randy; Lapointe, Gary; Medero, Jason; Molnar, Agnes; O'Brien, Chris; Klindt, Todd; Poelmans, Joris; Rehmani, Asif; Ross, John; Swan, Nick; Walsh, Mike; Williams, Randy; Young, Shane; Macori, Igor

2010-01-01

Proven real-world best practices from leading Microsoft SharePoint MVPsSharePoint enables Web sites to host shared workspaces and is a leading solution for Enterprise Content Management. The newest version boasts significant changes, impressive enhancements, and new features, requiring developers and administrators of all levels of experience to quickly get up to speed on the latest changes. This book is a must-have anthology of current best practices for SharePoint 2010 from 20 of the top SharePoint MVPs. They offer insider advice on everything from installation, workflow, and Web parts to bu

A second life for eHealth: prospects for the use of 3-D virtual worlds in clinical psychology.

Science.gov (United States)

Gorini, Alessandra; Gaggioli, Andrea; Vigna, Cinzia; Riva, Giuseppe

2008-08-05

The aim of the present paper is to describe the role played by three-dimensional (3-D) virtual worlds in eHealth applications, addressing some potential advantages and issues related to the use of this emerging medium in clinical practice. Due to the enormous diffusion of the World Wide Web (WWW), telepsychology, and telehealth in general, have become accepted and validated methods for the treatment of many different health care concerns. The introduction of the Web 2.0 has facilitated the development of new forms of collaborative interaction between multiple users based on 3-D virtual worlds. This paper describes the development and implementation of a form of tailored immersive e-therapy called p-health whose key factor is interreality, that is, the creation of a hybrid augmented experience merging physical and virtual worlds. We suggest that compared with conventional telehealth applications such as emails, chat, and videoconferences, the interaction between real and 3-D virtual worlds may convey greater feelings of presence, facilitate the clinical communication process, positively influence group processes and cohesiveness in group-based therapies, and foster higher levels of interpersonal trust between therapists and patients. However, challenges related to the potentially addictive nature of such virtual worlds and questions related to privacy and personal safety will also be discussed.

Impact Of Real-World Driving Characteristics On Vehicular Emissions

OpenAIRE

Nesamani, K S; Subramanian, K. P.

2005-01-01

With increase in traffic volume and change in travel related characteristics, vehicular emissions and energy consumption have increased significantly since two decades in India. Current models are not capable of estimating vehicular emissions accurately due to inadequate representation of real-world driving. The focus of this paper is to understand the level of Indian Driving cycle (IDC) in representing the real-world driving and to assess the impact of real-world driving on vehicular emissio...

Real-world driving behaviour

NARCIS (Netherlands)

Rijkeboer, R.C.; Hendriksen, P.; Gense, N.L.J.

2001-01-01

With increasing complexity of engine management system there is a tendency for traditional driving cyles to become further and further removed from reality. So for a sensible evaluation of emissions and fuel consumption of road vehicles in the field there is an urgent need for 'real-world' driving

Real-world evidence analysis of palbociclib prescribing patterns for patients with advanced/metastatic breast cancer treated in community oncology practice in the USA one year post approval.

Science.gov (United States)

Kish, J K; Ward, M A; Garofalo, D; Ahmed, H V; McRoy, L; Laney, J; Zanotti, G; Braverman, J; Yu, H; Feinberg, B A

2018-05-02

Rapidly evolving understanding of cancer biology has presented novel opportunities to translate that understanding into clinically relevant therapy. Palbociclib, a novel, first-in-class cyclin-dependent kinase (CDK) 4/6 inhibitor was approved in the USA in February 2015 for the treatment of advanced/metastatic breast cancer. We examined real-world evidence in the first year post approval to understand the clinical and demographic characteristics of patients treated with palbociclib in community oncology practices and the dosing, treatment, and complete blood count (CBC) monitoring patterns. This was a retrospective observational study of structured data from a US electronic medical record (EMR) database. Female patients receiving palbociclib after 31 January 2015 were followed through 31 March 2016. Our methodological rules were constructed to aggregate drugs received according to the order in which they are given, i.e., identify the line of therapy as first, second, or third line, etc., using treatment order and course description fields from the EMR. There were 763 patients initiating palbociclib who met the selection criteria. Of those, 612 (80.2%) received palbociclib concomitantly with letrozole. Mean follow up was 6.4 months and mean age at palbociclib initiation was 64 years. Of patients with a known starting dose (n = 417), 79.9% started on palbociclib 125 mg. Dose reductions were observed in 20.1% of patients. Percentages of patients according to line of therapy at initiation of palbociclib were first-line, 39.5%; second-line, 15.7%; third-line, 13.1%; and fourth-line therapy or later, 31.7%. On average, two CBC tests were conducted during the first cycle of palbociclib treatment. Overall, 74.6% of patients had a neutropenic event during follow up including 47.3% and 8.0% of patients with a grade 3 or 4 occurrence, respectively. Real-world palbociclib use one year post US approval demonstrates a more heterogeneous patient population than that

The real-world effectiveness of vedolizumab on intestinal and articular outcomes in inflammatory bowel diseases.

Science.gov (United States)

Macaluso, Fabio Salvatore; Orlando, Rosalba; Fries, Walter; Scolaro, Mariangela; Magnano, Antonio; Pluchino, Dario; Cappello, Maria; Morreale, Gaetano Cristian; Siringo, Sebastiano; Privitera, Antonino Carlo; Ferracane, Concetta; Belluardo, Nunzio; Alberghina, Nadia; Ventimiglia, Marco; Rizzuto, Giulia; Renna, Sara; Cottone, Mario; Orlando, Ambrogio

2018-03-01

The effectiveness of vedolizumab in real-world practice is under evaluation, while its role in inflammatory bowel disease-associated spondyloarthritis is still unclear. To report real-world data about the effectiveness of vedolizumab on intestinal and articular symptoms after 10 and 22 weeks of treatment. Web-based data from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) were extracted to perform a prospective multicentre observational study. 163 patients (84 with Crohn's disease and 79 with ulcerative colitis) were included. At week 10, a steroid-free remission was achieved in 71 patients (43.6%), while at week 22 a steroid-free remission was obtained in 40.8% of patients. A response on articular symptoms was reported after 10 weeks of treatment in 17 out of 43 (39.5%) patients with active spondyloarthritis at baseline, and in 10 out of 22 (45.4%) patients at week 22. The only factor associated with articular response was the coexistence of clinical benefit on intestinal symptoms (at week 10: OR 8.471, p = 0.05; at week 22: OR 5.600, p = 0.08). Vedolizumab showed good effectiveness after 10 and 22 weeks of treatment. A subset of patients reported improvement also on articular symptoms, probably as a consequence of the concomitant control of gut inflammation. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Can singular examples change implicit racial attitudes in the real-world?

Directory of Open Access Journals (Sweden)

Leslie E. Roos

2013-09-01

Full Text Available Implicit attitudes about social groups persist independently of explicit beliefs and can influence not only social behavior, but also medical and legal practices. Although examples presented in the laboratory can alter such implicit attitudes, it is unclear whether the same influence is exerted by real-world exemplars. Following the 2008 US election, Plant et al. reported that the Implicit Association Test or IAT revealed a decrease in negative implicit attitudes towards African-Americans. However, a large-scale study also employing the IAT found little evidence for a change in implicit attitudes pre- and post-election. Here we present evidence that the 2008 US election may have facilitated at least a temporary change in implicit racial attitudes in the US. Our results rely on the Affective Lexical Priming Score or ALPS and pre- and post-election measurements for both US and non-US participants. US students who, pre-election, exhibited negative associations with black faces, post-election showed positive associations with black faces. Canadian students pre- and post-election did not show a similar shift. To account for these findings, we posit that the socio-cognitive processes underlying ALPS are different from those underlying the IAT. Acknowledging that we cannot form a causal link between an intervening real-world event and laboratory-measured implicit attitudes, we speculate that our findings may be driven by the fact that the 2008 election campaign included extremely positive media coverage of President Obama and prominently featured his face in association with positive words – similar to the structure of ALPS. Even so, our real-world finding adds to the literature demonstrating the malleability of implicit attitudes and has implications for how we understand the socio-cognitive mechanisms underlying stereotypes.

Organising nursing practice into care models that catalyse quality: A clinical nurse leader case study.

Science.gov (United States)

Bender, Miriam; Spiva, LeeAnna; Su, Wei; Hites, Lisle

2018-02-09

To determine the power of a conceptual clinical nurse leader practice model to explain the care model's enactment and trajectory in real world settings. How nursing, organised into specific models of care, functions as an organisational strategy for quality is not well specified. Clinical nurse leader integrated care delivery is one emerging model with growing adoption. A recently validated clinical nurse leader practice model conceptualizes the care model's characteristics and hypothesizes their mechanisms of action. Pattern matching case study design and mixed methods were used to determine how the care model's constructs were operationalized in one regional United States health system that integrated clinical nurse leaders into their care delivery system in 2010. The findings confirmed the empirical presence of all clinical nurse leader practice model constructs and provided a rich description of how the health system operationalized the constructs in practice. The findings support the hypothesized model pathway from Clinical Nurse Leader structuring to Clinical Nurse Leader practice and outcomes. The findings indicate analytic generalizability of the clinical nurse leader practice model. Nursing practice organised to focus on microsystem care processes can catalyse multidisciplinary engagement with, and consistent enactment of, quality practices. The model has great potential for transferability across diverse health systems. © 2018 John Wiley & Sons Ltd.

Clinical effectiveness and cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men: risk calculators for real-world decision-making.

Directory of Open Access Journals (Sweden)

Anders Chen

Full Text Available BACKGROUND: Oral pre-exposure prophylaxis (PrEP can be clinically effective and cost-effective for HIV prevention in high-risk men who have sex with men (MSM. However, individual patients have different risk profiles, real-world populations vary, and no practical tools exist to guide clinical decisions or public health strategies. We introduce a practical model of HIV acquisition, including both a personalized risk calculator for clinical management and a cost-effectiveness calculator for population-level decisions. METHODS: We developed a decision-analytic model of PrEP for MSM. The primary clinical effectiveness and cost-effectiveness outcomes were the number needed to treat (NNT to prevent one HIV infection, and the cost per quality-adjusted life-year (QALY gained. We characterized patients according to risk factors including PrEP adherence, condom use, sexual frequency, background HIV prevalence and antiretroviral therapy use. RESULTS: With standard PrEP adherence and national epidemiologic parameters, the estimated NNT was 64 (95% uncertainty range: 26, 176 at a cost of $160,000 (cost saving, $740,000 per QALY--comparable to other published models. With high (35% HIV prevalence, the NNT was 35 (21, 57, and cost per QALY was $27,000 (cost saving, $160,000, and with high PrEP adherence, the NNT was 30 (14, 69, and cost per QALY was $3,000 (cost saving, $200,000. In contrast, for monogamous, serodiscordant relationships with partner antiretroviral therapy use, the NNT was 90 (39, 157 and cost per QALY was $280,000 ($14,000, $670,000. CONCLUSIONS: PrEP results vary widely across individuals and populations. Risk calculators may aid in patient education, clinical decision-making, and cost-effectiveness evaluation.

Medical Science Liaisons in Real-World Evidence Studies: Experience of AstraZeneca Russia.

Science.gov (United States)

Suvorov, Nikolay; Karaseva, Vera; Stukalina, Ekaterina; Sanay, Elkhan; Petrakovskaya, Vera; Bulatov, Vladimir

2018-01-01

There is no doubt that real-world evidence studies have the potential to improve and accelerate the development and delivery of safe and cost-effective innovative medicines to patients as well as influence the way we approach health and health care. Real-world evidence studies are a great challenge in terms of development and conduct, so there should be a good collaboration between the study team and clinical sites at all times, resulting eventually in timely and efficient enrollment. Engaging the sites and key external experts as early as possible during feasibility and routine visits, as well as highlighting the science rationale behind AstraZeneca's portfolio at investigator meetings and during medical science liaison (MSL) interactions, can create a positive impact on physician perception of a particular study and prioritization of patient recruitment in such studies. Therefore, we would like to underline the important role of MSLs in the risk-based monitoring setting of real-world evidence studies, with special attention to the studies with complicated patient profiles, tough timelines, and/or seasonal factors. This approach will be used further for other real world evidence projects of AstraZeneca Russia MC to ensure timelines and budget deliverables are met for the generation of high-quality evidence and eventually better health care for all of us.

The Development of a Teaching Strategy for Implementing a Real-World Business Project into Database Courses

Science.gov (United States)

Seyed-Abbassi, Behrooz; King, Ronnie; Wiseman, Eddie

2007-01-01

Collaborations between business and academia provide valuable opportunities for students to connect classroom learning with practical work experience. To effectively reach a significant number of students, one approach is to meld a real-world business project and classroom assignment into a realistic business scenario that can be addressed by…

Potential health gains for patients with metastatic renal cell carcinoma in daily clinical practice: A real-world cost-effectiveness analysis of sequential first- and second-line treatments.

Directory of Open Access Journals (Sweden)

S De Groot

Full Text Available Randomised controlled trials have shown that targeted therapies like sunitinib are effective in metastatic renal cell carcinoma (mRCC. Little is known about the current use of these therapies, and their associated costs and effects in daily clinical practice. We estimated the real-world cost-effectiveness of different treatment strategies comprising one or more sequentially administered drugs.Analyses were performed using patient-level data from a Dutch population-based registry including patients diagnosed with primary mRCC from January 2008 to December 2010 (i.e., treated between 2008 and 2013. The full disease course of these patients was estimated using a patient-level simulation model based on regression analyses of the registry data. A healthcare sector perspective was adopted; total costs included healthcare costs related to mRCC. Cost-effectiveness was expressed in cost per life-year and cost per quality-adjusted life-year (QALY gained. Probabilistic sensitivity analysis was conducted to estimate the overall uncertainty surrounding cost-effectiveness.In current daily practice, 54% (336/621 of all patients was treated with targeted therapies. Most patients (84%; 282/336 received sunitinib as first-line therapy. Of the patients receiving first-line therapy, 30% (101/336 also received second-line therapy; the majority was treated with everolimus (40%, 40/101 or sorafenib (28%, 28/101. Current treatment practice (including patients not receiving targeted therapy led to 0.807 QALYs; mean costs were €58,912. This resulted in an additional €105,011 per QALY gained compared to not using targeted therapy at all. Forty-six percent of all patients received no targeted therapy; of these patients, 24% (69/285 was eligible for sunitinib. If these patients were treated with first-line sunitinib, mean QALYs would improve by 0.062-0.076 (where the range reflects the choice of second-line therapy. This improvement is completely driven by the health

Genetic drift. The real tiger mother: from the clinical geneticist's perspective.

Science.gov (United States)

Shur, Natasha

2011-09-01

The Battle Hymn of the Tiger Mother by Amy Chua raises questions about motherhood and what is admirable. Chua promotes strict, Old World, uncompromising values stressing academic performance above all, insisting on drilling and practice, and instilling respect for authority. As clinical geneticists, we meet an entirely different type of mother than Chua, the clinical genetics mother who fights illnesses, schools, hospital policies, and insurance companies. She battles not against her child but for her child. With brilliance and resilience, she creates a child-centered world. The stories of four clinical genetics mothers rally us to reject extreme parenting and appreciate the simple joys of childhood. Copyright © 2011 Wiley-Liss, Inc.

Designing "Real-World" trials to meet the needs of health policy makers at marketing authorization.

Science.gov (United States)

Calvert, Melanie; Wood, John; Freemantle, Nick

2011-07-01

There is increasing interest in conducting "Real-World" trials that go beyond traditional assessment of efficacy and safety to examine market access and value for money questions before marketing authorization of a new pharmaceutical product or health technology. This commentary uses practical examples to demonstrate how high-quality evidence of the cost-effectiveness of an intervention may be gained earlier in the development process. Issues surrounding the design and analysis of "Real-World" trials to demonstrate relative cost-effectiveness early in the life of new technologies are discussed. The modification of traditional phase III trial designs, de novo trial designs, the combination of trial-based and epidemiological data, and the use of simulation model-based approaches to address reimbursement questions are described. Modest changes to a phase III trial protocol and case report form may be undertaken at the design stage to provide valid estimates of health care use and the benefits accrued; however, phase III designs often preclude "real-life" practice. Relatively small de novo trials may be used to address adherence to therapy or patient preference, although simply designed studies with active comparators enrolling large numbers of patients may provide evidence on long-term safety and rare adverse events. Practical examples demonstrate that it is possible to provide high-quality evidence of the cost-effectiveness of an intervention earlier in the development process. Payers and decision makers should preferentially adopt treatments with such evidence than treatments for which evidence is lacking or of lower quality. Copyright © 2011 Elsevier Inc. All rights reserved.

How Symmetric Are Real-World Graphs? A Large-Scale Study

Directory of Open Access Journals (Sweden)

Fabian Ball

2018-01-01

Full Text Available The analysis of symmetry is a main principle in natural sciences, especially physics. For network sciences, for example, in social sciences, computer science and data science, only a few small-scale studies of the symmetry of complex real-world graphs exist. Graph symmetry is a topic rooted in mathematics and is not yet well-received and applied in practice. This article underlines the importance of analyzing symmetry by showing the existence of symmetry in real-world graphs. An analysis of over 1500 graph datasets from the meta-repository networkrepository.com is carried out and a normalized version of the “network redundancy” measure is presented. It quantifies graph symmetry in terms of the number of orbits of the symmetry group from zero (no symmetries to one (completely symmetric, and improves the recognition of asymmetric graphs. Over 70% of the analyzed graphs contain symmetries (i.e., graph automorphisms, independent of size and modularity. Therefore, we conclude that real-world graphs are likely to contain symmetries. This contribution is the first larger-scale study of symmetry in graphs and it shows the necessity of handling symmetry in data analysis: The existence of symmetries in graphs is the cause of two problems in graph clustering we are aware of, namely, the existence of multiple equivalent solutions with the same value of the clustering criterion and, secondly, the inability of all standard partition-comparison measures of cluster analysis to identify automorphic partitions as equivalent.

CLINICAL CHARACTERISTICS OF ANKYLOSING SPONDYLITIS IN REAL PRACTICE IN RUSSIA: RESULTS OF THE CROSS-SECTIONAL NON-INTERVENTIONAL TRIAL EPICA2

Directory of Open Access Journals (Sweden)

Sh. F. Erdes

2016-01-01

Full Text Available The literature virtually lacks the results of investigations aimed to study the clinical picture of ankylosing spondylitis (AS in the real practice of rheumatologists  in Russia. At the same time, these investigations may give information  on not only the epidemiological aspects of the disease, but also a variety of its clinical presentation, its social importance, allow evaluation of the efficiency of therapy, and plan a system of further health care costs.Subjects and methods. In early 2015, the cross-sectional multicenter  non-interventional trial EPICA2 was conducted to refine the clinical picture of AS in the real practice of a rheumatologist. The trial involved 402 patients with AS from 10 centers of Russia. The patients were examined using the international standards accepted for this disease. Results and discussion. 180 out of the 402 patients were treated in hospital; the others were examined during outpatient visits. The patients' mean age was 40.8±11.5 years; there were 292 (72.6% men; 82.6% were HLA-B27 positive. The average age of onset was 27.6 years; the interval between symptom onset and diagnosis was 85.2 months. The rheumatologists  established the diagnosis in 87.3% of the cases. BASDAI and BASFI averaged 4.3±2.1 and 4.1±1.8, respectively. At the trial, there was peripheral arthritis in 33.1% of the patients, enthesitis in 37.1%, and dactylitis in 1.2%. Joint endoprosthesis was carried out in 4.7% of the patients. The most common  comorbidities were hypertension (25.1%, gastric ulcer (9.7%, coronary heart disease (4.0%, and diabetes mellitus (3.0%.Conclusion. AS is diagnosed in real practice more than 7 years after its onset mainly by rheumatologists.The delay of the diagnosis is mostly associated with the fact that specialists of other medical specialties are unaware of the clinical presentation  of the disease. The examined group of patients with AS shows a relatively high activity and obvious functional impairments

Real-World Evidence, Public Participation, and the FDA.

Science.gov (United States)

Schwartz, Jason L

2017-11-01

For observers of pharmaceutical regulation and the Food and Drug Administration, these are uncertain times. Events in late 2016 raised concerns that the FDA's evidentiary standards were being weakened, compromising the agency's ability to adequately perform its regulatory and public health responsibilities. Two developments most directly contributed to these fears-the approval of eteplirsen, a treatment for Duchenne muscular dystrophy, against the recommendations of both FDA staff and an advisory committee and the December 2016 signing of the 21st Century Cures Act, which encouraged greater use by the FDA of "real-world" evidence not obtained through randomized controlled trials. The arrival of the Trump administration-with its deregulatory, industry-friendly approach-has only amplified concerns over the future of the FDA. It is too early to know whether the recent developments are truly harbingers of an FDA less likely to prevent unsafe or ineffective products from reaching the market. But elements in the two events-the role of patient narratives in deliberations regarding eteplirsen and the enthusiasm for real-world evidence in the 21st Century Cures Act-raise critical issues for the future of evidence in the FDA's work. The rigorous, inclusive approach under way to consider issues related to real-world evidence provides a model for a similarly needed inquiry regarding public participation in FDA decision-making. © 2017 The Hastings Center.

Impaired behavior on real-world tasks following damage to the ventromedial prefrontal cortex.

Science.gov (United States)

Tranel, Daniel; Hathaway-Nepple, Julie; Anderson, Steven W

2007-04-01

Patients with damage to the ventromedial prefrontal cortices (VMPC) commonly manifest blatant behavioral navigation defects in the real world, but it has been difficult to measure these impairments in the clinic or laboratory. Using a set of "strategy application" tasks, which were designed by Shallice and Burgess (1991) to be ecologically valid for detecting executive dysfunction, we investigated the hypothesis that VMPC damage would be associated with defective performance on such tasks, whereas damage outside the VMPC region would not. A group of 9 patients with bilateral VMPC damage was contrasted with comparison groups of participants with (a) prefrontal brain damage outside the VMPC region (n = 8); (b) nonprefrontal brain damage (n = 17); and (c) no brain damage (n = 20). We found support for the hypothesis: VMPC patients had more impaired performances on the strategy application tasks, especially on a Multiple Errands Test that required patients to execute a series of unstructured tasks in a real-world setting (shopping mall). The results are consistent with the notion that efficacious behavioral navigation is dependent on the VMPC region. However, the strategy application tasks were relatively time consuming and effortful, and their diagnostic yield over and above conventional executive functioning tests may not be sufficient to warrant their inclusion in standard clinical assessment.

An accelerometry-based methodology for assessment of real-world bilateral upper extremity activity.

Directory of Open Access Journals (Sweden)

Ryan R Bailey

Full Text Available The use of both upper extremities (UE is necessary for the completion of many everyday tasks. Few clinical assessments measure the abilities of the UEs to work together; rather, they assess unilateral function and compare it between affected and unaffected UEs. Furthermore, clinical assessments are unable to measure function that occurs in the real-world, outside the clinic. This study examines the validity of an innovative approach to assess real-world bilateral UE activity using accelerometry.Seventy-four neurologically intact adults completed ten tasks (donning/doffing shoes, grooming, stacking boxes, cutting playdough, folding towels, writing, unilateral sorting, bilateral sorting, unilateral typing, and bilateral typing while wearing accelerometers on both wrists. Two variables, the Bilateral Magnitude and Magnitude Ratio, were derived from accelerometry data to distinguish between high- and low-intensity tasks, and between bilateral and unilateral tasks. Estimated energy expenditure and time spent in simultaneous UE activity for each task were also calculated.The Bilateral Magnitude distinguished between high- and low-intensity tasks, and the Magnitude Ratio distinguished between unilateral and bilateral UE tasks. The Bilateral Magnitude was strongly correlated with estimated energy expenditure (ρ = 0.74, p<0.02, and the Magnitude Ratio was strongly correlated with time spent in simultaneous UE activity (ρ = 0.93, p<0.01 across tasks.These results demonstrate face validity and construct validity of this methodology to quantify bilateral UE activity during the performance of everyday tasks performed in a laboratory setting, and can now be used to assess bilateral UE activity in real-world environments.

Eligibility of sacubitril-valsartan in a real-world heart failure population: a community-based single-centre study.

Science.gov (United States)

Norberg, Helena; Bergdahl, Ellinor; Lindmark, Krister

2018-04-01

This study aims to investigate the eligibility of the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) study to a real-world heart failure population. Medical records of all heart failure patients living within the catchment area of Umeå University Hospital were reviewed. This district consists of around 150 000 people. Out of 2029 patients with a diagnosis of heart failure, 1924 (95%) had at least one echocardiography performed, and 401 patients had an ejection fraction of ≤35% at their latest examination. The major PARADIGM-HF criteria were applied, and 95 patients fulfilled all enrolment criteria and thus were eligible for sacubitril-valsartan. This corresponds to 5% of the overall heart failure population and 24% of the population with ejection fraction ≤ 35%. The eligible patients were significantly older (73.2 ± 10.3 vs. 63.8 ± 11.5 years), had higher blood pressure (128 ± 17 vs. 122 ± 15 mmHg), had higher heart rate (77 ± 17 vs. 72 ± 12 b.p.m.), and had more atrial fibrillation (51.6% vs. 36.2%) than did the PARADIGM-HF population. Only 24% of our real-world heart failure and reduced ejection fraction population was eligible for sacubitril-valsartan, and the real-world heart failure and reduced ejection fraction patients were significantly older than the PARADIGM-HF population. The lack of data on a majority of the patients that we see in clinical practice is a real problem, and we are limited to extrapolation of results on a slightly different population. This is difficult to address, but perhaps registry-based randomized clinical trials will help to solve this issue. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Semantic guidance of eye movements in real-world scenes.

Science.gov (United States)

Hwang, Alex D; Wang, Hsueh-Cheng; Pomplun, Marc

2011-05-25

The perception of objects in our visual world is influenced by not only their low-level visual features such as shape and color, but also their high-level features such as meaning and semantic relations among them. While it has been shown that low-level features in real-world scenes guide eye movements during scene inspection and search, the influence of semantic similarity among scene objects on eye movements in such situations has not been investigated. Here we study guidance of eye movements by semantic similarity among objects during real-world scene inspection and search. By selecting scenes from the LabelMe object-annotated image database and applying latent semantic analysis (LSA) to the object labels, we generated semantic saliency maps of real-world scenes based on the semantic similarity of scene objects to the currently fixated object or the search target. An ROC analysis of these maps as predictors of subjects' gaze transitions between objects during scene inspection revealed a preference for transitions to objects that were semantically similar to the currently inspected one. Furthermore, during the course of a scene search, subjects' eye movements were progressively guided toward objects that were semantically similar to the search target. These findings demonstrate substantial semantic guidance of eye movements in real-world scenes and show its importance for understanding real-world attentional control. Copyright © 2011 Elsevier Ltd. All rights reserved.

Learning about the "Real World" in an Urban Arts Youth Program

Science.gov (United States)

Larson, Reed W.; Walker, Kathrin C.

2006-01-01

To make the transition to adulthood, youth must learn to function in the complex and unpredictable "real world" of adult life. This is an intensive case study of an urban arts program that sought to provide youth with experiences that prepared them for the real world of arts careers. We conducted 75 interviews with 12 youth and their adult leader…

The real world effect of omalizumab add on therapy for patients with moderate to severe allergic asthma: The ASTERIX Observational study.

Science.gov (United States)

Bhutani, Mohit; Yang, William H; Hébert, Jacques; de Takacsy, Frederica; Stril, Jean-Louis

2017-01-01

Omalizumab is a non-steroidal medication indicated for the treatment of poorly controlled moderate-to-severe allergic asthmatics. This observational study examines the "real world" effectiveness of omalizumab in this population. This is a one year open-label observational study that compared clinical outcomes including total oral corticosteroid use, exacerbation history, measures of quality of life and inflammation in patients with moderate-to-severe allergic asthma, who were prescribed omalizumab as part of their treatment with the year prior to therapy. A total of 99 patients were enrolled at 25 sites in Canada. During the study period, the mean total annual OCS dose was reduced from 2301.5 mg (prednisone equivalents) in the year prior to omalizumab to 1130.0 mg (pomalizumab remained exacerbation free when compared to the year prior to study entry. Associated with this was reduced health care utilization. There were significant improvements in the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life questionnaire (AQLQ) Patients with an elevated FeNO at baseline showed a better response to treatment. No new safety issues were identified during the study period. Our study demonstrates that in "real world" clinical practice, after initiating omalizumab, there is a reduction in total OCS use and exacerbation frequency in patients with moderate-to-severe allergic asthma. Patients on treatment reported improved asthma control and quality of life. FeNO may be a useful biomarker to identify patients who may benefit with omalizumab treatment.

Analyzing Real-World Light Duty Vehicle Efficiency Benefits

Energy Technology Data Exchange (ETDEWEB)

Gonder, Jeffrey; Wood, Eric; Chaney, Larry; Holden, Jacob; Jeffers, Matthew; Wang, Lijuan

2016-06-08

Off-cycle technologies represent an important pathway to achieve real-world fuel savings, through which OEMs can potentially receive credit toward CAFE compliance. DOE national labs such as NREL are well positioned to provide objective input on these technologies using large, national data sets in conjunction with OEM- and technology-specific testing. This project demonstrates an approach that combines vehicle testing (dynamometer and on-road) with powertrain modeling and simulation over large, representative datasets to quantify real-world fuel economy. The approach can be applied to specific off-cycle technologies (engine encapsulation, start/stop, connected vehicle, etc.) in A/B comparisons to support calculation of realistic real-world impacts. Future work will focus on testing-based A/B technology comparisons that demonstrate the significance of this approach.

UP TO DATE ANTIPLATELET THERAPY IN PATIENTS WITH HIGH RISK OF THROMBOTIC EVENTS AND REAL CLINICAL PRACTICE

Directory of Open Access Journals (Sweden)

S. Yu. Martsevich

2012-01-01

Full Text Available Aim. To assess the real rate of dual antiplatelet therapy (DAT, acetylsalicylic acid + clopidogrel use in patients having appropriate indications according to current clinical guidelines and to study the possibility of prescription rate improvement by education activity directed to doctors. Material and methods. The study consisted of 3 parts. Parts I and II present the results of two questionnaire surveys of patients with acute myocardial infarction, or stenting, who needed in DAT according to current clinical guidelines. The real use of the DAT was assessed in part III on the basis of the multicenter study conducted in different regions of Russia (ROMB study in a large sample of patients having DAT indications. Results. Part I - PROGNOZ-IBS study. According to the questionnaire survey only 112 out of 239 patients (47% having an absolute indications, received DOT. Part II - phone survey of patients with acute myocardial infarction in two towns of Lyubertsy and Podolsk. 28 of 71 patients (39% took the DAT (from some days to 6 months and 35 patients (49% — did not take it. Part III - ROMB study. 519 patients did not take DAT, at that 259 (50% in hospital and 260 (50% - in out-patient clinic. 521 patients took DAT according to indications, at that 238 (46% in hospital and 283 (54% - in out-patient clinic. Conclusion. Less than 50% of patients, having direct indications, received DAT in the real clinical practice. The prescription rate can be improved due to education activity directed to doctors and increase in clopidogrel drugs affordability.

CODA performance in the real world

International Nuclear Information System (INIS)

Abbott, D.J.; Heyes, W.G.; Jastrzembski, E.; MacLeod, R.W.; Timmer, C.; Wolin, E.

1999-01-01

The most ambitious implementation of the Jefferson Lab data acquisition system (CODA) to date is for the CLAS spectrometer in Experimental Hall B. CLAS has over 40,000 instrumented channels and uses up to 30 front-end (FASTBUS/VME) crates in the DAQ subsystem. During the initial experiments the authors found that performance of the fully instrumented DAQ system did not scale as expected based on single point to point benchmarks. Over the past year the authors have been able to study various performance bottlenecks in the CLAS DAQ system including front-end real time performance, switched 100BaseT Ethernet data transport, and online data distribution and recording. Performance tuning was necessary for components on both real time (VxWorks) and UNIX (Solaris) operating systems. In addition, a new efficient Event Transfer System (ET) was developed to provide faster online monitoring while having minimal impact on data throughput to storage. They discuss these issues and efforts to overcome the real world problems associated with running a high performance DAQ system on a variety of commercial hardware and software

CODA Performance in the Real World

International Nuclear Information System (INIS)

D.J. Abbott; W.G. Heyes; E. Jastrzembski; R. W. MacLeod; C. Timmer; E. Wolin

2000-01-01

The most ambitious implementation of the Jefferson Lab data acquisition system (CODA) to date is for the CLAS spectrometer in Experimental Hall B. CLAS has over 40,000 instrumented channels and uses up to 30 front-end (FASTBUS/VME) crates in the DAQ subsystem. During the initial experiments we found that performance of the fully instrumented DAQ system did not scale as expected based on single point to point benchmarks. Over the past year we have been able to study various performance bottlenecks in the CLAS DAQ system including front-end real time performance, switched 100BaseT Ethernet data transport, and online data distribution and recording. Performance tuning was necessary for components on both real time (VxWorks) and UNIX (Solaris) operating systems. In addition, a new efficient Event Transfer System (ET) was developed to provide faster online monitoring while having minimal impact on data throughput to storage. We discuss these issues and efforts to overcome the real world problems associated with running a high performance DAQ system on a variety of commercial hardware and software

Unified underpinning of human mobility in the real world and cyberspace

Science.gov (United States)

Zhao, Yi-Ming; Zeng, An; Yan, Xiao-Yong; Wang, Wen-Xu; Lai, Ying-Cheng

2016-05-01

Human movements in the real world and in cyberspace affect not only dynamical processes such as epidemic spreading and information diffusion but also social and economical activities such as urban planning and personalized recommendation in online shopping. Despite recent efforts in characterizing and modeling human behaviors in both the real and cyber worlds, the fundamental dynamics underlying human mobility have not been well understood. We develop a minimal, memory-based random walk model in limited space for reproducing, with a single parameter, the key statistical behaviors characterizing human movements in both cases. The model is validated using relatively big data from mobile phone and online commerce, suggesting memory-based random walk dynamics as the unified underpinning for human mobility, regardless of whether it occurs in the real world or in cyberspace.

Improving practices in nanomedicine through near real-time pharmacokinetic analysis

Science.gov (United States)

Magafia, Isidro B.

More than a decade into the development of gold nanoparticles, with multiple clinical trials underway, ongoing pre-clinical research continues towards better understanding in vivo interactions. The goal is treatment optimization through improved best practices. In an effort to collect information for healthcare providers enabling informed decisions in a relevant time frame, instrumentation for real-time plasma concentration (multi-wavelength photoplethysmography) and protocols for rapid elemental analysis (energy dispersive X-Ray fluorescence) of biopsied tumor tissue have been developed in a murine model. An initial analysis, designed to demonstrate the robust nature and utility of the techniques, revealed that area under the bioavailability curve (AUC) alone does not currently inform tumor accumulation with a high degree of accuracy (R2=0.56), marginally better than injected dose (R2=0.46). This finding suggests that the control of additional experimental and physiological variables (chosen through modeling efforts) may yield more predictable tumor accumulation. Subject core temperature, blood pressure, and tumor perfusion are evaluated relative to particle uptake in a murine tumor model. New research efforts are also focused on adjuvant therapies that are employed to modify circulation parameters, including the AUC, of nanorods and gold nanoshells. Preliminary studies demonstrated a greater than 300% increase in average AUC using a reticuloendothelial blockade agent versus control groups. Given a better understanding of the relative importance of the physiological factors that influence rates of tumor accumulation, a set of experimental best practices is presented. This dissertation outlines the experimental protocols conducted, and discusses the real-world needs discovered and how these needs became specifications of developed protocols.

Research in dental practice: a 'SWOT' analysis.

Science.gov (United States)

Burke, F J T; Crisp, R J; McCord, J F

2002-03-01

Most dental treatment, in most countries, is carried out in general dental practice. There is therefore a potential wealth of research material, although clinical evaluations have generally been carried out on hospital-based patients. Many types of research, such as clinical evaluations and assessments of new materials, may be appropriate to dental practice. Principal problems are that dental practices are established to treat patients efficiently and to provide an income for the staff of the practice. Time spent on research therefore cannot be used for patient treatment, so there are cost implications. Critics of practice-based research have commented on the lack of calibration of operative diagnoses and other variables; however, this variability is the stuff of dental practice, the real-world situation. Many of the difficulties in carrying out research in dental practice may be overcome. For the enlightened, it may be possible to turn observations based on the volume of treatment carried out in practice into robust, clinically related and relevant research projects based in the real world of dental practice.

Bringing the Real World into the Biology Curriculum

Science.gov (United States)

Lewis, Jenny

2006-01-01

This study followed a small but diverse group of biology teachers through the first two years of the pilot for a new Advanced Level Biology course--Salters-Nuffield Advanced Biology. SNAB aims to modernise A-level Biology using real world contexts and examples as the starting point, promoting conceptual understanding rather than factual recall,…

Cellphones and Real-World Communication

Science.gov (United States)

Bugeja, Michael

2004-01-01

In this article, the author shares his views on cellphones and real-world communication. He claims that the cellphone has changed society more than the home computer, which it has assimilated. Cellphones sound during worship, wakes, births, graduations, hearings, trials, and accreditation meetings--interrupting life-changing spiritual or secular…

Wars, Revolutions and the First Real World Revolution

Directory of Open Access Journals (Sweden)

Petri Minkkinen

2009-12-01

Full Text Available El objetivo de este artículo es promover la discusión conceptual para una publicación más amplia “Los Ciclos del Imperialismo, Guerra, y Revolución”. Empieza desde una presuposición que nuestro mundo común esta atravesando una transición desde un contexto histórico amplio eurocéntrico hacia un contexto histórico amplio non-eurocéntrico. Continua con la discusión histórica de los conceptos relacionados con la guerra, la reforma y la revolución y explica porque, en el contexto de la fase actual de la transición mundial y la Primera Verdadera Guerra Mundial, a pesar de la discusión anterior acerca de las revoluciones y revoluciones mundiales, es razonable sugerir que nuestro mundo común esta atravesando la Primera Verdadera Revolución Mundial._____________________ABSTRACTThe purpose of this article is to engage in a conceptual discussion for a broader publication on “The Cycles of Imperialism, War and Revolution”. It departs from a presupposition that our common world is experiencing a transition from a broad Eurocentric historical context into a non-Eurocentric broad historical context. It proceeds by a historical discussion on the concepts related to wars, reforms and revolutions and explains why, in the context of the actual phase of global transition and the First Real World War, it is, despite earlier discussions on revolutions and world revolutions, meaningful to suggest that our common world is experiencing a First Real World Revolution.

Guidance for Researchers Developing and Conducting Clinical Trials in Practice-based Research Networks (PBRNs)

Science.gov (United States)

Dolor, Rowena J.; Schmit, Kristine M.; Graham, Deborah G.; Fox, Chester H.; Baldwin, Laura Mae

2015-01-01

Background There is increased interest nationally in multicenter clinical trials to answer questions about clinical effectiveness, comparative effectiveness, and safety in real-world community settings. Primary care practice-based research networks (PBRNs), comprising community- and/or academically affiliated practices committed to improving medical care for a range of health problems, offer ideal settings for these trials, especially pragmatic clinical trials. However, many researchers are not familiar with working with PBRNs. Methods Experts in practice-based research identified solutions to challenges that researchers and PBRN personnel experience when collaborating on clinical trials in PBRNs. These were organized as frequently asked questions in a draft document presented at a 2013 Agency for Health care Research and Quality PBRN conference workshop, revised based on participant feedback, then shared with additional experts from the DARTNet Institute, Clinical Translational Science Award PBRN, and North American Primary Care Research Group PBRN workgroups for further input and modification. Results The “Toolkit for Developing and Conducting Multi-site Clinical Trials in Practice-Based Research Networks” offers guidance in the areas of recruiting and engaging practices, budgeting, project management, and communication, as well as templates and examples of tools important in developing and conducting clinical trials. Conclusion Ensuring the successful development and conduct of clinical trials in PBRNs requires a highly collaborative approach between academic research and PBRN teams. PMID:25381071

Variants of Evolutionary Algorithms for Real-World Applications

CERN Document Server

Weise, Thomas; Michalewicz, Zbigniew

2012-01-01

Evolutionary Algorithms (EAs) are population-based, stochastic search algorithms that mimic natural evolution. Due to their ability to find excellent solutions for conventionally hard and dynamic problems within acceptable time, EAs have attracted interest from many researchers and practitioners in recent years. This book “Variants of Evolutionary Algorithms for Real-World Applications” aims to promote the practitioner’s view on EAs by providing a comprehensive discussion of how EAs can be adapted to the requirements of various applications in the real-world domains. It comprises 14 chapters, including an introductory chapter re-visiting the fundamental question of what an EA is and other chapters addressing a range of real-world problems such as production process planning, inventory system and supply chain network optimisation, task-based jobs assignment, planning for CNC-based work piece construction, mechanical/ship design tasks that involve runtime-intense simulations, data mining for the predictio...

The real world effect of omalizumab add on therapy for patients with moderate to severe allergic asthma: The ASTERIX Observational study.

Directory of Open Access Journals (Sweden)

Mohit Bhutani

Full Text Available Omalizumab is a non-steroidal medication indicated for the treatment of poorly controlled moderate-to-severe allergic asthmatics. This observational study examines the "real world" effectiveness of omalizumab in this population.This is a one year open-label observational study that compared clinical outcomes including total oral corticosteroid use, exacerbation history, measures of quality of life and inflammation in patients with moderate-to-severe allergic asthma, who were prescribed omalizumab as part of their treatment with the year prior to therapy.A total of 99 patients were enrolled at 25 sites in Canada. During the study period, the mean total annual OCS dose was reduced from 2301.5 mg (prednisone equivalents in the year prior to omalizumab to 1130.0 mg (p<0.0001. There was a 71% reduction in asthma exacerbations and 56% of patients on omalizumab remained exacerbation free when compared to the year prior to study entry. Associated with this was reduced health care utilization. There were significant improvements in the Asthma Control Questionnaire (ACQ and Asthma Quality of Life questionnaire (AQLQ Patients with an elevated FeNO at baseline showed a better response to treatment. No new safety issues were identified during the study period.Our study demonstrates that in "real world" clinical practice, after initiating omalizumab, there is a reduction in total OCS use and exacerbation frequency in patients with moderate-to-severe allergic asthma. Patients on treatment reported improved asthma control and quality of life. FeNO may be a useful biomarker to identify patients who may benefit with omalizumab treatment.

The real-world safety potential of connected vehicle technology.

Science.gov (United States)

Doecke, Sam; Grant, Alex; Anderson, Robert W G

2015-01-01

This article estimates the safety potential of a current commercially available connected vehicle technology in real-world crashes. Data from the Centre for Automotive Safety Research's at-scene in-depth crash investigations in South Australia were used to simulate the circumstances of real-world crashes. A total of 89 crashes were selected for inclusion in the study. The crashes were selected as representative of the most prevalent crash types for injury or fatal crashes and had potential to be mitigated by connected vehicle technology. The trajectory, speeds, braking, and impact configuration of the selected in-depth cases were replicated in a software package and converted to a file format allowing "replay" of the scenario in real time as input to 2 Cohda Wireless MK2 onboard units. The Cohda Wireless onboard units are a mature connected vehicle technology that has been used in both the German simTD field trial and the U.S. Department of Transport's Safety Pilot project and have been tuned for low false alarm rates when used in the real world. The crash replay was achieved by replacing each of the onboard unit Global Positioning System (GPS) inputs with the simulated data of each of the involved vehicles. The time at which the Cohda Wireless threat detection software issued an elevated warning was used to calculate a new impact speed using 3 different reaction scenarios and 2 levels of braking. It was found that between 37 and 86% of the simulated crashes could be avoided, with highest percentage due a fully autonomous system braking at 0.7 g. The same system also reduced the impact speed relative to the actual crash in all cases. Even when a human reaction time of 1.2 s and moderate braking of 0.4 g was assumed, the impact speed was reduced in 78% of the crashes. Crash types that proved difficult for the threat detection engine were head-on crashes where the approach angle was low and right turn-opposite crashes. These results indicate that connected vehicle

Vigilance in the laboratory predicts avoidance in the real world: A dimensional analysis of neural, behavioral, and ecological momentary data in anxious youth

Directory of Open Access Journals (Sweden)

Rebecca B. Price

2016-06-01

Full Text Available Vigilance and avoidance of threat are observed in anxious adults during laboratory tasks, and are posited to have real-world clinical relevance, but data are mixed in anxious youth. We propose that vigilance-avoidance patterns will become evident in anxious youth through a focus on individual differences and real-world strategic avoidance. Decreased functional connectivity between the amygdala and prefrontal cortex (PFC could play a mechanistic role in this link. 78 clinically anxious youth completed a dot-probe task to assess vigilance to threat while undergoing fMRI. Real-world avoidance was assessed using Ecological Momentary Assessment (EMA of self-reported suppression and distraction during negative life events. Vigilance toward threat was positively associated with EMA distraction and suppression. Functional connectivity between a right amygdala seed region and dorsomedial and right dorsolateral PFC regions was inversely related to EMA distraction. Dorsolateral PFC-amygdalar connectivity statistically mediated the relationship between attentional vigilance and real-world distraction. Findings suggest anxious youth showing attentional vigilance toward threat are more likely to use suppression and distraction to regulate negative emotions. Reduced PFC control over limbic reactivity is a possible neural substrate of this pattern. These findings lend ecological validity to laboratory vigilance assessments and suggest PFC-amygdalar connectivity is a neural mechanism bridging laboratory and naturalistic contexts.

Multilingual children between real and imaginary worlds

DEFF Research Database (Denmark)

Laursen, Helle Pia; Kolstrup, Kirsten Lundgaard

2017-01-01

This article analyzes how a group of multilingual children in their early adolescence use various forms of language play and position themselves symbolically through involvement in signifying practices. By developing a conceptual framework that combines insights on language play (Cook 2000......) and the signifying self (Kramsch 2009), it demonstrates how the children as sign makers and symbolic subjects (re)signify their own learning space. The analysis reveals how, during a reading and joint text construction activity in Danish, they explore the symbolic possibilities of signs and subjectivities, while...... moving in and out of the text and back and forth between imagined and real worlds. These findings illustrate how the children’s interest both shapes their playful interaction and takes shape through it. It furthermore shows how language play contributes to paving the way for a resignification...

Pain worlds: towards the integration of a sociocultural perspective of pain in clinical physical therapy.

Science.gov (United States)

Killick, Lara; Davenport, Todd E

2014-12-01

The World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) model has been advocated as a model of function to conceptualize physical therapist practice. Among its advances, the WHO-ICF model explicitly recognizes the existence of social factors that may influence patients' and clients' understanding of pain. However, understandings of the historical, social and cultural processes that shape the individual and collective experiences of pain and the therapeutic relationship remain limited. We call for a more intentional and sustained dialogue between clinical practice and sociology to help elucidate the nature, characteristics, complexities and clinical implications of one specific element of the WHO-ICF model, environmental factors. The purpose of this review is to advocate for the continued adoption of a sociological lens to help physical therapists better understand the broader networks of people, ideologies and practices in which people 'in pain' are enmeshed and the historical, geographical and cultural spaces in which they operate. In this review, we discuss existing empirical findings in sociology to introduce the concept of 'pain worlds', which can be applied by physical therapists to help characterize the sociocultural factors identified in the WHO-ICF model. Pain worlds is designed to complement the WHO-ICF model and assist in developing interdisciplinary research agendas that illuminate and examine the role, significance and clinical implications of sociocultural and environmental dimensions of pain. We conclude with a brief set of recommendations for the development of such translational research agendas and call for the integration of pain worlds in clinical practice. Copyright © 2014 John Wiley & Sons, Ltd.

The real world in the clinic before and after the establishment of guidelines for coronary artery spasm: a questionnaire for members of the Japanese Cine-angio Association.

Science.gov (United States)

Sueda, Shozo; Kohno, Hiroaki; Yoshino, Hideaki

2017-06-01

We investigated the clinical situations and the present knowledge of Japanese cardiologists about coronary artery spasm before and after the establishment of guidelines for this condition in the real world. A questionnaire was developed regarding the number of cases of coronary angiography, percutaneous coronary intervention, and invasive/non-invasive spasm provocation tests before (2008) and after (2014) the establishment of the Japanese Circulation Society (JCS) guidelines for coronary artery spasm and the status of spasm provocation tests. The questionnaire was sent to members of the Japanese Cine-angio Association in 81 cardiology hospitals in Japan. The completed surveys were returned from 20 hospitals, giving a response rate of 24.7%. Pharmacological spasm provocation tests increased in 2014 and vasospastic angina and variant angina also increased in 2014 compared with 2008, but the increase was not significant. Non-invasive spasm provocation tests such as hyperventilation tests and cold stress tests decreased remarkably in 2014. Spasm provocation tests were initially performed in the left coronary artery was employed in just 30% of the hospitals. The majority of institutions did not perform the spasm provocation testing in patients with unknown causes of heart failure or in survivors of ventricular fibrillation. Although 40% of the hospitals were not satisfied with standard spasm provocation tests, the majority of the hospitals agreed that spasm provocation tests will be necessary in the future. In general, the JCS guidelines contributed to the widespread use of provocative testing for coronary artery spasm in the real world. However, some issues about spasm still remained in the clinic.

Clinical outcomes with daptomycin: a post-marketing, real-world evaluation.

Science.gov (United States)

Sakoulas, G

2009-12-01

The Cubicin Outcomes Registry and Experience (CORE) is an ongoing, retrospective, post-marketing database of daptomycin use in the USA. Although non-comparative, CORE offers insight into real-life clinical experience with daptomycin in various Gram-positive infections and specific patient types. Analyses of daptomycin treatment outcomes using the CORE database revealed that treatment with daptomycin has resulted in high rates of clinical success for a variety of Gram-positive infections, including indicated infections such as complicated skin and soft tissue infections, Staphylococcus aureus bacteraemia and right-sided infective endocarditis, and non-indicated infections such as osteomyelitis. Treatment outcomes did not differ significantly according to the causative pathogen for any of the analyses performed and were not influenced by the vancomycin MIC. Patients frequently received therapy with alternative antibiotics prior to treatment with daptomycin, particularly those patients with more serious infections. However, similar treatment outcomes were observed when daptomycin was used as first-line therapy or as salvage therapy, demonstrating the effectiveness of daptomycin in the treatment of these patients.

Further support for the role of dysfunctional attitudes in models of real-world functioning in schizophrenia.

Science.gov (United States)

Horan, William P; Rassovsky, Yuri; Kern, Robert S; Lee, Junghee; Wynn, Jonathan K; Green, Michael F

2010-06-01

According to A.T. Beck and colleagues' cognitive formulation of poor functioning in schizophrenia, maladaptive cognitive appraisals play a key role in the expression and persistence of negative symptoms and associated real-world functioning deficits. They provided initial support for this model by showing that dysfunctional attitudes are elevated in schizophrenia and account for significant variance in negative symptoms and subjective quality of life. The current study used structural equation modeling to further evaluate the contribution of dysfunctional attitudes to outcome in schizophrenia. One hundred eleven outpatients and 67 healthy controls completed a Dysfunctional Attitudes Scale, and patients completed a competence measure of functional capacity, clinical ratings of negative symptoms, and interview-based ratings of real-world functioning. Patients reported higher defeatist performance beliefs than controls and these were significantly related to lower functional capacity, higher negative symptoms, and worse community functioning. Consistent with Beck and colleagues' formulation, modeling analyses indicated a significant indirect pathway from functional capacity-->dysfunctional attitudes-->negative symptoms-->real-world functioning. These findings support the value of dysfunctional attitudes for understanding the determinants of outcome in schizophrenia and suggest that therapeutic interventions targeting these attitudes may facilitate functional recovery. (c) 2009 Elsevier Ltd. All rights reserved.

Real-world Clinical Outcomes Among Patients With Type 2 Diabetes Receiving Canagliflozin at a Specialty Diabetes Clinic: Subgroup Analysis by Baseline HbA1c and Age.

Science.gov (United States)

Johnson, June Felice; Parsa, Rahul; Bailey, Robert A

2017-06-01

Canagliflozin, a sodium glucose co-transporter 2 inhibitor developed for the treatment of type 2 diabetes mellitus (T2DM), has demonstrated effectiveness in patients with T2DM receiving care at a specialty diabetes clinic. We report the outcomes in these patients in subgroups classified by baseline hemoglobin A 1c (HbA 1c ) and age. This subgroup analysis was based on a review of data from the electronic health records of adults with T2DM who were prescribed canagliflozin at a specialty diabetes clinic and who returned for ≥1 follow-up office visit. Mean changes from baseline to the first and second follow-up office visits in HbA 1c , body weight, and systolic and diastolic blood pressure (BP) were calculated in each subgroup classified by baseline HbA 1c (≥7.0%, ≥8.0%, and >9.0%) and age (baseline HbA 1c ≥7.0%, ≥8.0%, and >9.0%, respectively; 396 and 66 patients were aged baseline HbA 1c and age experienced clinically and statistically significant reductions from baseline in HbA 1c , body weight, and systolic BP that were sustained over 2 office visits; diastolic BP was also reduced across baseline HbA 1c and age subgroups. Greater reductions in HbA 1c were seen among the canagliflozin-treated patients with higher baseline HbA 1c and among younger versus older patients. These findings from clinical practice demonstrate real-world effectiveness of canagliflozin in lowering HbA 1c , body weight, and systolic BP among patients with T2DM, regardless of baseline HbA 1c levels or age. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Virtual plagues and real-world pandemics: reflecting on the potential for online computer role-playing games to inform real world epidemic research.

Science.gov (United States)

Oultram, Stuart

2013-12-01

In the wake of the Corrupted Blood incident, which afflicted the massively multiplayer online computer role-playing game World of Warcraft in 2005, it has been suggested that both, the incident itself and massively multiplayer online computer role-playing games in general, can be utilised to inform and assist real-world epidemic and public health research. In this paper, I engage critically with these claims.

The perception of spatial layout in real and virtual worlds.

Science.gov (United States)

Arthur, E J; Hancock, P A; Chrysler, S T

1997-01-01

As human-machine interfaces grow more immersive and graphically-oriented, virtual environment systems become more prominent as the medium for human-machine communication. Often, virtual environments (VE) are built to provide exact metrical representations of existing or proposed physical spaces. However, it is not known how individuals develop representational models of these spaces in which they are immersed and how those models may be distorted with respect to both the virtual and real-world equivalents. To evaluate the process of model development, the present experiment examined participant's ability to reproduce a complex spatial layout of objects having experienced them previously under different viewing conditions. The layout consisted of nine common objects arranged on a flat plane. These objects could be viewed in a free binocular virtual condition, a free binocular real-world condition, and in a static monocular view of the real world. The first two allowed active exploration of the environment while the latter condition allowed the participant only a passive opportunity to observe from a single viewpoint. Viewing conditions were a between-subject variable with 10 participants randomly assigned to each condition. Performance was assessed using mapping accuracy and triadic comparisons of relative inter-object distances. Mapping results showed a significant effect of viewing condition where, interestingly, the static monocular condition was superior to both the active virtual and real binocular conditions. Results for the triadic comparisons showed a significant interaction for gender by viewing condition in which males were more accurate than females. These results suggest that the situation model resulting from interaction with a virtual environment was indistinguishable from interaction with real objects at least within the constraints of the present procedure.

Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis

OpenAIRE

Vercellino, Matteo; S?nchez, Federico Ariel; Boasi, Valentina; Perri, Dino; Tacchi, Chiara; Secco, Gioel Gabrio; Cattunar, Stefano; Pistis, Gianfranco; Mascelli, Giovanni

2017-01-01

Background European guidelines recommend the use of ticagrelor versus clopidogrel in patients with ST elevation myocardial infarction (STEMI). This recommendation is based on inconclusive results and subanalyses from clinical trials. Few data are available on the effects of ticagrelor in a real-world population. Methods To compare the effects of ticagrelor and clopidogrel in a real-world STEMI population, we conducted a pre-post case-control study examining all patients with STEMI included in...

LabVIEW A Developer's Guide to Real World Integration

CERN Document Server

Fairweather, Ian

2011-01-01

LabVIEW(t) has become one of the preeminent platforms for the development of data acquisition and data analysis programs. LabVIEW(t): A Developer's Guide to Real World Integration explains how to integrate LabVIEW into real-life applications. Written by experienced LabVIEW developers and engineers, the book describes how LabVIEW has been pivotal in solving real-world challenges. Each chapter is self-contained and demonstrates the power and simplicity of LabVIEW in various applications, from image processing to solar tracking systems. Many of the chapters explore how exciting new technologies c

Practical performance of real-time shot-noise measurement in continuous-variable quantum key distribution

Science.gov (United States)

Wang, Tao; Huang, Peng; Zhou, Yingming; Liu, Weiqi; Zeng, Guihua

2018-01-01

In a practical continuous-variable quantum key distribution (CVQKD) system, real-time shot-noise measurement (RTSNM) is an essential procedure for preventing the eavesdropper exploiting the practical security loopholes. However, the performance of this procedure itself is not analyzed under the real-world condition. Therefore, we indicate the RTSNM practical performance and investigate its effects on the CVQKD system. In particular, due to the finite-size effect, the shot-noise measurement at the receiver's side may decrease the precision of parameter estimation and consequently result in a tight security bound. To mitigate that, we optimize the block size for RTSNM under the ensemble size limitation to maximize the secure key rate. Moreover, the effect of finite dynamics of amplitude modulator in this scheme is studied and its mitigation method is also proposed. Our work indicates the practical performance of RTSNM and provides the real secret key rate under it.

Real-world practice and Expectation of Asia-Pacific physicians and patients in Helicobacter Pylori eradication (REAP-HP Survey).

Science.gov (United States)

Chuah, Yoen-Young; Wu, Deng-Chyang; Chuah, Seng-Kee; Yang, Jyh-Chin; Lee, Tzong-Hsi; Yeh, Hong-Zen; Chen, Chan-Lin; Liu, Yu-Hwa; Hsu, Ping-I

2017-06-01

The aims of the study were: 1, to survey the most popular anti-H. pylori regimens in Asia-Pacific region and the real-world effectiveness of these regimens; and 2, to investigate the expectation gaps of eradication rate between physicians and patients. A questionnaire was distributed to Asia-Pacific physicians who attended the Asia-Pacific Digestive Week 2015 meeting. Reported eradication rates from the literatures were compared with real-world rates of surveyed popular regimens within the region. In addition, a questionnaire was distributed to H. pylori-infected patients in three regions of Taiwan. A total of 691 physicians and 539 patients participated in the survey. The top five most commonly used regimens were 7-day clarithromycin-based standard triple therapy (50.4%), 14-day clarithromycin-based standard triple therapy (31.0%), 10-day sequential therapy (6.1%), 14-day bismuth quadruple therapy (3.9%), and 14-day hybrid therapy (3.6%). All countries except for China had a significant gap between the expectation of physicians on anti-H. pylori therapy and the real-world eradication rate of most commonly adopted regimens (all P value Asia-Pacific countries to adopt newer and more efficacious anti-H. pylori regimens to meet the Kyoto consensus recommendation and their patients' expectations. © 2017 John Wiley & Sons Ltd.

Numerical simulation of real-world flows

Energy Technology Data Exchange (ETDEWEB)

Hayase, Toshiyuki, E-mail: hayase@ifs.tohoku.ac.jp [Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, 980-8577 (Japan)

2015-10-15

Obtaining real flow information is important in various fields, but is a difficult issue because measurement data are usually limited in time and space, and computational results usually do not represent the exact state of real flows. Problems inherent in the realization of numerical simulation of real-world flows include the difficulty in representing exact initial and boundary conditions and the difficulty in representing unstable flow characteristics. This article reviews studies dealing with these problems. First, an overview of basic flow measurement methodologies and measurement data interpolation/approximation techniques is presented. Then, studies on methods of integrating numerical simulation and measurement, namely, four-dimensional variational data assimilation (4D-Var), Kalman filters (KFs), state observers, etc are discussed. The first problem is properly solved by these integration methodologies. The second problem can be partially solved with 4D-Var in which only initial and boundary conditions are control parameters. If an appropriate control parameter capable of modifying the dynamical structure of the model is included in the formulation of 4D-Var, unstable modes are properly suppressed and the second problem is solved. The state observer and KFs also solve the second problem by modifying mathematical models to stabilize the unstable modes of the original dynamical system by applying feedback signals. These integration methodologies are now applied in simulation of real-world flows in a wide variety of research fields. Examples are presented for basic fluid dynamics and applications in meteorology, aerospace, medicine, etc. (topical review)

Multi-robot team design for real-world applications

Energy Technology Data Exchange (ETDEWEB)

Parker, L.E.

1996-10-01

Many of these applications are in dynamic environments requiring capabilities distributed in functionality, space, or time, and therefore often require teams of robots to work together. While much research has been done in recent years, current robotics technology is still far from achieving many of the real world applications. Two primary reasons for this technology gap are that (1) previous work has not adequately addressed the issues of fault tolerance and adaptivity in multi-robot teams, and (2) existing robotics research is often geared at specific applications and is not easily generalized to different, but related, applications. This paper addresses these issues by first describing the design issues of key importance in these real-world cooperative robotics applications: fault tolerance, reliability, adaptivity, and coherence. We then present a general architecture addressing these design issues (called ALLIANCE) that facilities multi-robot cooperation of small- to medium-sized teams in dynamic environments, performing missions composed of loosely coupled subtasks. We illustrate an implementation of ALLIANCE in a real-world application, called Bounding Overwatch, and then discuss how this architecture addresses our key design issues.

Improving multiple sclerosis management and collecting safety information in the real world: the MSDS3D software approach.

Science.gov (United States)

Haase, Rocco; Wunderlich, Maria; Dillenseger, Anja; Kern, Raimar; Akgün, Katja; Ziemssen, Tjalf

2018-04-01

For safety evaluation, randomized controlled trials (RCTs) are not fully able to identify rare adverse events. The richest source of safety data lies in the post-marketing phase. Real-world evidence (RWE) and observational studies are becoming increasingly popular because they reflect usefulness of drugs in real life and have the ability to discover uncommon or rare adverse drug reactions. Areas covered: Adding the documentation of psychological symptoms and other medical disciplines, the necessity for a complex documentation becomes apparent. The collection of high-quality data sets in clinical practice requires the use of special documentation software as the quality of data in RWE studies can be an issue in contrast to the data obtained from RCTs. The MSDS3D software combines documentation of patient data with patient management of patients with multiple sclerosis. Following a continuous development over several treatment-specific modules, we improved and expanded the realization of safety management in MSDS3D with regard to the characteristics of different treatments and populations. Expert opinion: eHealth-enhanced post-authorisation safety study may complete the fundamental quest of RWE for individually improved treatment decisions and balanced therapeutic risk assessment. MSDS3D is carefully designed to contribute to every single objective in this process.

Integrating a virtual agent into the real world

OpenAIRE

André, Elisabeth

2007-01-01

Integrating a virtual agent into the real world : the virtual anatomy assistant ritchie / K. Dorfmüller-Ulhaas ... - In: Intelligent virtual agents : 7th international conference, IVA 2007, Paris, France, September 17-19, 2007 ; proceedings / Catherine Pelachaud ... (eds.). - Berlin [u.a.] : Springer, 2007. - S. 211-224. - (Lecture notes in computer science ; 4722 : Lecture notes in artificial intelligence)

Bridging between basic theory and clinical practice.

Science.gov (United States)

Barnard, Philip J

2004-09-01

This paper articulates and discusses the parts played by different processes and representations in the overall conduct of applied clinical science. It distinguishes two sorts of representation, theories in the science base and bridging representations needed to map from real world behaviour to basic theory and from theory back to the real world. It is then argued that macro-theories of the "normal" human mental architecture could help synthesise basic theoretical accounts of diverse psychopathologies, without recourse to special purpose clinical cognitive theories of particular psychopathologies or even specific symptoms. Using the Interacting Cognitive Subsystems model [Affect, Cognition and Change: Re-modelling Depressive Thought, Lawrence Erlbaum Associates, Hove, 1993], some specific macro-theoretic variables are identified. Concrete illustrations are given of how the essence of quite complex basic theory can be translated into a simpler representational format to help clinicians conceptualise a psychopathological state and pinpoint relevant variables that might be changed by therapeutic interventions. Some suggestions are also offered about how the inevitable problem of complexity in multiple component theories might be directly confronted.

Construction of ethics in clinical research: clinical trials registration

Directory of Open Access Journals (Sweden)

C. A. Caramori

2007-01-01

Full Text Available Scientific development that has been achieved through decades finds in clinical research a great possibility of translating findings to human health application. Evidence given by clinical trials allows everyone to have access to the best health services. However, the millionaire world of pharmaceutical industries has stained clinical research with doubt and improbability. Study results (fruits of controlled clinical trials and scientific publications (selective, manipulated and with wrong conclusions led to an inappropriate clinical practice, favoring the involved economic aspect. In 2005, the International Committee of Medical Journal Editors (ICMJE, supported by the World Association of Medical Editors, started demanding as a requisite for publication that all clinical trials be registered at the database ClinicalTrials.gov. In 2006, the World Health Organization (WHO created the International Clinical Trial Registry Platform (ICTRP, which gathers several registry centers from all over the world, and required that all researchers and pharmaceutical industries register clinical trials. Such obligatory registration has progressed and will extend to all scientific journals indexed in all worldwide databases. Registration of clinical trials means another step of clinical research towards transparency, ethics and impartiality, resulting in real evidence to the forthcoming changes in clinical practice as well as in the health situation.

The clinical practice of intraoperative neurophysiological monitoring in Shanghai Huashan Hospital

Directory of Open Access Journals (Sweden)

WU Jin-song

2012-12-01

Full Text Available Intraoperative neurophysiological monitoring (IONM is the gold standard of the intraoperative functional brain mapping. It employs various electrophysiological methods such as awake craniotomy, intraoperative somatosensory and motor evoked potentials monitoring, intraoperative cortical stimulation and sub-cortical stimulation to accurately map the cortical and sub-cortical nervous pathways so that the continuous assessment and real -time protection of the functional integrity of certain neural structures can be achieved during surgery. Based on decades of clinical practice, the Department of Neurosurgery of Shanghai Huashan Hospital has set up an "IONM clinical practice guideline" used in the institute. The clinical practice guideline covers technical and operation standards of IONM in all kinds of common neurosurgery diseases and does improve the clinical efficacy in neurosurgical procedures.

Three-year data from the XIENCE V® INDIA study: Safety and efficacy of XIENCE V® in 1000 real world Indian patients

Directory of Open Access Journals (Sweden)

Ashok Seth

2014-05-01

Conclusion: Despite the high risk population of coronary artery disease, the use of XIENCE V® in 'real world' Indian patients was associated with very low clinical event rates upto three years of follow up.

Symbolic Victimization and Real World Fear.

Science.gov (United States)

Morgan, Michael

1983-01-01

Examines the relationship between victimization of characters in television drama and susceptibility to the viewers' cultivation of a sense of personal risk in the real world. Found that viewers whose fictional counterparts are more likely to be shown as victims show stronger associations between viewing and perceived vulnerability. (PD)

Fairer machine learning in the real world: Mitigating discrimination without collecting sensitive data

Directory of Open Access Journals (Sweden)

Michael Veale

2017-11-01

Full Text Available Decisions based on algorithmic, machine learning models can be unfair, reproducing biases in historical data used to train them. While computational techniques are emerging to address aspects of these concerns through communities such as discrimination-aware data mining (DADM and fairness, accountability and transparency machine learning (FATML, their practical implementation faces real-world challenges. For legal, institutional or commercial reasons, organisations might not hold the data on sensitive attributes such as gender, ethnicity, sexuality or disability needed to diagnose and mitigate emergent indirect discrimination-by-proxy, such as redlining. Such organisations might also lack the knowledge and capacity to identify and manage fairness issues that are emergent properties of complex sociotechnical systems. This paper presents and discusses three potential approaches to deal with such knowledge and information deficits in the context of fairer machine learning. Trusted third parties could selectively store data necessary for performing discrimination discovery and incorporating fairness constraints into model-building in a privacy-preserving manner. Collaborative online platforms would allow diverse organisations to record, share and access contextual and experiential knowledge to promote fairness in machine learning systems. Finally, unsupervised learning and pedagogically interpretable algorithms might allow fairness hypotheses to be built for further selective testing and exploration. Real-world fairness challenges in machine learning are not abstract, constrained optimisation problems, but are institutionally and contextually grounded. Computational fairness tools are useful, but must be researched and developed in and with the messy contexts that will shape their deployment, rather than just for imagined situations. Not doing so risks real, near-term algorithmic harm.

Reperfusion Treatment for STEMI in Age Over 75 Years: Unsatisfactory Real-Life Practice

Czech Academy of Sciences Publication Activity Database

Monhart, Z.; Grünfeldová, H.; Zvárová, Jana; Janský, P.

2010-01-01

Roč. 122, č. 2 (2010), e69 ISSN 0009-7322. [World Congress of Cardiology . 16.06.2010-19.06.2010, Beijing] Institutional research plan: CEZ:AV0Z10300504 Keywords : cardiology * reperfusion treatment * real-life practice Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

Pattern theory the stochastic analysis of real-world signals

CERN Document Server

Mumford, David

2010-01-01

Pattern theory is a distinctive approach to the analysis of all forms of real-world signals. At its core is the design of a large variety of probabilistic models whose samples reproduce the look and feel of the real signals, their patterns, and their variability. Bayesian statistical inference then allows you to apply these models in the analysis of new signals. This book treats the mathematical tools, the models themselves, and the computational algorithms for applying statistics to analyze six representative classes of signals of increasing complexity. The book covers patterns in text, sound

Real-world persistence with fingolimod for the treatment of multiple sclerosis: A systematic review and meta-analysis.

Science.gov (United States)

Kantor, Daniel; Johnson, Kristen; Vieira, Maria Cecilia; Signorovitch, James; Li, Nanxin; Gao, Wei; Koo, Valerie; Duchesneau, Emilie; Herrera, Vivian

2018-05-15

To systematically review reports of fingolimod persistence in the treatment of relapsing-remitting multiple sclerosis (RRMS) across data sources and practice settings, and to develop a consensus estimate of the 1-year real-world persistence rate. A systematic literature review was conducted (MEDLINE, EMBASE, and abstracts from selected conferences [2013-2015]) to identify observational studies reporting 1-year fingolimod persistence among adult patients with RRMS (sample size ≥50). A random-effects meta-analysis was performed to estimate a synthesized 1-year persistence rate and to assess heterogeneity across studies. Of 527 publications identified, 25 real-world studies reporting 1-year fingolimod persistence rates were included. The studies included patients from different data sources (e.g., administrative claims, electronic medical records, or registries), used different definitions of persistence (e.g., based on prescriptions refills, patient report, or prescription orders), and spanned multiple geographic regions. Reported 1-year persistence rates ranged from 72%-100%, and exhibited statistical evidence of heterogeneity (I 2  = 93% of the variability due to heterogeneity across studies). The consensus estimate of the 1-year persistence rate was 82% (95% confidence interval: 79%-85%). Across heterogeneous study designs and patient populations found in real-world studies, the consensus 1-year fingolimod persistence rate exceeded 80%, consistent with persistence rates identified in the recently-completed trial, PREFERMS. Copyright © 2018. Published by Elsevier B.V.

Persistence with golimumab in immune-mediated rheumatic diseases: a systematic review of real-world evidence in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis

Directory of Open Access Journals (Sweden)

Svedbom A

2017-04-01

Full Text Available Axel Svedbom,1 Chiara Storck,2 Sumesh Kachroo,3 Marinella Govoni,4 Ahmed Khalifa5 1Real World Strategy and Analytics, Mapi Group, Stockholm, Sweden; 2Real World Strategy and Analytics, Mapi Group, Munich, Germany; 3Center for Observational and Real-World Evidence (CORE, Merck & Co, Kenilworth, NJ, USA; 4MSD Italy, Rome, Italy; 5Medical Affairs Immunology, MSD Switzerland, Luzern, Switzerland Purpose: In immune-mediated rheumatic diseases (IMRDs, persistence to treatment may be used as a surrogate marker for long-term treatment success. In previous comparisons of persistence to tumor necrosis factor α inhibitors (TNFis, a paucity of data for subcutaneous (SC golimumab was identified. The aim of this study was to conduct a systematic review of persistence to SC golimumab in clinical practice and contextualize these data with five-year persistence estimates from long-term open-label extension (OLE trials of SC TNFis in IMRDs.Patients and methods: PubMed, Embase, MEDLINE, and conference proceedings from European League Against Rheumatism (EULAR, American College of Rheumatology (ACR, and International Society for Pharmacoeconomics and Outcomes Research (ISPOR were searched. All studies on patients treated with SC golimumab for IMRD were included if they reported data on the persistence to golimumab.Results: Of 376 available references identified through the searches, 12 studies with a total of 4,910 patients met the inclusion criteria. Furthermore, nine OLE trials were available. Among the included studies from clinical practice, at six months, one year, two years, and three years, the proportion of patients persistent to treatment ranged from 63% to 91%, 47% to 80%, 40% to 77%, and 32% to 67%, respectively. In the four studies that included comparisons to other biologics, golimumab was either statistically noninferior or statistically superior to other treatments, an observation that was supported by indirect comparisons of unadjusted point

Treatment Dosing Patterns and Clinical Outcomes for Patients with Type 2 Diabetes Starting or Switching to Treatment with Insulin Glargine (300 Units per Milliliter) in a Real-World Setting: A Retrospective Observational Study.

Science.gov (United States)

Gupta, Shaloo; Wang, Hongwei; Skolnik, Neil; Tong, Liyue; Liebert, Ryan M; Lee, Lulu K; Stella, Peter; Cali, Anna; Preblick, Ronald

2018-01-01

Usage patterns and effectiveness of a longer-acting formulation of insulin glargine at a strength of 300 units per milliliter (Gla-300) have not been studied in real-world clinical practice. This study evaluated differences in dosing and clinical outcomes before and after Gla-300 treatment initiation in patients with type 2 diabetes starting or switching to treatment with Gla-300 to assess whether the benefits observed in clinical trials translate into real-world settings. This was a retrospective observational study using medical record data obtained by physician survey for patients starting treatment with insulin glargine at a strength of 100 units per milliliter (Gla-100) or Gla-300, or switching to treatment with Gla-300 from treatment with another basal insulin (BI). Differences in dosing and clinical outcomes before versus after treatment initiation or switching were examined by generalized linear mixed-effects models. Among insulin-naive patients starting BI treatment, no difference in the final titrated dose was observed in patients starting Gla-300 treatment versus those starting Gla-100 treatment [least-squares (LS) mean 0.43 units per kilogram vs 0.44 units per kilogram; P = 0.77]. Both groups had significant hemoglobin A 1c level reductions (LS mean 1.21 percentage points for Gla-300 and 1.12 percentage points for Gla-100 ; both P per kilogram before switch vs 0.58 units per kilogram after switch; P = 0.02). The mean hemoglobin A 1c level was significantly lower after switching than before switching (adjusted difference - 0.95 percentage points, 95% CI - 1.13 to - 0.78 percentage points ; P per patient-year were significantly lower (relative risk 0.17, 95% CI 0.11-0.26; P < 0.0001). Insulin-naive patients starting Gla-300 treatment had fewer hypoglycemic events, a similar hemoglobin A 1c level reduction, and no difference in insulin dose versus patients starting Gla-100 treatment. Patients switching to Gla-300 treatment from treatment with

Development of database of real-world diesel vehicle emission factors for China.

Science.gov (United States)

Shen, Xianbao; Yao, Zhiliang; Zhang, Qiang; Wagner, David Vance; Huo, Hong; Zhang, Yingzhi; Zheng, Bo; He, Kebin

2015-05-01

A database of real-world diesel vehicle emission factors, based on type and technology, has been developed following tests on more than 300 diesel vehicles in China using a portable emission measurement system. The database provides better understanding of diesel vehicle emissions under actual driving conditions. We found that although new regulations have reduced real-world emission levels of diesel trucks and buses significantly for most pollutants in China, NOx emissions have been inadequately controlled by the current standards, especially for diesel buses, because of bad driving conditions in the real world. We also compared the emission factors in the database with those calculated by emission factor models and used in inventory studies. The emission factors derived from COPERT (Computer Programmer to calculate Emissions from Road Transport) and MOBILE may both underestimate real emission factors, whereas the updated COPERT and PART5 (Highway Vehicle Particulate Emission Modeling Software) models may overestimate emission factors in China. Real-world measurement results and emission factors used in recent emission inventory studies are inconsistent, which has led to inaccurate estimates of emissions from diesel trucks and buses over recent years. This suggests that emission factors derived from European or US-based models will not truly represent real-world emissions in China. Therefore, it is useful and necessary to conduct systematic real-world measurements of vehicle emissions in China in order to obtain the optimum inputs for emission inventory models. Copyright © 2015. Published by Elsevier B.V.

Exploring Non-Traditional Learning Methods in Virtual and Real-World Environments

Science.gov (United States)

Lukman, Rebeka; Krajnc, Majda

2012-01-01

This paper identifies the commonalities and differences within non-traditional learning methods regarding virtual and real-world environments. The non-traditional learning methods in real-world have been introduced within the following courses: Process Balances, Process Calculation, and Process Synthesis, and within the virtual environment through…

Fuel consumption rates of passenger cars in China: Labels versus real-world

International Nuclear Information System (INIS)

Huo Hong; Yao Zhiliang; He Kebin; Yu Xin

2011-01-01

Recently, China has implemented many policy measures to control the oil demand of on-road vehicles. In 2010, China started to report the fuel consumption rates of light-duty vehicles tested in laboratory and to require new vehicles to show the rates on window labels. In this study, we examined the differences between the test and real-world fuel consumption of Chinese passenger cars by using the data reported by real-world drivers on the internet voluntarily. The sales-weighted average fuel consumption of new cars in China in 2009 was 7.80 L/100 km in laboratory and 9.02 L/100 km in real-world, representing a difference of 15.5%. For the 153 individual car models examined, the real-world fuel consumption rates were -8 to 60% different from the test values. The simulation results of the International Vehicle Emission model show that the real-world driving cycles in 22 selected Chinese cities could result in -8 to 34% of changes in fuel consumption compared to the laboratory driving cycle. Further government effort on fuel consumption estimates adjustment, local driving cycle development, and real-world data accumulation through communication with the public is needed to improve the accuracy of the labeling policy. - Research highlights: → China requires new cars sold to show the test fuel use levels on window labels. → Real-world fuel consumption rates of cars are 15.5% higher than the label values. → Discrepancy between the test cycle and real conditions is a major cause for the gap. → China should adjust the estimates, collect fuel use data, and develop driving cycles. → More official and academic efforts are needed to improve the labeling policy.

Application Exercises Improve Transfer of Statistical Knowledge in Real-World Situations

Science.gov (United States)

Daniel, Frances; Braasch, Jason L. G.

2013-01-01

The present research investigated whether real-world application exercises promoted students' abilities to spontaneously transfer statistical knowledge and to recognize the use of statistics in real-world contexts. Over the course of a semester of psychological statistics, two classes completed multiple application exercises designed to mimic…

Practical considerations in clinical strategy to support the development of injectable drug-device combination products for biologics.

Science.gov (United States)

Li, Zhaoyang; Easton, Rachael

2018-01-01

The development of an injectable drug-device combination (DDC) product for biologics is an intricate and evolving process that requires substantial investments of time and money. Consequently, the commercial dosage form(s) or presentation(s) are often not ready when pivotal trials commence, and it is common to have drug product changes (manufacturing process or presentation) during clinical development. A scientifically sound and robust bridging strategy is required in order to introduce these changes into the clinic safely. There is currently no single developmental paradigm, but a risk-based hierarchical approach has been well accepted. The rigor required of a bridging package depends on the level of risk associated with the changes. Clinical pharmacokinetic/pharmacodynamic comparability or outcome studies are only required when important changes occur at a late stage. Moreover, an injectable DDC needs to be user-centric, and usability assessment in real-world clinical settings may be required to support the approval of a DDC. In this review, we discuss the common issues during the manufacturing process and presentation development of an injectable DDC and practical considerations in establishing a clinical strategy to address these issues, including key elements of clinical studies. We also analyze the current practice in the industry and review relevant and status of regulatory guidance in the DDC field.

Android arcade game app a real world project : case study approach

CERN Document Server

DiMarzio, Jerome

2012-01-01

Apress, the leading Android books publisher, continues to provide you with very hands-on, practical books for teaching and showing app developers how to build and design apps, including game apps, that can be built and deployed in the various Android app stores out there. Android Arcade Game App:  A Real World Project - Case Study Approach is no different in that it walks you through creating an arcade style Prison Break game app-top to bottom-for an Android smartphone or tablet.  This book teaches you the unique characteristics and challenges of creating an Arcade style game And it provides y

Real-world cure rates for hepatitis C virus treatments that include simeprevir and/or sofosbuvir are comparable to clinical trial results.

Science.gov (United States)

Bichoupan, Kian; Tandon, Neeta; Crismale, James F; Hartman, Joshua; Del Bello, David; Patel, Neal; Chekuri, Sweta; Harty, Alyson; Ng, Michel; Sigel, Keith M; Bansal, Meena B; Grewal, Priya; Chang, Charissa Y; Leong, Jennifer; Im, Gene Y; Liu, Lawrence U; Odin, Joseph A; Bach, Nancy; Friedman, Scott L; Schiano, Thomas D; Perumalswami, Ponni V; Dieterich, Douglas T; Branch, Andrea D

2017-11-12

To assess the real-world effectiveness and cost of simeprevir (SMV), and/or sofosbuvir (SOF)-based therapy for chronic hepatitis C virus (HCV) infection. The real-world performance of patients treated with SMV/SOF ± ribavirin (RBV), SOF/RBV, and SOF/RBV with pegylated-interferon (PEG) were analyzed in a consecutive series of 508 patients with chronic HCV infection treated at a single academic medical center. Patients with genotypes 1 through 4 were included. Rates of sustained virological response - the absence of a detectable serum HCV RNA 12 wk after the end of treatment [sustained virological response (SVR) 12] - were calculated on an intention-to-treat basis. Costs were calculated from the payer's perspective using Medicare/Medicaid fees and Redbook Wholesale Acquisition Costs. Patient-related factors associated with SVR12 were identified using multivariable logistic regression. SVR12 rates were as follows: 86% (95%CI: 80%-91%) among 178 patients on SMV/SOF ± RBV; 62% (95%CI: 55%-68%) among 234 patients on SOF/RBV; and 78% (95%CI: 68%-86%) among 96 patients on SOF/PEG/RBV. Mean costs-per-SVR12 were $174442 (standard deviation: ± $18588) for SMV/SOF ± RBV; $223003 (± $77946) for SOF/RBV; and $126496 (± $31052) for SOF/PEG/RBV. Among patients on SMV/SOF ± RBV, SVR12 was less likely in patients previously treated with a protease inhibitor [odds ratio (OR): 0.20, 95%CI: 0.06-0.56]. Higher bilirubin (OR: 0.47, 95%CI: 0.30-0.69) reduced the likelihood of SVR12 among patients on SOF/RBV, while FIB-4 score ≥ 3.25 reduced the likelihood of SVR12 (OR: 0.18, 95%CI: 0.05-0.59) among those on SOF/PEG/RBV. SVR12 rates for SMV and/or SOF-based regimens in a diverse real-world population are comparable to those in clinical trials. Treatment failure accounts for 27% of costs.

Cinacalcet and achievement of the NKF/K-DOQI recommended target values for bone and mineral metabolism in real-world clinical practice--the ECHO observational study

DEFF Research Database (Denmark)

Urena, P.; Jacobson, S.H.; Zitt, E.

2009-01-01

sevelamer; use of calcium-based phosphate binders increased by 5.6%. There was no unexpected safety or tolerability concerns. CONCLUSION: This analysis of current European clinical practice shows that-consistent with findings from randomized controlled trials and retrospective observational studies...

Uncertainties in real-world decisions on medical technologies.

Science.gov (United States)

Lu, C Y

2014-08-01

Patients, clinicians, payers and policy makers face substantial uncertainties in their respective healthcare decisions as they attempt to achieve maximum value, or the greatest level of benefit possible at a given cost. Uncertainties largely come from incomplete information at the time that decisions must be made. This is true in all areas of medicine because evidence from clinical trials is often incongruent with real-world patient care. This article highlights key uncertainties around the (comparative) benefits and harms of medical technologies. Initiatives and strategies such as comparative effectiveness research and coverage with evidence development may help to generate reliable and relevant evidence for decisions on coverage and treatment. These efforts could result in better decisions that improve patient outcomes and better use of scarce medical resources. © 2014 John Wiley & Sons Ltd.

Overall Survival of Patients with Locally Advanced or Metastatic Esophageal Squamous Cell Carcinoma Treated with Nimotuzumab in the Real World.

Science.gov (United States)

Saumell, Yaimarelis; Sanchez, Lizet; González, Sandra; Ortiz, Ramón; Medina, Edadny; Galán, Yaima; Lage, Agustin

2017-12-01

Despite improvements in surgical techniques and treatments introduced into clinical practice, the overall survival of patients with esophageal squamous cell carcinoma remains low. Several epidermal growth factor receptor inhibitors are being evaluated in the context of clinical trials, but there is little evidence of effectiveness in real-world conditions. This study aimed at assessing the effectiveness of nimotuzumab combined with onco-specific treatment in Cuban real-life patients with locally advanced or metastatic esophageal squamous cell carcinoma. A comparative and retrospective effectiveness study was performed. The 93 patients treated with nimotuzumab were matched, with use of propensity score matching, with patients who received a diagnosis of locally advanced or metastatic squamous cell carcinoma of the esophagus in three Cuban provinces reported between 2011 and 2015 to the National Cancer Registry. The Kaplan-Meier method was used to estimate event-time distributions. Log-rank statistics were used for comparisons of overall survival between groups. A two-component mixture model assuming a Weibull distribution was fitted to assess the effect of nimotuzumab on short-term and long-term survival populations. There was an increase in median overall survival in patients treated with nimotuzumab (11.9 months versus 6.5 months without treatment) and an increase in the 1-year survival rate (54.0% versus 21.9% without treatment). The 2-year survival rates were 21.1% for patients treated with nimotuzumab and 0% in the untreated cohort. There were statistically significant differences in survival between groups treated and not treated with nimotuzumab, both in the short-term survival population (6.0 months vs 4.0 months, p = 0.009) and in the long-term survival population (18.0 months vs 11.0 months, p = 0.001). Our study shows that nimotuzumab treatment concurrent with chemoradiotherapy increases the survival of real-world patients with locally advanced

Immunosuppressive Drug Discontinuation in Noninfectious Uveitis From Real-Life Clinical Practice: A Survival Analysis.

Science.gov (United States)

Abásolo, Lydia; Rosales, Zulema; Díaz-Valle, David; Gómez-Gómez, Alejandro; Peña-Blanco, Rayma C; Prieto-García, Ángela; Benítez-Del-Castillo, José Manuel; Pato, Esperanza; García-Feijoo, Julián; Fernández-Gutiérrez, Benjamín; Rodriguez-Rodriguez, Luis

2016-09-01

To assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs. Longitudinal retrospective cohort study. We included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models. We analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs. Clinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs. Copyright © 2016 Elsevier Inc. All rights reserved.

The patient registry: a high-impact tool for real world evidence

Directory of Open Access Journals (Sweden)

BarickUttam, MohantyRituraj, GowdaArun

2014-11-01

Full Text Available Background: In this world of seemingly infinite data across domains, one strives to acquire better tools and methodologies to fully exploit available data. This process begins with meticulous planning to gather relevant information and continues until there is an output in the form of credible evidence. The ability to generate real-world evidence would take such a process to new level: the factors that influence these processes under real-world conditions are varied, unpredictable, and unregulated. Results obtained in highly regulated or controlled conditions are universally accepted and sought after for regulatory approvals, but performance indicators in the real world will set the tone for the future. Hence, the demands for very reliant and robust tools and mechanisms for gathering evidence are all the more prominent and necessary. Patient registries fill this gap and stand tall among the various tools that could deliver the desired end results with acceptable accuracy. Over the years, pharmaceutical companies, along with policymakers and other stakeholders, have been actively involved in the development of such registries. Aims: Here we provide an overview of the usefulness of registries for the various stakeholders in healthcare in terms of conduct, approach, and barriers to initiating such studies. Conclusion: One of the impediments for the wider appeal and utility of registries is low awareness among the public and policymakers. Incorporating them as a part of the standard global healthcare system would involve setting up a regulatory framework.

A real world dissemination and implementation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders.

Science.gov (United States)

Gros, Daniel F; Szafranski, Derek D; Shead, Sarah D

2017-03-01

Dissemination and implementation of evidence-based psychotherapies is challenging in real world clinical settings. Transdiagnostic Behavior Therapy (TBT) for affective disorders was developed with dissemination and implementation in clinical settings in mind. The present study investigated a voluntary local dissemination and implementation effort, involving 28 providers participating in a four-hour training on TBT. Providers completed immediate (n=22) and six-month follow-up (n=12) training assessments and were encouraged to collect data on their TBT patients (delivery fidelity was not investigated). Findings demonstrated that providers endorsed learning of and interest in using TBT after the training. At six-months, 50% of providers reported using TBT with their patients and their perceived effectiveness of TBT to be very good to excellent. Submitted patient outcome data evidenced medium to large effect sizes. Together, these findings provide preliminary support for the effectiveness of a real world dissemination and implementation of TBT. Published by Elsevier Ltd.

Real-world objects are more memorable than photographs of objects

Directory of Open Access Journals (Sweden)

Jacqueline C Snow

2014-10-01

Full Text Available Research studies in psychology typically use two-dimensional (2D images of objects as proxies for real-world three-dimensional (3D stimuli. There are, however, a number of important differences between real objects and images that could influence cognition and behavior. Although human memory has been studied extensively, only a handful of studies have used real objects in the context of memory and virtually none have directly compared memory for real objects versus their 2D counterparts. Here we examined whether or not episodic memory is influenced by the format in which objects are displayed. We conducted two experiments asking participants to freely recall, and to recognize, a set of 44 common household objects. Critically, the exemplars were displayed to observers in one of three viewing conditions: real-world objects, colored photographs, or black and white line drawings. Stimuli were closely matched across conditions for size, orientation, and illumination. Surprisingly, recall and recognition performance was significantly better for real objects compared to colored photographs or line drawings (for which memory performance was equivalent. We replicated this pattern in a second experiment comparing memory for real objects versus color photos, when the stimuli were matched for viewing angle across conditions. Again, recall and recognition performance was significantly better for the real objects than matched color photos of the same items. Taken together, our data suggest that real objects are more memorable than pictorial stimuli. Our results highlight the importance of studying real-world object cognition and raise the potential for applied use in developing effective strategies for education, marketing, and further research on object-related cognition.

'Mind the gap' between the development of therapeutic innovations and the clinical practice in oncology: A proposal of the European Organisation for Research and Treatment of Cancer (EORTC) to optimise cancer clinical research.

Science.gov (United States)

Kempf, Emmanuelle; Bogaerts, Jan; Lacombe, Denis; Liu, Lifang

2017-11-01

In Europe, most of the cancer clinical research dedicated to therapeutic innovations aims primarily at regulatory approval. Once an anticancer drug enters the common market, each member state determines its real-world use based on its own criteria: pricing, reimbursement and clinical indications. Such an innovation-centred clinical research landscape might neglect patient-relevant issues in real-world setting, such as comparative effectiveness of distinct treatment options or long-term safety monitoring. The European Organisation for Research and Treatment of Cancer (EORTC) advocates reforming the current 'innovation-centred' system to a truly 'patient-centred' paradigm with systematically coordinated applied clinical research in conjunction with drug development, featuring the following strategy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Community Action Projects: Applying Biotechnology in the Real World

Science.gov (United States)

Nguyen, Phuong D.; Siegel, Marcelle A.

2015-01-01

Project-based learning and action research are powerful pedagogies in improving science education. We implemented a semester-long course using project-based action research to help students apply biotechnology knowledge learned in the classroom to the real world. Students had several choices to make in the project: working individually or as a…

Experiences in Automation and Control in Engineering Education with Real-world Based Educational Kits

Directory of Open Access Journals (Sweden)

Filomena SOARES

2015-10-01

Full Text Available The well-known paradigm learning by doing is particularly important in engineering courses. Still, in some situations, there is a lack of real-world didactic workbenches due to the absence of financial support, human resources or maintenances restrictions. The authors of this paper have been overcome this difficulty by designing and implementing virtual and remote laboratories in Process Monitoring, Control and Automation teaching applied to Mechanical, Electronics and Biomedical Engineering. The goal of this paper is to present the work developed regarding the real-world workbenches to be used in automation and control practical classes as an integrated virtual and remote laboratory. Some important points include the modelling and control of Discrete Event Systems, Continuous Systems and Real-Time Systems as well as Industrial Control Networks. The physical parts were developed and connected, in a closed-loop configuration, with the respective controllers. The developed kits and systems were geared towards the engineering students’ needs. This integrated approach is very useful for providing students with a global set of skills in this domain. Quantitative and qualitative studies are continuously applied not only for obtaining students feedback but also to gather information to devise strategies for future virtual and remote laboratory applications development suitable for the target public. The positive results achieved so far are very encouraging attesting its efficiency not only in terms of students’ learning but also as a first contact to face real-world problems. The less positive identified point is concerned with technical aspects.

Comparison between Euro NCAP test results and real-world crash data.

Science.gov (United States)

Kullgren, Anders; Lie, Anders; Tingvall, Claes

2010-12-01

The objective of this study was 2-fold: first, to compare Euro NCAP safety ratings of cars with those published by the Folksam real-world injury ratings; and second, to compare injury risk measures between Euro NCAP 2 and 5 Star cars with real-world injury and disability outcomes using police and insurance injury data. Car models were grouped according to the Euro NCAP star rating scores. Folksam risk of injury ratings come from statistical analysis of real-world crashes using police and insurance databases. The paired comparison method using 2-car crashes was used to control for crash speed and the mass differences between cars of different weights were normalized. For all comparisons, 5-star rated Euro NCAP cars were found to have a lower risk of injury compared to 2-star rated cars (5-star cars were 10% ± 2.5% lower risk than 2-star cars). For fatal and serious injuries, the difference was 23 ± 8 percent, and for fatal injuries alone the difference was 68 ± 32 percent. By comparison, the Folksam 5-star rated cars had a relative risk of 0.020 ± 0.0024, whereas 2-star rated car risk was 0.028 ± 0.0016, corresponding to a 27 percent difference in risk between 5- and 2-star cars. Good correlation was found between Euro NCAP test results and real-world injury outcomes. The largest difference in injury risk between 2- and 5-star rated cars in Euro NCAP was found for risk of fatality, confirming that car manufacturers have focused their safety performance on serious crash outcomes. In addition, Euro NCAP crash tests were shown to be highly correlated with serious crash performance, confirming their relevance for evaluating real-world crash performance. Good concordance was found between Euro NCAP and Folksam real-world crash and injury ratings.

Real-World Data on Prognostic Factors for Overall Survival in EGFR Mutation-Positive Advanced Non-Small Cell Lung Cancer Patients Treated with First-Line Gefitinib.

Science.gov (United States)

Yao, Zong-Han; Liao, Wei-Yu; Ho, Chao-Chi; Chen, Kuan-Yu; Shih, Jin-Yuan; Chen, Jin-Shing; Lin, Zhong-Zhe; Lin, Chia-Chi; Chih-Hsin Yang, James; Yu, Chong-Jen

2017-09-01

This study aimed to identify independent prognostic factors for overall survival (OS) of patients with advanced non-small cell lung cancer (NSCLC) harboring an activating epidermal growth factor receptor (EGFR) mutation and receiving gefitinib as first-line treatment in real-world practice. We enrolled 226 patients from June 2011 to May 2013. During this period, gefitinib was the only EGFR-tyrosine kinase inhibitor reimbursed by the Bureau of National Health Insurance of Taiwan. The median progression-free survival and median OS were 11.9 months (95% confidence interval [CI]: 9.7-14.2) and 26.9 months (21.2-32.5), respectively. The Cox proportional hazards regression model revealed that postoperative recurrence, performance status (Eastern Cooperative Oncology Grade [ECOG] ≥2), smoking index (≥20 pack-years), liver metastasis at initial diagnosis, and chronic hepatitis C virus (HCV) infection were independent prognostic factors for OS (hazard ratio [95% CI] 0.3 [0.11-0.83], p  = .02; 2.69 [1.60-4.51], p  lung cancer (NSCLC) patients treated with first-line gefitinib may raise awareness of benefit from anti-HCV treatment in this patient population. Brain metastasis in the initial diagnosis or intracranial progression during gefitinib treatment is not a prognostic factor for OS. This study, which enrolled a real-world population of NSCLC patients, including sicker patients who were not eligible for a clinical trial, may have impact on guiding usual clinical practice. © AlphaMed Press 2017.

Clinical Engineering: Experiences of assisted professional practices

International Nuclear Information System (INIS)

Langone, Luis; Vanetta, Marcos; Vazquez, Marcelo; Rotger, Viviana I; Olivera, Juan Manuel

2007-01-01

In the curricula of the Biomedical Engineering career of the Facultad de Ciencias Exactas y TecnologIa of the Universidad Nacional de Tucuman, Argenitna, there are the Assisted Professional Practices. Within this framework, the students have the possibility of performing practices in the clinic Sanatorio 9 de Julio. One of the objectives of these practices is to apply the concepts, methods and procedures studied along the career in the field work under real work conditions. From the point of view of the host institution, the objective is to improve the performance of the different services and areas applying the tools of Biomedical Engineering. The present work shows an example of such practices where an equipment preliminary analysis was made, its use and maintenance corresponding to the surgical unit of the clinic

Insulin Initiation in Insulin-Naïve Korean Type 2 Diabetic Patients Inadequately Controlled on Oral Antidiabetic Drugs in Real-World Practice: The Modality of Insulin Treatment Evaluation Study

Directory of Open Access Journals (Sweden)

Sang Soo Kim

2015-12-01

Full Text Available BackgroundThe Modality of Insulin Treatment Evaluation (MOTIV study was performed to provide real-world data concerning insulin initiation in Korean type 2 diabetes mellitus (T2DM patients with inadequate glycemic control with oral hypoglycemic agents (OHAs.MethodsThis multicenter, non-interventional, prospective, observational study enrolled T2DM patients with inadequate glycemic control (glycosylated hemoglobin [HbA1c] ≥7.0% who had been on OHAs for ≥3 months and were already decided to introduce basal insulin by their physician prior to the start of the study. All treatment decisions were at the physician's discretion to reflect real-world practice.ResultsA total of 9,196 patients were enrolled, and 8,636 patients were included in the analysis (mean duration of diabetes, 8.9 years; mean HbA1c, 9.2%. Basal insulin plus one OHA was the most frequently (51.0% used regimen. After 6 months of basal insulin treatment, HbA1c decreased to 7.4% and 44.5% of patients reached HbA1c <7%. Body weight increased from 65.2 kg to 65.5 kg, which was not significant. Meanwhile, there was significant increase in the mean daily insulin dose from 16.9 IU at baseline to 24.5 IU at month 6 (P<0.001. Overall, 17.6% of patients experienced at least one hypoglycemic event.ConclusionIn a real-world setting, the initiation of basal insulin is an effective and well-tolerated treatment option in Korean patients with T2DM who are failing to meet targets with OHA therapy.

5th International Workshop on Real-World Wireless Sensor Networks

CERN Document Server

Hu, Wen; Ferrari, Federico; Zimmerling, Marco; Mottola, Luca

2014-01-01

This edited book presents the results of the 5th Workshop on Real-world Wireless Sensor Networks (REALWSN). The purpose of this workshop  was to bring together researchers and practitioners working in the area of sensor networks, with focus on real-world experiments or deployments of wireless sensor networks. Included were, nonetheless, emerging forms of sensing such as those that leverage smart phones, Internet of Things, RFIDs, and robots. Indeed, when working with real-world experiments or deployments, many new or unforeseen issues may arise: the network environment may be composed of a variety of different technologies, leading to very heterogeneous network structures; software development for large scale networks poses new types of problems; the performance of prototype networks may differ significantly from the deployed system; whereas actual sensor network deployments may need a complex combination of autonomous and manual configuration. Furthermore, results obtained through simulation are typically n...

The role of hypnotherapy in evidence-based clinical practice.

Science.gov (United States)

Griffiths, M J

2017-05-01

The purpose of this review was to discuss the place of hypnotherapy in a modern medical world dominated by so-called evidence-based clinical practice. Hypnosis is an easily learned technique that is a valuable adjuvant to many medical, dental and psychological interventions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A FRET-based real-time PCR assay to identify the main causal agents of New World tegumentary leishmaniasis.

Directory of Open Access Journals (Sweden)

Pablo Tsukayama

Full Text Available In South America, various species of Leishmania are endemic and cause New World tegumentary leishmaniasis (NWTL. The correct identification of these species is critical for adequate clinical management and surveillance activities. We developed a real-time polymerase chain reaction (PCR assay and evaluated its diagnostic performance using 64 archived parasite isolates and 192 prospectively identified samples collected from individuals with suspected leishmaniasis enrolled at two reference clinics in Lima, Peru. The real-time PCR assay was able to detect a single parasite and provided unambiguous melting peaks for five Leishmania species of the Viannia subgenus that are highly prevalent in South America: L. (V. braziliensis, L. (V. panamensis, L. (V. guyanensis, L. (V. peruviana and L. (V. lainsoni. Using kinetoplastid DNA-based PCR as a gold standard, the real-time PCR had sensitivity and specificity values of 92% and 77%, respectively, which were significantly higher than those of conventional tests such as microscopy, culture and the leishmanin skin test (LST. In addition, the real-time PCR identified 147 different clinical samples at the species level, providing an overall agreement of 100% when compared to multilocus sequence typing (MLST data performed on a subset of these samples. Furthermore, the real-time PCR was three times faster and five times less expensive when compared to PCR - MLST for species identification from clinical specimens. In summary, this new assay represents a cost-effective and reliable alternative for the identification of the main species causing NWTL in South America.

Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice.

Science.gov (United States)

Saunders, Hannele

2015-07-01

To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.

Teaching Basic Science Content via Real-World Applications: A College-Level Summer Course in Veterinary Anatomy and Physiology

Science.gov (United States)

Maza, Paul; Miller, Allison; Carson, Brian; Hermanson, John

2018-01-01

Learning and retaining science content may be increased by applying the basic science material to real-world situations. Discussing cases with students during lectures and having them participate in laboratory exercises where they apply the science content to practical situations increases students' interest and enthusiasm. A summer course in…

Expanding our perspectives on research in musculoskeletal science and practice.

Science.gov (United States)

Kerry, Roger

2017-12-01

The quantity and quality of scientific research within physiotherapy has unquestionably grown and matured over the last few decades, especially since the "formal" onset of evidence-based physiotherapy in the 1990s. The urgent need to evaluate our practice for effectiveness and efficiency has been responded to with thought and respect to both scientific integrity and shop-floor clinical needs. However, after thirty years or more of a professionally-governed and strategic approach to research activity, it is now timely to reflect, review, and consider the next chapter in the relationship between scientific research and clinical practice. This masterclass aims to develop a research vision for the future of physiotherapy. It is proposed that a crisis is evident within evidence-based physiotherapy, particular so given the assumed complexity and context-sensitivity of our clinical practice. This crisis period has highlighted fundamental limitations within the way research and practice are currently related. These limitations are presented and framed within the problematisation of empirical and philosophical concerns. As research becomes increasingly aligned to traditional scientific principles, examination of the real world context in which its outcomes are intended expose critical challenges for both research and clinical practice. A reconceptualisation of fundamental elements of scientific research may allow more meaningful relationships between research and clinical practice. A proposed research vision encourages scientific activity to embrace real-world complexity in a way that it is presently unable to. An enhanced person-centered, scientifically-informed world of effective musculoskeletal practice is envisaged. Copyright © 2017 Elsevier Ltd. All rights reserved.

Practical considerations in clinical strategy to support the development of injectable drug-device combination products for biologics

Science.gov (United States)

Easton, Rachael

2018-01-01

ABSTRACT The development of an injectable drug-device combination (DDC) product for biologics is an intricate and evolving process that requires substantial investments of time and money. Consequently, the commercial dosage form(s) or presentation(s) are often not ready when pivotal trials commence, and it is common to have drug product changes (manufacturing process or presentation) during clinical development. A scientifically sound and robust bridging strategy is required in order to introduce these changes into the clinic safely. There is currently no single developmental paradigm, but a risk-based hierarchical approach has been well accepted. The rigor required of a bridging package depends on the level of risk associated with the changes. Clinical pharmacokinetic/pharmacodynamic comparability or outcome studies are only required when important changes occur at a late stage. Moreover, an injectable DDC needs to be user-centric, and usability assessment in real-world clinical settings may be required to support the approval of a DDC. In this review, we discuss the common issues during the manufacturing process and presentation development of an injectable DDC and practical considerations in establishing a clinical strategy to address these issues, including key elements of clinical studies. We also analyze the current practice in the industry and review relevant and status of regulatory guidance in the DDC field. PMID:29035675

Impact of triple antithrombotic therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention in real-world practice

NARCIS (Netherlands)

Yan, Yan; Wang, Xiao; Fan, Jing-Yao; Nie, Shao-Ping; Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Henriques, Jose P. Simao; D'Ascenzo, Fabrizio; Saucedo, Jorge; González-Juanatey, José R.; Wilton, Stephen B.; Kikkert, Wouter J.; Nuñez-Gil, Iván; Ariza-Sole, Albert; Song, Xian-Tao; Alexopoulos, Dimitrios; Liebetrau, Christoph; Kawaji, Tetsuma; Moretti, Claudio; Huczek, Zenon; Fujii, Toshiharu; Correia, Luis Cl; Kawashiri, Masa-Aki; Kedev, Sasko

2017-01-01

The optimal antithrombotic regimen for patients on oral anticoagulation (OAC) after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world

Surveillance on The Safety and Efficacy of Ambrisentan (Volibris Tablet 2.5 mg) in Patients with Pulmonary Arterial Hypertension in Real Clinical Practice: Post-marketing Surveillance (Interim Analysis Report).

Science.gov (United States)

Takahashi, Tomohiko; Hayata, Satoru; Kobayashi, Akihiro; Onaka, Yuna; Ebihara, Takeshi; Hara, Terufumi

2018-03-01

Pulmonary arterial hypertension (PAH) is an intractable and rare disease and the accumulation of clinical evidence under real-world setting is needed. A post-marketing surveillance for the endothelin receptor antagonist ambrisentan (Volibris tablet) has been conducted by all-case investigation since September 2010. This paper is an interim report on the safety and efficacy of ambrisentan in 702 patients with PAH. PAH patients aged 15 years or older were subjected to the analysis. The safety analysis by overall cases or stratification of patient backgrounds and the efficacy analysis were investigated. Regarding patient characteristics, the 702 patients subjected to safety analysis included 543 (77.4%) women and 546 (77.8%) patients at WHO functional class II/III. The mean observational time was 392.7 days. A total of 324 adverse drug reaction (ADR) occurred in 204 (29.1%) patients. Common ADRs (≥ 2%) included anemia (4.6%), peripheral edema (4.1%), headache (3.6%), edema and face edema (2.6% each), abnormal hepatic function (2.3%), and epistaxis (2.1%). There were 82 serious ADRs occurring in 44 (6.3%) patients (385 serious adverse events in 184 (26.2%) patients). Although 11 (1.6%) interstitial lung disease (ILD) cases were reported, all were observed in patients with disease that may contribute to ILD and therefore it is difficult to assess if ambrisentan was associated with these events. There was no difference in safety in relation to the presence/absence of connective tissue disease-related PAH (CTD-PAH) or combination therapy. Among 677 patients subjected to efficacy analysis, those in whom hemodynamic status was determined before and after treatment showed improvement in the mean pulmonary arterial pressure and pulmonary vascular resistance after treatment. The interim results showed safety consistent with the known profile of ambrisentan in terms of the types and frequencies of ADRs in patients with PAH in real clinical practice, in comparison with

Type 2 diabetes prevention in the "real world": one-year results of the GOAL Implementation Trial.

Science.gov (United States)

Absetz, Pilvikki; Valve, Raisa; Oldenburg, Brian; Heinonen, Heikki; Nissinen, Aulikki; Fogelholm, Mikael; Ilvesmäki, Vesa; Talja, Martti; Uutela, Antti

2007-10-01

"Real-world" implementation of lifestyle interventions is a challenge. The Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial was designed for the primary health care setting, with lifestyle and risk reduction objectives derived from the major diabetes prevention efficacy trials. We report on the program's effectiveness as well as findings related to the program's reach, adoption, and implementation. A total of 352 middle-aged participants with elevated type 2 diabetes risk were recruited from the health care centers in Päijät-Häme Province in Finland. The intervention included six group counseling sessions, delivered by trained public health nurses. Measurement was conducted at baseline and 12 months. Clinical risk factors were measured by study nurses, and lifestyle outcomes were analyzed from self-reports. Lifestyle outcomes were compared with the outcomes achieved in relevant efficacy trials, and within-subject changes were tested for risk reduction. At baseline, mean BMI was >32 kg/m2, and 25% of the participants had impaired glucose tolerance. At 12 months, 20% of participants achieved at least four of five key lifestyle outcomes, with these results being comparable with the reference trials. However, physical activity and weight loss goals were achieved significantly less frequently (65 vs. 86% and 12 vs. 43%, respectively). Several clinical risk factors decreased, more so among men than women. This trial demonstrates that lifestyle counseling can be effective and is feasible in real-world settings for individuals with elevated risk of type 2 diabetes. To increase program impact, program exposure and treatment intensity need to be increased.

Dosing of Intravenous Tocilizumab in a Real-World Setting of Rheumatoid Arthritis: Analyses from the Corrona Registry.

Science.gov (United States)

Pappas, Dimitrios A; John, Ani; Curtis, Jeffrey R; Reed, George W; Karki, Chitra; Magner, Robert; Kremer, Joel M; Shewade, Ashwini; Greenberg, Jeffrey D

2016-06-01

In the United States, the recommended starting dose of intravenous tocilizumab (TCZ) is 4 mg/kg every 4 weeks, with an increase to 8 mg/kg based on clinical response for patients with moderate to severe rheumatoid arthritis; however, data on how TCZ dose is escalated in real life are missing. The objective of this analysis was to describe patterns of early intravenous TCZ dose escalation in a real-world setting using data from the Corrona registry. All patients enrolled in the comparative effectiveness substudy (CERTAIN) nested within Corrona who initiated TCZ and completed 3- and 6-month study visits were eligible for inclusion. Patients who initiated TCZ 4 mg/kg were categorized into 1 of 2 groups: those who remained on TCZ 4 mg/kg at 3 months (Group 1) and those who escalated to TCZ 8 mg/kg by or at 3 months (Group 2). Changes in clinical disease activity measures were provided. Of the 213 patients who were eligible for analysis, 86 (40.4%) remained on their initial dose of TCZ 4 mg/kg (Group 1) and 110 (51.6%) were escalated to TCZ 8 mg/kg by or at 3 months (Group 2). Baseline demographic and clinical characteristics were similar between the 2 groups; except in Group 2, patients were older (58.3 vs. 54.0 years) and a lower proportion was female (75.5% vs. 89.4%) than in Group 1. Significant improvements in disease activity measures were observed at 3 and 6 months in both groups, with the majority of patients in both groups achieving moderate or good European League Against Rheumatism response. Real-world data demonstrated that physicians escalate TCZ dose at varying frequencies. The ability to administer TCZ in varying doses allows physicians to tailor TCZ therapy to disease activity. ClinicalTrials.gov identifier, NCT01625650.

Integrated Concentration in Science (iCons): Undergraduate Education Through Interdisciplinary, Team-Based, Real-World Problem Solving

Science.gov (United States)

Tuominen, Mark

2013-03-01

Attitude, Skills, Knowledge (ASK) - In this order, these are fundamental characteristics of scientific innovators. Through first-hand practice in using science to unpack and solve complex real-world problems, students can become self-motivated scientific leaders. This presentation describes the pedagogy of a recently developed interdisciplinary undergraduate science education program at the University of Massachusetts Amherst focused on addressing global challenges with scientific solutions. Integrated Concentration in Science (iCons) is an overarching concentration program that supplements the curricula provided within each student's chosen major. iCons is a platform for students to perform student-led research in interdisciplinary collaborative teams. With a schedule of one course per year over four years, the cohort of students move through case studies, analysis of real-world problems, development of potential solutions, integrative communication, laboratory practice, and capstone research projects. In this presentation, a track emphasizing renewable energy science is used to illustrate the iCons pedagogical methods. This includes discussion of a third-year laboratory course in renewable energy that is educationally scaffolded: beginning with a boot camp in laboratory techniques and culminating with student-designed research projects. Among other objectives, this course emphasizes the practice of using reflection and redesign, as a means of generating better solutions and embedding learning for the long term. This work is supported in part by NSF grant DUE-1140805.

Management of advanced pancreatic cancer in daily clinical practice.

Science.gov (United States)

Giuliani, Jacopo; Piacentini, Paolo; Bonetti, Andrea

2016-01-01

The aim of this outcome study was to evaluate the management of advanced pancreatic cancer in a real-world clinical practice; few such experiences have been reported in the literature. A retrospective analysis was performed of all consecutive patients with advanced pancreatic ductal adenocarcinoma followed at our medical oncology unit between January 2003 and December 2013. We evaluated 78 patients, mostly with metastatic disease (64.1%). Median follow-up was 10.77 months, by which time 74 patients (94.9%) had died. Median overall survival was 8.29 months. Median age was 67 years. In univariate analysis, pain at onset (p = 0.020), ECOG performance status (p<0.001), stage (p = 0.047), first-line chemotherapy (p<0.001), second-line chemotherapy (p<0.001) and weight loss at diagnosis (p = 0.029) were factors that had an impact on overall survival. In multivariate analysis, the presence of pain at onset (p = 0.043), stage (p = 0.003) and second-line chemotherapy (p = 0.004) were confirmed as independent prognostic factors. Our data, derived from daily clinical practice, confirmed advanced pancreatic cancer as an aggressive malignant disease with a very short expected survival. Second-line treatment seems to provide an advantage in terms of overall survival in patients who showed a partial response as their best response to first-line treatment.

24 CFR 100.50 - Real estate practices prohibited.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Real estate practices prohibited....50 Real estate practices prohibited. (a) This subpart provides the Department's interpretation of... in, any multiple-listing service, real estate brokers' association, or other service organization or...

Real-life efficacy of pregabalin for the treatment of peripheral neuropathic pain in daily clinical practice in Denmark: the NEP-TUNE study

Directory of Open Access Journals (Sweden)

Crawford ME

2016-05-01

Full Text Available Michael E Crawford,1 Peter Bo Poulsen,2 Berit Schiøttz-Christensen,3 Andreas Habicht,4 Mette Strand,2 Flemming W Bach5 1Copenhagen City Pain Clinic, Copenhagen K, 2Pfizer Denmark ApS, Ballerup, 3Spine Center Southern Denmark, Lillebælt Hospital, Middelfart, 4Signifikans ApS, Vedbæk, 5Department of Neurology, Aalborg University Hospital, Aalborg, Denmark Objective: The aim of this study was to provide evidence regarding the real-life efficacy of pregabalin in the treatment of peripheral neuropathic pain (NeP in Denmark. Methods: In this prospective, observational, noninterventional study, pregabalin (Lyrica® was prescribed following usual clinical practice. Compared with baseline, the primary study end points after 3 months of observation were changes in 1 the average level of pain during the past week, 2 the worst level of pain during the past week, and 3 the least level of pain during the past week. The Wilcoxon signed-rank test was used to perform paired analyses, and a multivariate regression analysis investigated factors driving change in pain. Results: A total of 86 of the 128 patients included were regarded as efficacy evaluable (those completing 3 months of pregabalin treatment. Patients (59 years were long-time sufferers of peripheral NeP, and 38% of them had comorbidities. The majority had previously been treated with tricyclic antidepressants or gabapentin. The average dose of pregabalin was 81.5 mg/d at baseline and 240 mg/d after 3 months. A clinically and statistically significant improvement of 2.2 points in the average level of pain intensity was found after 3 months. The higher the pain intensity at baseline, the higher was the reduction of the pain score. Positive results were also found for pain-related sleep interference, patients’ global impression of change, quality of life, and work and productivity impairment. Twenty-one patients reported 28 adverse events. Conclusion: This real-life study indicates that for some

Clinical Studies

DEFF Research Database (Denmark)

Pallesen, Ulla

universities and practicing dentists restore millions of teeth throughout the World with composite resin materials. Do we know enough about the clinical performance of these restorations over time? Numerous in vitro studies are being published on resin materials and adhesion, some of them attempting to imitate...... in vivo conditions. But real life is different and in vitro studies cannot include all variables. Only clinical studies can provide valid information on the clinical performance of restorations over time. What do we know about longevity of posterior resin restorations? What are the reasons for replacement...... and results from own up to 30-year prospective clinical university studies and practice based studies from Public Dental Health Service on the clinical performance of posterior composite resin restorations....

Producing Competent Doctors - The Art and Science of Teaching Clinical Skills.

Science.gov (United States)

Dhaliwal, Upreet; Supe, Avinash; Gupta, Piyush; Singh, Tejinder

2017-05-15

For a doctor to provide medical care with competence, he must not only have knowledge but must also be able to translate that knowledge into action. It is his competence in clinical skills that will enable him to practice safely and effectively in the real world. To ensure acquisition of clinical skills, medical teachers must adopt teaching methods that prioritise observation, practice, feedback; and more practice. We try to elucidate the meaning of clinical skills, the challenges inherent in clinical skills training in India, training models that have shown success in practice and can be adopted in the Indian context, and various techniques to enhance skill-training, including the giving of feedback, which is a critically important component of skills development.

Medical Ethics in Contemporary Clinical Practice

Directory of Open Access Journals (Sweden)

John R. Williams

2005-11-01

Full Text Available This review article describes and analyzes ethical issues in medical practice, particularly those issues encountered by physicians in their relationships with their patients. These relationships often involve ethical conflicts between 2 or more interests, which physicians need to recognize and resolve. The article deals with 4 topics in clinical practice in which ethical conflicts occur: physicians' duty of confidentiality in a digital environment, their responsibilities for dealing with abuses of the human rights of patients, their role in clinical research, and their relationships with commercial enterprises. The ethical policies of the World Medical Association provide the basis for determining appropriate physician conduct on these matters. The article concludes with reflections on the need for international standards of medical ethics.

Applications of Temporal Graph Metrics to Real-World Networks

Science.gov (United States)

Tang, John; Leontiadis, Ilias; Scellato, Salvatore; Nicosia, Vincenzo; Mascolo, Cecilia; Musolesi, Mirco; Latora, Vito

Real world networks exhibit rich temporal information: friends are added and removed over time in online social networks; the seasons dictate the predator-prey relationship in food webs; and the propagation of a virus depends on the network of human contacts throughout the day. Recent studies have demonstrated that static network analysis is perhaps unsuitable in the study of real world network since static paths ignore time order, which, in turn, results in static shortest paths overestimating available links and underestimating their true corresponding lengths. Temporal extensions to centrality and efficiency metrics based on temporal shortest paths have also been proposed. Firstly, we analyse the roles of key individuals of a corporate network ranked according to temporal centrality within the context of a bankruptcy scandal; secondly, we present how such temporal metrics can be used to study the robustness of temporal networks in presence of random errors and intelligent attacks; thirdly, we study containment schemes for mobile phone malware which can spread via short range radio, similar to biological viruses; finally, we study how the temporal network structure of human interactions can be exploited to effectively immunise human populations. Through these applications we demonstrate that temporal metrics provide a more accurate and effective analysis of real-world networks compared to their static counterparts.

Matching rendered and real world images by digital image processing

Science.gov (United States)

Mitjà, Carles; Bover, Toni; Bigas, Miquel; Escofet, Jaume

2010-05-01

Recent advances in computer-generated images (CGI) have been used in commercial and industrial photography providing a broad scope in product advertising. Mixing real world images with those rendered from virtual space software shows a more or less visible mismatching between corresponding image quality performance. Rendered images are produced by software which quality performance is only limited by the resolution output. Real world images are taken with cameras with some amount of image degradation factors as lens residual aberrations, diffraction, sensor low pass anti aliasing filters, color pattern demosaicing, etc. The effect of all those image quality degradation factors can be characterized by the system Point Spread Function (PSF). Because the image is the convolution of the object by the system PSF, its characterization shows the amount of image degradation added to any taken picture. This work explores the use of image processing to degrade the rendered images following the parameters indicated by the real system PSF, attempting to match both virtual and real world image qualities. The system MTF is determined by the slanted edge method both in laboratory conditions and in the real picture environment in order to compare the influence of the working conditions on the device performance; an approximation to the system PSF is derived from the two measurements. The rendered images are filtered through a Gaussian filter obtained from the taking system PSF. Results with and without filtering are shown and compared measuring the contrast achieved in different final image regions.

Will availability of inhaled human insulin (Exubera® improve management of type 2 diabetes? The design of the Real World trial

Directory of Open Access Journals (Sweden)

Freemantle Nick

2006-08-01

Full Text Available Abstract Background Common deterrents to insulin therapy for both physicians and patients are the complexity and burden of daily injections. In January 2006, the first inhaled human insulin (INH, Exubera® (insulinhuman [rDNA origin]InhalationPowder was approved for use in adult patients with type 1 diabetes mellitus (T1DM or type 2 diabetes mellitus (T2DM in the United States and European Union. Results from the INH clinical trial program have shown comparable efficacy of INH to subcutaneous (SC insulin and superior efficacy versus oral antidiabetic agents; thus providing effective glycemic control in adult patients with T2DM without the requirement for preprandial injections. However, because subjects in those trials were randomized to either INH or an alternative, the studies could not estimate the effect of INH on patient acceptance of insulin therapy. Therefore, traditional study designs cannot provide answers to important and practical questions regarding real world effectiveness, which is influenced by psychological and other access barriers. Methods To overcome these limitations, the Real World Trial was designed to estimate the effect of the availability of INH as a treatment option for glycemic control. A total of approximately 700 patients from Canada, France, Germany, Italy, Spain, United Kingdom, and the United States with T2DM poorly controlled by oral agent therapy will be randomized to two different treatment settings. Patients and clinicians in both groups (A & B may choose from all licensed therapies for diabetes including SC insulin delivered by pens; INH will be an additional treatment option only available in Group A. The Real World Trial (Protocol A2171018 has been registered with ClincalTrials.gov, registration id NCT00134147. Results The primary outcome for the trial will be the difference in mean glycosylated hemoglobin (HbA1c at 6 months between groups. The design was based on a preceding feasibility study examining the

A leadless pacemaker in the real-world setting

DEFF Research Database (Denmark)

Roberts, Paul R.; Clementy, Nicolas; Al Samadi, Faisal

2017-01-01

, telemetry, and battery issues. Objective The acute performance of the Micra transcatheter pacemaker from a worldwide Post-Approval Registry is reported. Methods The registry is an ongoing prospective single-arm observational study designed to assess the safety and effectiveness of Micra in the post...... were low and stable. Conclusion Performance of the Micra transcatheter pacemaker in a real-world setting demonstrates a high rate (99.6%) of implant success and low rate (1.51%) of major complications through 30 days post implant. In particular, the rates of pericardial effusion, device dislodgement...

Development and psychometric evaluation of the self-assessment of psoriasis symptoms (SAPS) - clinical trial and the SAPS - real world patient-reported outcomes.

Science.gov (United States)

Armstrong, April W; Banderas, Benjamin; Foley, Catherine; Stokes, Jonathan; Sundaram, Murali; Shields, Alan L

2017-09-01

The Self-Assessment of Psoriasis Symptoms - Clinical Trials (SAPS-CT) and SAPS - Real World (SAPS-RW) were simultaneously created to assess the experience of plaque psoriasis in two unique contexts. Qualitative and quantitative research was conducted in four phases namely concept elicitation, questionnaire construction, content evaluation and psychometric evaluation. Following concept elicitation, 18 concepts were selected to inform questionnaire construction of the SAPS-CT and SAPS-RW. To accommodate each context of use, the SAPS-CT asks respondents to rate the target symptom 'at its worst' in the 24 h prior to assessment, while the SAPS-RW asks respondents to rate the target symptom "on average" in the 7 days prior to assessment. Cognitive debriefing confirmed that patients could comprehend and provide meaningful responses to both versions and, after minor modifications, resulted in 11-item questionnaires administered in an observational study (N = 200). Results from the observational study informed further item reduction (SAPS-RW to six items and SAPS-CT to nine items) and demonstrated that scores from each were reliable (Cronbach's α > 0.90, test-retest intraclass correlation coefficient >0.70), construct valid and able to differentiate among clinically distinct groups. The SAPS-CT and SAPS-RW are content-valid PRO questionnaires capable of producing psychometrically sound scores when administered chronic to plaque psoriasis patients.

A Practical Framework for Sharing and Rendering Real-World Bidirectional Scattering Distribution Functions

Energy Technology Data Exchange (ETDEWEB)

Ward, Greg [Anywhere Software, Albany, CA (United States); Kurt, Murat [International Computer Institute, Ege University (Turkey); Bonneel, Nicolas [Harvard Univ., Cambridge, MA (United States)

2012-09-30

The utilization of real-world materials has been hindered by a lack of standards for sharing and interpreting measured data. This paper presents an XML representation and an Open Source C library to support bidirectional scattering distribution functions (BSDFs) in data-driven lighting simulation and rendering applications.The library provides for the efficient representation, query, and Monte Carlo sampling of arbitrary BSDFs in amodel-free framework. Currently, we support two BSDF data representations: one using a fixed subdivision of thehemisphere, and one with adaptive density. The fixed type has advantages for certain matrix operations, while theadaptive type can more accurately represent highly peaked data. We discuss advanced methods for data-drivenBSDF rendering for both types, including the proxy of detailed geometry to enhance appearance and accuracy.We also present an advanced interpolation method to reduce measured data into these standard representations.We end with our plan for future extensions and sharing of BSDF data.

The utility of observational studies in clinical decision making: lessons learned from statin trials.

Science.gov (United States)

Foody, JoAnne M; Mendys, Phillip M; Liu, Larry Z; Simpson, Ross J

2010-05-01

Contemporary clinical decision making is well supported by a wide variety of information sources, including clinical practice guidelines, position papers, and insights from randomized controlled trials (RCTs). Much of our fundamental understanding of cardiovascular risk factors is based on multiple observations from major epidemiologic studies, such as The Seven Country Studies and the US-based Framingham Heart Study. These studies provided the framework for the development of clinical practice guidelines, including the National Cholesterol Education Program Adult Treatment Panel series. The objective of this article is to highlight the value of observational studies as a complement to clinical trial data for clinical decision making in real-world practice. Although RCTs are still the benchmark for assessing clinical efficacy and safety of a specific therapeutic approach, they may be of limited utility to practitioners who must then adapt the lessons learned from the trial into the patient care environment. The use of well-structured observational studies can improve our understanding of the translation of clinical trials into clinical practice, as demonstrated here with the example of statins. Although such studies have their own limitations, improved techniques for design and analysis have reduced the impact of bias and confounders. The introduction of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines has provided more uniformity for such studies. When used together with RCTs, observational studies can enhance our understanding of effectiveness and utility in real-world clinical practice. In the examples of statin observational studies, the results suggest that relative effectiveness of different statins and potential impact of switching statins should be carefully considered in treating individual patients by practicing physicians.

Using mathematics to solve real world problems: the role of enablers

DEFF Research Database (Denmark)

Niss, Mogens Allan; Geiger, Vincent; Stillman, Gloria

2018-01-01

The purpose of this article is to report on a newly funded research project in which we will investigate how secondary students apply mathematical modelling to effectively address real world situations. Through this study, we will identify factors, mathematical, cognitive, social and environmenta...

Long-term outcomes of acute ischemic stroke patients treated with endovascular thrombectomy: A real-world experience.

Science.gov (United States)

Zhao, Wenbo; Shang, Shuyi; Li, Chuanhui; Wu, Longfei; Wu, Chuanjie; Chen, Jian; Song, Haiqing; Zhang, Hongqi; Zhang, Yunzhou; Duan, Jiangang; Feng, Wuwei; Ji, Xunming

2018-07-15

Long-term follow-up of large trials have confirmed the superiority of endovascular thrombectomy (ET) for treating acute ischemic stroke (AIS). However, it is still unknown whether these results can be generalized to clinical practice. In this study, we aimed to determine the long-term outcomes of AIS post-ET in the real-world clinical practice. This observational study is based on a single-center prospective registry study. AIS patients were treated with second-generation stent retrievers from December 2012 to April 2016. The primary outcome was modified Ranks scale (mRS) at the time of the latest assessment. Favorable outcome was defined as mRS scores 0-2, and the unfavorable outcome was defined as mRS scores 3-6. Eighty-nine AIS subjects with large artery occlusion in anterior circulation undergoing ET were eligible for analysis. Median follow-up duration was 20 months (interquartile range 6-32), and 47 subjects (53%) achieved favorable outcome whereas 17 subjects (19%) were functional dependence and 25 subjects (28%) died. Independent predicators for long-term unfavorable outcome were higher baseline National Institutes of Health Stroke Scale (NIHSS) score (odd ratio:1.21;95% confidence interval 1.09-1.35; p < 0.001) and symptomatic intracerebral hemorrhage (sICH) (odd ratio:16.45;95% confidence interval 1.34-193.44; p = 0.026). More subjects of large-artery-atherosclerosis underwent permanent intracranial stenting (22%vs.10%) as compared with those of cardioembolism, while subjects of cardioembolism were more likely to experience sICH (13%vs.8%) and died (32%vs.16%). Over half of AIS patients can achieve favorable long-term outcomes post-ET. Higher baseline NIHSS scores and sICH are independently associated with unfavorable outcome. Overall, clinical practice in this single canter can replicate the long-term outcomes from the published endovascular clinical trials. Copyright © 2018 Elsevier B.V. All rights reserved.

Experience as a doctor in the developing world: does it benefit the clinical and organisational performance in general practice?

Directory of Open Access Journals (Sweden)

de Wit Niek J

2009-12-01

Full Text Available Abstract Background Many physicians have medical experience in developing countries early in their career, but its association with their medical performance later is not known. To explore possible associations we compared primary care physicians (GPs with and without professional experience in a developing country in performance both clinical and organisational. Methods A retrospective survey using two databases to analyse clinical and organisational performance respectively. Analysis was done at the GP level and practice level. 517 GPs received a questionnaire regarding relevant working experience in a developing country. Indicators for clinical performance were: prescription, referral, external diagnostic procedures and minor procedures. We used the district health insurance data base covering 570.000 patients. Explorative secondary analysis of practice visits of 1004 GPs in 566 practices in the Netherlands from 1999 till 2001. We used a validated practice visit method (VIP; 385 indicators in 51 dimensions of practice management to compare having experience in a developing country or not. Results Almost 8% of the GPs had experience in a developing country of at least two years. These GPs referred 9,5% less than their colleagues and did more surgical procedures. However, in the multivariate analysis 'experience in a developing country' was not significantly associated with clinical performance or with other GP- and practice characteristics. 16% of the practices a GP or GPs with at least two years experience in a developing country. They worked more often in group and rural practices with less patients per fte GP and more often part-time. These practices are more hygienic, collaborate more with the hospital and score better on organisation of the practice. These practices score less on service and availability, spend less time on patients in the consultation and the quality of recording in the EMD is lower. Conclusions We found interesting

Mobile computing deployment and management real world skills for Comptia Mobility+ certification and beyond

CERN Document Server

Bartz, Robert J

2015-01-01

Mobile computing skills are becoming standard in the IT industry Mobile Computing Deployment and Management: Real World Skills for CompTIA Mobility+ Certification and Beyond is the ultimate reference for mobile computing. Certified Wireless Network Expert Robert J. Bartz guides IT and networking professionals through the fundamental and advanced concepts of mobile computing, providing the information and instruction necessary to get up to speed on current technology and best practices. The book maps to the CompTIA Mobility+ (MB0-001) exam, making it an ideal resource for those s

Rationale and design of the DARWIN-T2D (DApagliflozin Real World evIdeNce in Type 2 Diabetes): A multicenter retrospective nationwide Italian study and crowdsourcing opportunity.

Science.gov (United States)

Fadini, G P; Zatti, G; Consoli, A; Bonora, E; Sesti, G; Avogaro, A

2017-12-01

Randomized controlled trials (RCTs) in the field of diabetes have limitations inherent to the fact that design, setting, and patient characteristics may be poorly transferrable to clinical practice. Thus, evidence from studies using routinely accumulated clinical data are increasingly valued. We herein describe rationale and design of the DARWIN-T2D (DApagliflozin Real World evIdeNce in Type 2 Diabetes), a multicenter retrospective nationwide study conducted at 50 specialist outpatient clinics in Italy and promoted by the Italian Diabetes Society. The primary objective of the study is to describe the baseline clinical characteristics (particularly HbA1c) of patients initiated on dapagliflozin from marketing authorization approval to the end of 2016. Secondary and exploratory objectives will evaluate the changes in glycaemic and extraglycaemic efficacy parameters after initiation of dapagliflozin or after initiation of comparator glucose lowering medications (DPP-4 inhibitors, gliclazide extended release, and long-acting GLP-1 receptor agonists). An automated software will extract relevant data from the same electronic chart system at all centres, thereby minimizing data treatment and human intervention. The study is expected to collect an enormous dataset of information on dapagliflozin- and comparator-using patients. After study completion, the Italian Diabetes Society will launch an open crowdsourcing call on the DARWIN-T2D database, challenging diabetes researchers to apply their ideas and approaches to address new unmet needs and knowledge gaps in diabetes. We believe this will move DARWIN-T2D to the next generation of real world studies. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Developing Humanoid Robots for Real-World Environments

Science.gov (United States)

Stoica, Adrian; Kuhlman, Michael; Assad, Chris; Keymeulen, Didier

2008-01-01

Humanoids are steadily improving in appearance and functionality demonstrated in controlled environments. To address the challenges of operation in the real-world, researchers have proposed the use of brain-inspired architectures for robot control, and the use of robot learning techniques that enable the robot to acquire and tune skills and behaviours. In the first part of the paper we introduce new concepts and results in these two areas. First, we present a cerebellum-inspired model that demonstrated efficiency in the sensory-motor control of anthropomorphic arms, and in gait control of dynamic walkers. Then, we present a set of new ideas related to robot learning, emphasizing the importance of developing teaching techniques that support learning. In the second part of the paper we propose the use in robotics of the iterative and incremental development methodologies, in the context of practical task-oriented applications. These methodologies promise to rapidly reach system-level integration, and to early identify system-level weaknesses to focus on. We apply this methodology in a task targeting the automated assembly of a modular structure using HOAP-2. We confirm this approach led to rapid development of a end-to-end capability, and offered guidance on which technologies to focus on for gradual improvement of a complete functional system. It is believed that providing Grand Challenge type milestones in practical task-oriented applications accelerates development. As a meaningful target in short-mid term we propose the 'IKEA Challenge', aimed at the demonstration of autonomous assembly of various pieces of furniture, from the box, following included written/drawn instructions.

Adding Value by Hospital Real Estate: An Exploration of Dutch Practice.

Science.gov (United States)

van der Zwart, Johan; van der Voordt, Theo J M

2016-01-01

To explore how hospital real estate can add value to the healthcare organization, which values are prioritized in practice, and why. Dutch healthcare organizations are self-responsible for the costs and benefits of their accommodation. Meanwhile, a lively debate is going on about possible added values of corporate and public real estate in the fields of corporate real estate management and facility management. This article connects both worlds and compares insights from literature with experiences from practice. Added values extracted from literature have been discussed with 15 chief executive officers and project leaders of recently newly built hospitals in the Netherlands. Interviewees were asked (1) which values are included in the design and management of their hospital and why, (2) to prioritize most important values from a list of nine predefined values, and (3) to explain how the chosen real estate decisions are supposed to support organizational objectives. Stimulating innovation, user satisfaction, and improving organizational culture are most highly valued, followed by improving productivity, reducing building costs, and creating building flexibility. Image, risk control, and financing possibilities got lower rankings. The findings have been used to develop a value-impact matrix that connects nine values to various stakeholders and possible interventions. The findings and the value-impact matrix can make different stakeholders aware of many possible added values of hospital real estate, potential synergy and conflicts between different values, and how to steer on value add in different phases of the life cycle. © The Author(s) 2015.

Getting Real Results with Ohio State University Extension’s Real Money. Real World. Program

Directory of Open Access Journals (Sweden)

Theresa M. Ferrari

2010-06-01

Full Text Available Youth development organizations have a unique opportunity to offer programs that help young people develop financial skills they need to become successful adults. This article describes Ohio State University Extension’s Real Money. Real World. (RMRW and the systematic approach used to evaluate its effectiveness. The RMRW curriculum includes an active, hands-on experience that gives young people the opportunity to make lifestyle and budget choices similar to those they will make as adults. The realistic simulation creates a teachable moment. The outcomes of the statewide evaluation clearly indicate the curriculum accomplishes its goals of raising awareness, changing attitudes, and motivating students to plan for behavior changes concerning financial management, education, and career choices. The article concludes with a discussion of the organizational outcomes of conducting the evaluation.

Chronic urticaria in the real-life clinical practice setting in Sweden, Norway and Denmark

DEFF Research Database (Denmark)

Thomsen, S F; Pritzier, E C; Anderson, C D

2017-01-01

]; chronic urticaria quality of life questionnaire [CU-Q2 oL; Danish patients only]) and work productivity and activity impairment (WPAI) scores were also assessed. RESULTS: Overall, 158 CU patients from seven centres in Denmark (n = 80), Norway (n = 50) and Sweden (n = 28) were included in this baseline......BACKGROUND: Chronic urticaria (CU) is characterized by the recurrence of itchy hives and/or angioedema for more than 6 weeks. AWARE (A World-wide Antihistamine-Refractory Chronic Urticaria Patient Evaluation) is a multinational study designed to document the real-life treatment situation, burden...... (>2 months) that is refractory to H1-antihistamines. Baseline patient characteristics, disease activity (urticaria control test [UCT]), pharmacological treatment, comorbidities and healthcare usage were documented by the treating physician. Quality of life (QoL; dermatology life quality index [DLQI...

Clinical decision making in veterinary practice

OpenAIRE

Everitt, Sally

2011-01-01

Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, how...

What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London.

Science.gov (United States)

Lennox, Laura; Doyle, Cathal; Reed, Julie E; Bell, Derek

2017-09-24

Although improvement initiatives show benefits to patient care, they often fail to sustain. Models and frameworks exist to address this challenge, but issues with design, clarity and usability have been barriers to use in healthcare settings. This work aimed to collaborate with stakeholders to develop a sustainability tool relevant to people in healthcare settings and practical for use in improvement initiatives. Tool development was conducted in six stages. A scoping literature review, group discussions and a stakeholder engagement event explored literature findings and their resonance with stakeholders in healthcare settings. Interviews, small-scale trialling and piloting explored the design and tested the practicality of the tool in improvement initiatives. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). CLAHRC NWL improvement initiative teams and staff. The iterative design process and engagement of stakeholders informed the articulation of the sustainability factors identified from the literature and guided tool design for practical application. Key iterations of factors and tool design are discussed. From the development process, the Long Term Success Tool (LTST) has been designed. The Tool supports those implementing improvements to reflect on 12 sustainability factors to identify risks to increase chances of achieving sustainability over time. The Tool is designed to provide a platform for improvement teams to share their own views on sustainability as well as learn about the different views held within their team to prompt discussion and actions. The development of the LTST has reinforced the importance of working with stakeholders to design strategies which respond to their needs and preferences and can practically be implemented in real-world settings. Further research is required to study the use and effectiveness of the tool in practice and assess engagement with

Effects of age on a real-world What-Where-When memory task.

Directory of Open Access Journals (Sweden)

Adele eMazurek

2015-05-01

Full Text Available Many cognitive abilities decline with aging, making it difficult to detect pathological changes against a background of natural changes in cognition. Most of the tests to assess cognitive decline are artificial tasks that have little resemblance to the problems faced by people in everyday life. This means both that people may have little practice doing such tasks (potentially contributing to the decline in performance and that the tasks may not be good predictors of real-world cognitive problems.In this study, we test the performance of young people (18-25 years and older people (60+-year-olds on a novel, more ecologically valid test of episodic memory: the real-world What-Where-When (WWW memory test. We also compare them on a battery of other cognitive tests, including working memory, psychomotor speed, executive function, and episodic memory. Older people show the expected age-related declines on the test battery. In the WWW memory task, older people were more likely to fail to remember any What-Where-When combination than younger people were, although they did not significantly differ in their overall WWW score due to some older people performing as well as or better than most younger people. WWW memory performance was significantly predicted by other measures of episodic memory, such as the single-trial learning and long-term retention in the Rey Auditory Verbal Learning task and Combined Object Location Memory in the Object Relocation task. Self-reported memory complaints also predicted performance on the WWW task.These findings confirm that our real-world WWW memory task is a valid measure of episodic memory, with high ecological validity, which may be useful as a predictor of everyday memory abilities. The task will require a bit more development to improve its sensitivity to cognitive declines in aging and to potentially distinguish between mentally healthy older adults and those with early signs of cognitive pathologies.

The Database of the Catalogue of Clinical Practice Guidelines Published via Internet in the Czech Language -The Current State

Czech Academy of Sciences Publication Activity Database

Zvolský, Miroslav

2010-01-01

Roč. 6, č. 1 (2010), s. 83-89 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : internet * World Wide Web * database * clinical practice guideline * clinical practice * evidence-based medicine * formalisation * GLIF (Guideline Inerchange Format) * doctor of medicine, * decision support systems Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/en/ejbi/article/63-en-the-database-of-the-catalogue-of-clinical- practice -guidelines-published-via-internet-in-the-czech-language-the-current-state.html

Implications of Nursing Clinical Practice to The Student’s Spiritual Health

Directory of Open Access Journals (Sweden)

Bhandesa Asthadi Mahendra

2018-01-01

Full Text Available This study aimed to clarify the implications of Nursing Clinical Practice (PLKK to the spiritual health of STIKES Bali students. This study employed purposive sampling method to determine the number of respondents. To conduct this study, the fourth grade of nursing students were recruited as the sample with total number 136 respondents. A questionnaire about spirituality from World Health Organization (WHO was used in this study as the instrument. In addition, the data were analysed by using quantitative descriptive technique. The result showed that 50.0% of students had a very good spiritual health, 42.6% had good spiritual health, 6.6% had moderate spiritual health, and 0.7 % had poor spiritual health. It can be interpreted that spiritual health of nursing students of STIKES Bali is good after conducting Nursing Clinical Practice. Thus, this study can be concluded that Nursing Clinical Practice has implication to the ability of students to love themselves and others meaningfully as the evidence of students’ spiritual health.

How does a clinical trial fit into the real world? The RELAX-AHF study population into the EAHFE registry.

Science.gov (United States)

Miró, Òscar; Gil, Víctor; Müller, Christian; Mebazaa, Alexander; Bueno, Héctor; Martín-Sánchez, Francisco Javier; Herrero, Pablo; Jacob, Javier; Llorens, Pere

2015-10-01

To test how accurate the recently published RELAX-AHF trial was in recruiting real-world patients with acute-decompensated heart failure (ADHF). We compared clinical and outcome data of patients receiving serelaxin in the RELAX-AHF trial (RELAX group, n = 581) with patients included in the EAHFE registry [5497 ADHF from 29 Spanish emergency departments (EDs)]. The EAHFE registry was split into two groups: EAHFE-non-RELAX (patients not fulfilling the RELAX-AHF inclusion criteria; n = 3205, 58.3 %) and EAHFE-RELAX A (patients fulfilling RELAX-AHF inclusion criteria; n = 2292, 41.7 %). The latter group was further refined by also applying exclusion criteria (EAHFE-RELAX B; n = 964, 17.4 %). Both EAHFE-RELAX groups differed from the EAHFE-non-RELAX group in multiple aspects, with the lower the proportion of patients with implantable cardiac defibrillator and with pulmonary diseases the greater the differences found. The RELAX group, compared with the EAHFE-RELAX groups, significantly included fewer females, younger patients, less in NYHA class I/II, less with implantable cardiac defibrillator and on beta-blocker treatment, and patients had lower systolic blood pressure and cardiac and respiratory rates at ED arrival. The EAHFE-RELAX groups had a significantly lower all-cause mortality than EAHFE-non-RELAX group, and qualitative analysis suggested that EAHFE-RELAX groups had a higher mortality than the RELAX group. Patients included in the RELAX-AHF trial showed unanticipated differences when compared with a population from the EAHFE registry fulfilling very similar inclusion and exclusion criteria.

The Effects of Musical and Linguistic Components in Recognition of Real-World Musical Excerpts by Cochlear Implant Recipients and Normal-Hearing Adults

Science.gov (United States)

Gfeller, Kate; Jiang, Dingfeng; Oleson, Jacob; Driscoll, Virginia; Olszewski, Carol; Knutson, John F.; Turner, Christopher; Gantz, Bruce

2011-01-01

Background Cochlear implants (CI) are effective in transmitting salient features of speech, especially in quiet, but current CI technology is not well suited in transmission of key musical structures (e.g., melody, timbre). It is possible, however, that sung lyrics, which are commonly heard in real-world music may provide acoustical cues that support better music perception. Objective The purpose of this study was to examine how accurately adults who use CIs (n=87) and those with normal hearing (NH) (n=17) are able to recognize real-world music excerpts based upon musical and linguistic (lyrics) cues. Results CI recipients were significantly less accurate than NH listeners on recognition of real-world music with or, in particular, without lyrics; however, CI recipients whose devices transmitted acoustic plus electric stimulation were more accurate than CI recipients reliant upon electric stimulation alone (particularly items without linguistic cues). Recognition by CI recipients improved as a function of linguistic cues. Methods Participants were tested on melody recognition of complex melodies (pop, country, classical styles). Results were analyzed as a function of: hearing status and history, device type (electric only or acoustic plus electric stimulation), musical style, linguistic and musical cues, speech perception scores, cognitive processing, music background, age, and in relation to self-report on listening acuity and enjoyment. Age at time of testing was negatively correlated with recognition performance. Conclusions These results have practical implications regarding successful participation of CI users in music-based activities that include recognition and accurate perception of real-world songs (e.g., reminiscence, lyric analysis, listening for enjoyment). PMID:22803258

The effects of musical and linguistic components in recognition of real-world musical excerpts by cochlear implant recipients and normal-hearing adults.

Science.gov (United States)

Gfeller, Kate; Jiang, Dingfeng; Oleson, Jacob J; Driscoll, Virginia; Olszewski, Carol; Knutson, John F; Turner, Christopher; Gantz, Bruce

2012-01-01

Cochlear implants (CI) are effective in transmitting salient features of speech, especially in quiet, but current CI technology is not well suited in transmission of key musical structures (e.g., melody, timbre). It is possible, however, that sung lyrics, which are commonly heard in real-world music may provide acoustical cues that support better music perception. The purpose of this study was to examine how accurately adults who use CIs (n = 87) and those with normal hearing (NH) (n = 17) are able to recognize real-world music excerpts based upon musical and linguistic (lyrics) cues. CI recipients were significantly less accurate than NH listeners on recognition of real-world music with or, in particular, without lyrics; however, CI recipients whose devices transmitted acoustic plus electric stimulation were more accurate than CI recipients reliant upon electric stimulation alone (particularly items without linguistic cues). Recognition by CI recipients improved as a function of linguistic cues. Participants were tested on melody recognition of complex melodies (pop, country, & classical styles). Results were analyzed as a function of: hearing status and history, device type (electric only or acoustic plus electric stimulation), musical style, linguistic and musical cues, speech perception scores, cognitive processing, music background, age, and in relation to self-report on listening acuity and enjoyment. Age at time of testing was negatively correlated with recognition performance. These results have practical implications regarding successful participation of CI users in music-based activities that include recognition and accurate perception of real-world songs (e.g., reminiscence, lyric analysis, & listening for enjoyment).

Show Me the Evidence: How a Unit Challenge Can Support Middle School Teachers and Students in Investigating Climate Change Using Real-World Data and Science Practices

Science.gov (United States)

Gochis, E. E.; Tubman, S.; Grazul, K.; Bluth, G.; Huntoon, J. E.

2017-12-01

Michigan Science Teaching and Assessment Reform (Mi-STAR) is developing an NGSS-aligned integrated science middle school curriculum and associated teacher professional learning program that addresses all performance expectations for the 6-8 grade-band. The Mi-STAR instructional model is a unit- and lesson-level model that scaffolds students in using science practices to investigate scientific phenomena and apply engineering principles to address a real-world challenge. Mi-STAR has developed an 8th grade unit on climate change based on the Mi-STAR instructional model and NGSS performance expectations. The unit was developed in collaboration with Michigan teachers, climate scientists, and curriculum developers. The unit puts students in the role of advisers to local officials who need an evidence-based explanation of climate change and recommendations about community-based actions to address it. Students discover puzzling signs of global climate change, ask questions about these signs, and engage in a series of investigations using simulations and real data to develop scientific models for the mechanisms of climate change. Students use their models as the basis for evidence-based arguments about the causes and impacts of climate change and employ engineering practices to propose local actions in their community to address climate change. Dedicated professional learning supports teachers before and during implementation of the unit. Before implementing the unit, all teachers complete an online self-paced "unit primer" during which they assume the role of their students as they are introduced to the unit challenge. During this experience, teachers experience science as a practice by using real data and simulations to develop a model of the causes of climate change, just as their students will later do. During unit implementation, teachers are part of a professional learning community led by a teacher facilitator in their local area or school. This professional learning

Using real-worldness and cultural difference to enhance student ...

African Journals Online (AJOL)

differences, influences the quality of students' learning in a Life Skills module ... Studies reveal that real-world experiences will allow students to activate .... comprised 78 female students of whom 69 were Afrikaans-speaking and nine English-.

Tracking the reading eye: towards a model of real-world reading

NARCIS (Netherlands)

Jarodzka, Halszka; Brand-Gruwel, Saskia

2018-01-01

Eye tracking has helped to understand the process of reading a word or a sentence, and this research has been very fruitful over the past decades. However, everyday real-world reading dramatically differs from this scenario: we read a newspaper on the bus, surf the Internet for movie reviews or

Hybrid Instantaneous Wave-Free Ratio–Fractional Flow Reserve versus Fractional Flow Reserve in the Real World

Directory of Open Access Journals (Sweden)

Kara Shuttleworth

2017-05-01

Full Text Available BackgroundThe instantaneous wave-free ratio (iFR is a novel method to assess the ischemic potential of coronary artery stenoses. Clinical trial data have shown that iFR has acceptable diagnostic agreement with fractional flow reserve (FFR, the reference standard for the functional assessment of coronary stenoses. This study compares iFR measurements with FFR measurements in a real world, single-center setting.Methods and resultsInstantaneous wave-free ratio and FFR were measured in 50 coronary artery lesions in 42 patients, with FFR ≤ 0.8 classified as functionally significant. An iFR-only technique, using a treatment cut-off value, iFR ≤ 0.89, provided a classification agreement of 84% with FFR ≤ 0.80. Use of a hybrid iFR–FFR technique, incorporating FFR measurement for lesions within the iFR gray zone of 0.86–0.93, would improve classification agreement with FFR to 94%, with diagnosis achieved without the need for hyperemia in 57% patients.ConclusionThis study in a real-world setting demonstrated good classification agreement between iFR and FFR. Use of a hybrid iFR–FFR technique would achieve high diagnostic accuracy while minimizing adenosine use, compared with routine FFR.

Results of a real-world study on vortioxetine in patients with major depressive disorder in South East Asia (REVIDA).

Science.gov (United States)

Chin, Cheuk Ngen; Zain, Azhar; Hemrungrojn, Solaphat; Ung, Eng Khean; Kwansanit, Patanon; Au Yong, Koon Choong; Chong, Marvin Swee Woon; Inpa, Chalowat; Yen, Teck Hoe; Yeoh, Boon Beng David; Tay, Liam Kai; Bernardo, Carmina; Lim, Lionel Chee-Chong; Yap, Chin Hong; Fones, Calvin; Nayak, Ashwini; Nelleman, Lars

2018-05-17

The REVIDA study aimed to assess the evolution of major depression symptoms in South East Asian (SEA) patients treated with vortioxetine for major depression in real-world clinical practice. This non-interventional study was conducted from Aug 2016 to Apr 2017. A total of 138 patients (aged 18-65 years) with an active episode of major depression were recruited from Malaysia, Philippines, Singapore, and Thailand. Vortioxetine was initiated on the first visit and patients were followed for 3 months. Depression severity was assessed using the PHQ-9 questionnaire (patient-assessed) and CGI-S scale (physician-assessed); cognitive function was assessed with the PDQ-D questionnaire; work productivity and activity impairment (WPAI) was assessed with the WPAI questionnaire. At baseline, 89.9% of patients were moderately to severely depressed (PHQ-9 score ≥ 10). During the 3-month treatment period, mean±SD PHQ-9 score decreased from 18.7±5.7 to 5.0±5.3, mean±SD CGI-S score decreased from 4.4±0.7 to 2.2±1.1, and mean±SD PDQ-D score decreased from 42.1±18.8 to 13.4±13.0. By month 3, response and remission rates reached 80.8% and 59.0%, respectively. Work productivity loss decreased from 73.6% to 30.5%, while activity impairment decreased from 71.5% to 24.6%. Positive correlations were observed between PHQ-9, PDQ-D, and WPAI work productivity loss and activity impairment. By month 3, 82.0% of patients were either not depressed or only mildly depressed (PHQ-9 score ≤ 9). In real-world clinical settings, vortioxetine was effective in reducing depression severity and improving cognitive function and work productivity in SEA patients with major depression.

On-Road Validation of a Simplified Model for Estimating Real-World Fuel Economy: Preprint

Energy Technology Data Exchange (ETDEWEB)

Wood, Eric; Gonder, Jeff; Jehlik, Forrest

2017-01-01

On-road fuel economy is known to vary significantly between individual trips in real-world driving conditions. This work introduces a methodology for rapidly simulating a specific vehicle's fuel economy over the wide range of real-world conditions experienced across the country. On-road test data collected using a highly instrumented vehicle is used to refine and validate this modeling approach. Model accuracy relative to on-road data collection is relevant to the estimation of 'off-cycle credits' that compensate for real-world fuel economy benefits that are not observed during certification testing on a chassis dynamometer.

The twinning of Scottish general practices and Malawian clinics: the provision of email and internet services

Directory of Open Access Journals (Sweden)

Ron Neville

2007-01-01

Full Text Available Many patients and health care professionals in the developed world are uncomfortable about doing nothing in the face of the glaring inequities in health care between their own environment and that of Africa. In an effort to 'think global, act local' a Scottish GP practice used personal contacts to build a twinning link with a clinic serving a township in Malawi. This article describes the experience of establishing e-mail and internet services for Malawian health care staff to afford them the same level of access as developed world staff enjoy in accessing educational materials and professional supports. Using our twin link as an exemplar we are now matching other Scottish General Practices to Malawian Clinics around a common theme of modern communication media.

Real world use of an Internet intervention for pediatric encopresis.

Science.gov (United States)

Ritterband, Lee M; Ardalan, Kaveh; Thorndike, Frances P; Magee, Joshua C; Saylor, Drew K; Cox, Daniel J; Sutphen, James L; Borowitz, Stephen M

2008-06-30

The Internet is a significant source of medical information and is now being shown to be an important conduit for delivering various health-related interventions. This paper aimed to examine the utility and impact of an Internet intervention for childhood encopresis as part of standard medical care in a "real world" setting. Patients diagnosed with encopresis were given a Web-based information prescription to use an Internet intervention for pediatric encopresis. A total of 22 families utilized the intervention between July 2004 and June 2006. A chart review and phone interview were undertaken to collect user characteristics; defecation-related information, including frequency of soiling, bowel movements (BMs) in the toilet, and amount of pain associated with defecation; and information on computer/Internet usage. Three questionnaires were used to examine the utility of, impact of, and adherence to the Internet intervention. Program utilization was obtained from a data tracking system that monitored usage in real time. Overall, parents rated the Internet intervention as enjoyable, understandable, and easy to use. They indicated that the Internet intervention positively affected their children, decreasing overall accidents and increasing child comfort on the toilet at home. Of the 20 children who initially reported fecal accidents, 19 (95%) experienced at least a 50% improvement, with a reduction of accident frequency from one fecal accident per day to one accident per week. Although it is not clear whether this improvement is directly related to the use of the Internet intervention, patient feedback suggests that the program was an important element, further establishing Internet interventions as a viable and desirable addition to standard medical care for pediatric encopresis. To our knowledge, this is the first time a pediatric Internet intervention has been examined as part of a "real world" setting. This is an important step toward establishing Internet

Evidence-based clinical practice, [corrected] evidence-based medicine and the Cochrane collaboration.

Science.gov (United States)

Gambrill, E

1999-03-01

Encouraging professionals in training and later to consider practice-related research findings when making important clinical decisions is an on-going concern. Evidenced-Based Medicine (EBM) and the Cochrane Collaboration (CC) provide a source of tools and ideas for doing so, as well as a roster of colleagues who share this interest. Evidenced-based medicine involves integrating clinical expertise with the best available external evidence from systematic research as well as considering the values and expectations of patients/clients. Advantage can be taken of educational formats developed in EBM, such as problem-based learning and critical-appraisal workshops in which participants learn how to ask key answerable questions related to important clinical practice questions (e.g., regarding effectiveness, accuracy of assessment measures, prediction, prevention, and quality of clinical practice guidelines) and to access and critically appraise related research. The Cochrane Collaboration is a world-wide network of centers that prepare, maintain, and disseminate high-quality systematic reviews on the efficacy of healthcare. These databases allow access to evidence related to clinical practice decisions. Forging reciprocal working relationships with those involved in EBM reciprocal and the CC should contribute to the pursuit of shared goals such as basing clinical decisions on the best-available evidence and involving clients as informed consumers.

Waking up from the dream of reason; Rationality in the real world

NARCIS (Netherlands)

Van Hezewijk, René

2007-01-01

Review Essay of: Gerd Gigerenzer, Adaptive Thinking: Rationality in the Real World. Oxford: Oxford University Press, 2000. 344 pp. ISBN 0–19–513622–5 (hbk). Gerd Gigerenzer, Reckoning with Risk: Learning to Live with Uncertainty. London: Allen Lane/Penguin, 2002. 310 pp. ISBN 0–713–99512–2

Use of etoricoxib in patients with gout in real clinical practice

Directory of Open Access Journals (Sweden)

M S Eliseyev

2013-01-01

Full Text Available Objective: to evaluate the efficacy and safety of etoricoxib (Arcoxia ® in gouty patients with an acute arthritis attack in real clinical practice. Subjects and methods. Thirty patients (25 men and 5 women; mean age 52.4±13.5 years with crystal-verified gout participated in the pilot open-label study of the patients with arthritis, including those who had taken other nonsteroidal anti-inflammatory drugs (NSAIDs without any effect. All the patients received etoricoxib (Arcoxia ® in a dose of 120 mg/day for 7 days and, if arthritis persisted, in a dose of 90 mg/day for 7 more days. The authors estimated an articular index, swelling and hyperemia indices, resting and movement pain by a visual analogue scale (VAS, therapy tolerance in the patient's opinion before and 7 days after therapy and, in the patients taking etoricoxib for 14 days, after 14 days of therapy. Biochemical and clinical blood tests were carried out at the first and subsequent visits. Results. Seven days after therapy, an arthritis attack was abolished in 24 of the 28 patients, following 14 days, arthritis persisted only in 1 patient, but the number of affected joints reduced from 8 to 2. Following 7 days, there was a reduction in the mean erythrocyte sedimentation rate from 37.2+10.2 (before etoricoxib intake to 15.3±8.3 mm/h (p<0.001, VAS resting pain from 48.6±21.4 to 5.2±3.5 mm (p<0.001, swelling (p<0.001 and hyperemia (p< 0.001 indices, and articular index (p<0.001. In 2 patients with baseline uncontrolled arterial hypertension, the drug was discontinued because of elevated blood pressure; periorbital edema was noted in one case by the end of a therapy course. There were no increases in the serum levels of liver enzymes, in the concentrations of creatinine and urea, and in glomerular filtration rate. Conclusion. Etoricoxib (Arcoxia ® is highly effective and safe when used in patients with acute gouty arthritis, including those who had not benefited from previous NSAID

Use of etoricoxib in patients with gout in real clinical practice

Directory of Open Access Journals (Sweden)

M S Eliseyev

2013-06-01

Full Text Available Objective: to evaluate the efficacy and safety of etoricoxib (Arcoxia ® in gouty patients with an acute arthritis attack in real clinical practice. Subjects and methods. Thirty patients (25 men and 5 women; mean age 52.4±13.5 years with crystal-verified gout participated in the pilot open-label study of the patients with arthritis, including those who had taken other nonsteroidal anti-inflammatory drugs (NSAIDs without any effect. All the patients received etoricoxib (Arcoxia ® in a dose of 120 mg/day for 7 days and, if arthritis persisted, in a dose of 90 mg/day for 7 more days. The authors estimated an articular index, swelling and hyperemia indices, resting and movement pain by a visual analogue scale (VAS, therapy tolerance in the patient's opinion before and 7 days after therapy and, in the patients taking etoricoxib for 14 days, after 14 days of therapy. Biochemical and clinical blood tests were carried out at the first and subsequent visits. Results. Seven days after therapy, an arthritis attack was abolished in 24 of the 28 patients, following 14 days, arthritis persisted only in 1 patient, but the number of affected joints reduced from 8 to 2. Following 7 days, there was a reduction in the mean erythrocyte sedimentation rate from 37.2+10.2 (before etoricoxib intake to 15.3±8.3 mm/h (p<0.001, VAS resting pain from 48.6±21.4 to 5.2±3.5 mm (p<0.001, swelling (p<0.001 and hyperemia (p< 0.001 indices, and articular index (p<0.001. In 2 patients with baseline uncontrolled arterial hypertension, the drug was discontinued because of elevated blood pressure; periorbital edema was noted in one case by the end of a therapy course. There were no increases in the serum levels of liver enzymes, in the concentrations of creatinine and urea, and in glomerular filtration rate. Conclusion. Etoricoxib (Arcoxia ® is highly effective and safe when used in patients with acute gouty arthritis, including those who had not benefited from previous NSAID

An antimicrobial stewardship program's real-world experience with fidaxomicin for treatment of Clostridium difficile infection: a case series.

Science.gov (United States)

Vargo, Craig A; Bauer, Karri A; Mangino, Julie E; Johnston, Jessica E W; Goff, Debra A

2014-09-01

To evaluate real-world clinical and economic outcomes in patients with Clostridium difficile infection (CDI) treated with fidaxomicin. Retrospective case series. Academic medical center. A total of 61 patients with CDI who were treated with fidaxomicin monotherapy or combination therapy from September 2011 to December 2012. Data on demographics, infection characteristics, and clinical and economic outcomes were evaluated. Clinical cure was defined as resolution of diarrhea (less than or equal to three unformed stools for at least 2 consecutive days) maintained for the duration of therapy with no further requirement for CDI therapy and was achieved in 44 (72.1%) patients. Clinical cure was significantly higher for patients receiving fidaxomicin monotherapy compared with fidaxomicin combination therapy (25/29 [86.2%] patients vs 19/32 [59.4%] patients, p=0.04). Clinical cure was similar in patients with a first or prior CDI episode (65.5% vs 78.1%, p=0.27) and in patients with severe versus nonsevere disease (68.4% vs 73.8%, p=0.66). Recurrence occurred in 6 (13.6%) of the 44 patients who achieved clinical cure. Mortality attributable to CDI was 11.5%, and 30-day readmission rate was 4.9%. Median cost accrued during CDI was $19,483/patient. Our real-world experience with fidaxomicin significantly differs from the findings of phase III clinical trials. Fidaxomicin is also associated with substantial costs. Multicenter studies are needed to determine the optimal role of fidaxomicin in the treatment of CDI. © 2014 Pharmacotherapy Publications, Inc.

Application of Ion Chromatography to the Investigation of Real-World Samples

Science.gov (United States)

Whelan, Rebecca J.; Hannon, Theresa E.; Zare, Richard N.

2004-01-01

The use of ion chromatography (IC) as a means to teach important analytical concepts while giving the students a valuable opportunity to identify and investigate a real-world system of interest to them is described. A single IC apparatus can be tailored for different classes of analyses by the selection of different column-eluent combinations.

Clinical Practice Realities: World and African Perspectives

African Journals Online (AJOL)

of human health resources, infrastructure, and equipment are common in many countries of the world and ... In recent years, there has been a global call to standard- ize nursing ... lacks nurses and midwives who are qualified to take up roles ...

A Coding of Real Null Four-Momenta into World-Sheet Coordinates

Directory of Open Access Journals (Sweden)

David B. Fairlie

2009-01-01

Full Text Available The results of minimizing the action for string-like systems on a simply connected world sheet are shown to encode the Cartesian components of real null momentum four-vectors into coordinates on the world sheet. This identification arises consistently from different approaches to the problem.

Modeling Interdependent and Periodic Real-World Action Sequences

Science.gov (United States)

Kurashima, Takeshi; Althoff, Tim; Leskovec, Jure

2018-01-01

Mobile health applications, including those that track activities such as exercise, sleep, and diet, are becoming widely used. Accurately predicting human actions in the real world is essential for targeted recommendations that could improve our health and for personalization of these applications. However, making such predictions is extremely difficult due to the complexities of human behavior, which consists of a large number of potential actions that vary over time, depend on each other, and are periodic. Previous work has not jointly modeled these dynamics and has largely focused on item consumption patterns instead of broader types of behaviors such as eating, commuting or exercising. In this work, we develop a novel statistical model, called TIPAS, for Time-varying, Interdependent, and Periodic Action Sequences. Our approach is based on personalized, multivariate temporal point processes that model time-varying action propensities through a mixture of Gaussian intensities. Our model captures short-term and long-term periodic interdependencies between actions through Hawkes process-based self-excitations. We evaluate our approach on two activity logging datasets comprising 12 million real-world actions (e.g., eating, sleep, and exercise) taken by 20 thousand users over 17 months. We demonstrate that our approach allows us to make successful predictions of future user actions and their timing. Specifically, TIPAS improves predictions of actions, and their timing, over existing methods across multiple datasets by up to 156%, and up to 37%, respectively. Performance improvements are particularly large for relatively rare and periodic actions such as walking and biking, improving over baselines by up to 256%. This demonstrates that explicit modeling of dependencies and periodicities in real-world behavior enables successful predictions of future actions, with implications for modeling human behavior, app personalization, and targeting of health interventions. PMID

A real-world comparison of apnea-hypopnea indices of positive airway pressure device and polysomnography.

Directory of Open Access Journals (Sweden)

Ritwick Agrawal

Full Text Available The apnea hypopnea index (AHI reported by positive airway pressure (PAP device is widely used in clinical practice, yet its correlation with standardized AHI obtained during the sleep study is not established. The current study was conducted to investigate the correlation between AHI estimated by the PAP device and reported on the smart card with the AHI found during the PAP polysomnography (PSG in the "real world" setting at an academic sleep center. We retrospectively reviewed the medical records of 280 patients who underwent a PAP titration PSG at Drexel sleep center, and were later prescribed a PAP device. The AHI was categorized in clinically relevant subgroups (as AHI ≤5 and AHI >5. The AHI at the final pressure on the PSG and the average AHI from the prescribed PAP device were compared. The results showed that in the majority (77.3% of patients (126 of 163, the AHI from both PAP device and PSG correlated well and were in the same category (AHI ≤5 and AHI >5 respectively. The majority of patients (80.7% with PSG AHI of 5, 61.5% patients reported good control, with AHI <5 on PAP device AHI. We conclude that in a majority of patients who were optimally titrated in the sleep laboratory, the PAP device continued to show optimal control at home.

Effectiveness of an annular closure device in a "real-world" population: stratification of registry data using screening criteria from a randomized controlled trial.

Science.gov (United States)

Kuršumović, Adisa; Rath, Stefan A

2018-01-01

Increased focus has been put on the use of "'real-world" data to support randomized clinical trial (RCT) evidence for clinical decision-making. The objective of this study was to assess the performance of an annular closure device (ACD) after stratifying a consecutive series of "real-world" patients by the screening criteria of an ongoing RCT. This was a single-center registry analysis of 164 subjects who underwent limited discectomy combined with ACD for symptomatic lumbar disc herniation. Patients were stratified into two groups using the selection criteria of a pivotal RCT on the same device: Trial (met inclusion; n=44) or non-Trial (did not meet inclusion; n=120). Patient-reported outcomes, including Oswestry Disability Index (ODI) and visual analog scale (VAS) for leg and back pain, and adverse events were collected from baseline to last follow-up (mean: Trial - 15.6 months; non-Trial - 14.6 months). Statistical analyses were performed with significance set at p population. Stratification of this "real-world" series on the basis of RCT screening criteria did not result in significant between-group differences. These findings suggest that the efficacy of the ACD extends beyond the strictly defined patient population being studied in the RCT of this device. Furthermore, reducing the reherniation rate following lumbar discectomy has positive clinical and economic implications.

Designing Inclusive Systems Designing Inclusion for Real-world Applications

CERN Document Server

Clarkson, John; Robinson, Peter; Lazar, Jonathan; Heylighen, Ann

2012-01-01

The Cambridge Workshops on Universal Access and Assistive Technology (CWUAAT) are a series of workshops held at a Cambridge University College every two years. The workshop theme: “Designing inclusion for real-world applications” refers to the emerging potential and relevance of the latest generations of inclusive design thinking, tools, techniques, and data, to mainstream project applications such as healthcare and the design of working environments. Inclusive Design Research involves developing tools and guidance enabling product designers to design for the widest possible population, for a given range of capabilities. There are five main themes: •Designing for the Real-World •Measuring Demand And Capabilities •Designing Cognitive Interaction with Emerging Technologies •Design for Inclusion •Designing Inclusive Architecture In the tradition of CWUAAT, we have solicited and accepted contributions over a wide range of topics, both within individual themes and also across the workshop’s scope. ...

Semantic guidance of eye movements in real-world scenes

OpenAIRE

Hwang, Alex D.; Wang, Hsueh-Cheng; Pomplun, Marc

2011-01-01

The perception of objects in our visual world is influenced by not only their low-level visual features such as shape and color, but also their high-level features such as meaning and semantic relations among them. While it has been shown that low-level features in real-world scenes guide eye movements during scene inspection and search, the influence of semantic similarity among scene objects on eye movements in such situations has not been investigated. Here we study guidance of eye movemen...

Towards a conceptual framework for identifying student difficulties with solving Real-World Problems in Physics

DEFF Research Database (Denmark)

Niss, Martin

2012-01-01

This paper develops a conceptual framework for identifying the challenges and obstacles university students encounter when solving real-world problems involving Physics. The framework is based on viewing problem solving as a modelling process. In order to solve a real-world problem, the problem...... solver has to go through the steps and do the tasks of such a process. The paper presents a theoretical analysis of what it takes to solve three real-world problems, demonstrating how the framework presented captures the essential aspects of solving them. Moreover, it is argued that three steps critical...... for real-world problem solving – initial analysis of the problem situation, choice of relevant physical theory (the so-called paradigmatic choice) and mathematization – are not covered by existing models of problem solving in Physics. Finally, the existing research on student difficulties with problem...

Improving clinical practice through simulation: A case study of ...

African Journals Online (AJOL)

Acquisition of knowledge and skills by nursing students before real-life practice is a familiar nursing education challenge. The use of clinical simulation in nursing education provides many opportunities for students to learn and apply theoretical principles of nursing care in a safe environment. The purpose of this study was ...

Stable operation of a Secure QKD system in the real-world setting

Science.gov (United States)

Tomita, Akihisa

2007-06-01

Quantum Key Distribution (QKD) now steps forward from the proof of principle to the validation of the practical feasibility. Nevertheless, the QKD technology should respond to the challenges from the real-world such as stable operation against the fluctuating environment, and security proof under the practical setting. We report our recent progress on stable operation of a QKD system, and key generation with security assurance. A QKD system should robust to temperature fluctuation in a common office environment. We developed a loop-mirror, a substitution of a Faraday mirror, to allow easy compensation for the temperature dependence of the device. Phase locking technique was also employed to synchronize the system clock to the quantum signals. This technique is indispensable for the transmission system based on the installed fiber cables, which stretch and shrink due to the temperature change. The security proof of QKD, however, has assumed the ideal conditions, such as the use of a genuine single photon source and/or unlimited computational resources. It has been highly desirable to give an assurance of security for practical systems, where the ideal conditions are no longer satisfied. We have constructed a theory to estimate the leakage information on the transmitted key under the practically attainable conditions, and have developed a QKD system equipped with software for secure key distillation. The QKD system generates the final key at the rate of 2000 bps after 20 km fiber transmission. Eavesdropper's information on the final key is guaranteed to be less than 2-7 per bit. This is the first successful generation of the secure key with quantitative assurance of the upper bound of the leakage information. It will put forth the realization of highly secure metropolitan optical communication network against any types of eavesdropping.

Estimation of minimal clinically important change of the Japanese version of EQ-5D in patients with chronic noncancer pain: a retrospective research using real-world data.

Science.gov (United States)

Yoshizawa, Kazutake; Kobayashi, Hisanori; Fujie, Motoko; Ogawa, Yoshimasa; Yajima, Tsutomu; Kawai, Koji

2016-03-01

Quality of life (QoL) is routinely assessed and evaluated in medical research. However, in Japan, there is a lack of solid cutoff criteria for evaluating QoL improvement in chronic noncancer pain management. The present study was conducted to identify the minimal clinically important change (MCIC) of the Japanese version of EuroQol-5D 3L(EQ-5D) utility score and numeric rating scale (NRS) with an emphasis on chronic noncancer pain. The data source for this post hoc research was the post-marketing surveillance (PMS) data for a tramadol/acetaminophen combination tablet, which was previously conducted in real-world settings. The parameters extracted from the PMS data were sociodemographic characteristics, NRS, EQ-5D, and dichotomous physician's global impression of treatment effectiveness (PGI). The optimal cutoff points of MCIC for EQ-5D utility and NRS scores were evaluated using receiver operating characteristics (ROC) analysis. An anchor-based approach using PGI was applied. Data of 710 patients with chronic noncancer pain were extracted from the PMS database. The NRS score decreased by 2.7 (standard deviation, 2.3) points, whereas the EQ-5D score increased by 0.16 (0.20) points at 4 weeks from baseline. The changes from baseline in NRS and EQ-5D were significantly correlated (r = 0.53, p 0.80 in both analyses. These results demonstrated novel cutoff criteria for the Japanese version of EQ-5D, focusing on patients with chronic noncancer pain. The obtained criteria were fairly consistent and can be confidently utilized as an evaluation tool in medical research on chronic noncancer pain in Japan, with additional functionality and usability for QoL assessment in pain management practice. The data source of this post hoc research was a PMS study with the identifier number UMIN000015901 at umin.ac.jp, UMIN clinical trial registry (UMIN-CTR).

Clinical and Demographic Profile of Patients Receiving Fingolimod in Clinical Practice in Germany and the Benefit-Risk Profile of Fingolimod After 1 Year of Treatment: Initial Results From the Observational, Noninterventional Study PANGAEA.

Science.gov (United States)

Ziemssen, Tjalf; Lang, Michael; Tackenberg, Björn; Schmidt, Stephan; Albrecht, Holger; Klotz, Luisa; Haas, Judith; Lassek, Christoph; Medin, Jennie; Cornelissen, Christian

2018-01-01

The population with multiple sclerosis receiving treatment in clinical practice differs from that in randomized controlled trials (RCTs). An assessment of the real-world benefit-risk profile of therapies is needed. This analysis used data from the large, noninterventional, observational German study Post-Authorization Non-interventional German sAfety study of GilEnyA (PANGAEA) to assess prospectively baseline characteristics and outcomes after 12 months (± 90 days) of fingolimod treatment. Patients were divided into 2 cohorts: fingolimod starter [first received fingolimod in PANGAEA (n = 3315)] and previous study [received fingolimod before enrollment in PANGAEA in RCTs (n = 875), some of whom also had baseline data at entry into RCTs (n = 505)]. At PANGAEA baseline, patients in the fingolimod starter versus the previous study cohort had a higher annualized relapse rate [ARR (95% confidence interval): 1.79 (1.75-1.83) vs 1.32 (1.25-1.40)] and Expanded Disability Status Scale score [3.11 (3.04-3.17) vs 2.55 (2.44-2.66)]. A greater proportion in the fingolimod starter versus previous study cohort had diabetes (2.0% vs 0.7%). After 12 months of fingolimod, ARRs were lower than in the 12 months before PANGAEA enrollment in the fingolimod starter [0.386 (0.360-0.414)] and previous study [0.276 (0.238-0.320)] cohorts. Expanded Disability Status Scale scores were stable versus baseline. Adverse events were experienced by similar proportions in both cohorts during fingolimod treatment. Relevant differences exist in disease activity and comorbidities between patients receiving fingolimod in clinical practice versus RCTs. Irrespective of baseline differences indicating a higher proportion at an advanced stage of multiple sclerosis in the real world versus RCTs, fingolimod remains effective, with a manageable safety profile.

When drugs in the same controlled substance schedule differ in real-world abuse, should they be differentiated in labeling?

Science.gov (United States)

Dasgupta, Nabarun; Henningfield, Jack E; Ertischek, Michelle D; Schnoll, Sidney H

2011-12-01

The prescription drugs regulated in the most restrictive controlled substance schedule for those with an approved therapeutic use vary widely in their real world risk of abuse and harm. Opioid analgesics have the highest rates of abuse, overdose death, drug abuse treatment needs and societal costs in comparison to other Schedule II drugs. Stimulants for attention-deficit/hyperactivity disorders (ADHD) account for substantially lower rates of abuse, harm, and public health impact. The scheduling of drugs is determined by the World Health Organization, the United States Food and Drug Administration, and other regulatory agencies, through a quasi-public process that relies heavily on pre-marketing studies that are conducted in highly controlled clinical settings. We propose that it is increasingly in the interest of science-based regulation and public health to recognize and communicate differences among drugs based on their real-world abuse and public health harm using surveillance data. Appropriate differentiation through labeling of drugs that will likely remain in the same schedule could provide powerful incentives for drug development and research, would aid prescriber/patient decision making by informing them of real differences across drugs within a schedule, and may also contribute to public health efforts to reduce drug abuse. There are risks of course, that include inadvertent perceptions that drugs labeled to be lower in risk are not taken as seriously as others in the same category. Challenges such as these, however, can be overcome and should not serve as barriers to objective communications regarding a drug's actual risks. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Emissions During and Real-world Frequency of Heavy-duty Diesel Particulate Filter Regeneration.

Science.gov (United States)

Ruehl, Chris; Smith, Jeremy D; Ma, Yilin; Shields, Jennifer Erin; Burnitzki, Mark; Sobieralski, Wayne; Ianni, Robert; Chernich, Donald J; Chang, M-C Oliver; Collins, John Francis; Yoon, Seungju; Quiros, David; Hu, Shaohua; Dwyer, Harry

2018-05-15

Recent tightening of particulate matter (PM) emission standards for heavy-duty engines has spurred the widespread adoption of diesel particulate filters (DPFs), which need to be regenerated periodically to remove trapped PM. The total impact of DPFs therefore depends not only on their filtering efficiency during normal operation, but also on the emissions during and the frequency of regeneration events. We performed active (parked and driving) and passive regenerations on two heavy-duty diesel vehicles (HDDVs), and report the chemical composition of emissions during these events, as well as the efficiency with which trapped PM is converted to gas-phase products. We also collected activity data from 85 HDDVs to determine how often regeneration occurs during real-world operation. PM emitted during regeneration ranged from 0.2 to 16.3 g, and the average time and distance between real-world active regenerations was 28.0 h and 599 miles. These results indicate that regeneration of real-world DPFs does not substantially offset the reduction of PM by DPFs during normal operation. The broad ranges of regeneration frequency per truck (3-100 h and 23-4078 miles) underscore the challenges in designing engines and associated aftertreatments that reduce emissions for all real-world duty cycles.

Reflective Practice: How the World Bank Explored Its Own Biases?

Science.gov (United States)

McKee, Martin; Stuckler, David

2015-12-10

While many international organisations have independent evaluations, including the International Monetary Fund (IMF) and World Health organization (WHO), uniquely the World Bank in its 2015 World Development Report sought to ascertain the potential biases that influence how its staff interpret evidence and influence policy. Here, we describe the World Bank's study design, including experiments to ascertain the impact on Bank staff's judgements of complexity, confirmation bias, sunk cost bias, and an understanding of the wishes of those whom they seek to help. We then review the Bank's proposed mechanisms to minimise the impact of the biases they identified. We argue that this approach, that we refer to as 'reflective practice,' deserves to be adopted more widely among institutions that seek to use evidence from research to inform policy and practice. © 2016 by Kerman University of Medical Sciences.

Tensions in learning professional identities - nursing students' narratives and participation in practical skills during their clinical practice: an ethnographic study.

Science.gov (United States)

Ewertsson, Mona; Bagga-Gupta, Sangeeta; Allvin, Renée; Blomberg, Karin

2017-01-01

Clinical practice is a pivotal part of nursing education. It provides students with the opportunity to put the knowledge and skills they have acquired from lectures into practice with real patients, under the guidance of registered nurses. Clinical experience is also essential for shaping the nursing students' identity as future professional nurses. There is a lack of knowledge and understanding of the ways in which students learn practical skills and apply knowledge within and across different contexts, i.e. how they apply clinical skills, learnt in the laboratory in university settings, in the clinical setting. The aim of this study was therefore to explore how nursing students describe, and use, their prior experiences related to practical skills during their clinical practice. An ethnographic case study design was used. Fieldwork included participant observations (82 h), informal conversations, and interviews ( n  = 7) that were conducted during nursing students' ( n  = 17) clinical practice at an emergency department at a university hospital in Sweden. The overarching theme identified was "Learning about professional identities with respect to situated power". This encompasses tensions in students' learning when they are socialized into practical skills in the nursing profession. This overarching theme consists of three sub-themes: "Embodied knowledge", "Divergent ways of assessing and evaluating knowledge" and "Balancing approaches". Nursing students do not automatically possess the ability to transfer knowledge from one setting to another; rather, their development is shaped by their experiences and interactions with others when they meet real patients. The study revealed different ways in which students navigated tensions related to power differentials. Reflecting on actions is a prerequisite for developing and learning practical skills and professional identities. This highlights the importance of both educators' and the preceptors' roles for

Caffeine Enhances Real-World Language Processing: Evidence from a Proofreading Task

Science.gov (United States)

Brunye, Tad T.; Mahoney, Caroline R.; Rapp, David N.; Ditman, Tali; Taylor, Holly A.

2012-01-01

Caffeine has become the most prevalently consumed psychostimulant in the world, but its influences on daily real-world functioning are relatively unknown. The present work investigated the effects of caffeine (0 mg, 100 mg, 200 mg, 400 mg) on a commonplace language task that required readers to identify and correct 4 error types in extended…

The real world of blood glucose point-of-care testing (POCT) system running in China teaching hospital.

Science.gov (United States)

Li, Feng-Fei; Xie, Yun; Shi, Bing-Yin; Niu, Min; Guo, Hui; Cao, Yan; Liu, Bing-Li; Yan, Reng-Na; Su, Xiao-Fei; Wu, Jin-Dan; Zhang, Dan-Feng; Chen, Li-Ming; Ma, Jian-Hua

2018-06-01

 The blood glucose point-of-care testing (POCT) system is important in the decision-making process involving patients suspected of having hypoglycemia. To investigate the real world of the POCT system being used in teaching hospitals in China. The survey was conducted by Hisend Research Group from May 2015 to July 2015 in four teaching hospitals in China. The survey questions were referred to the ISO 15197:2013 standard requirements for the use of the POCT system in a hospital setting. A total of 170 subjects were included from 4 hospitals, which included nursing staff, nurse unit managers, employees from the department of medical instruments, and staff members employed by the clinical laboratories in the Tianjin Metabolism Hospital, Nanjing First Hospital, First Affiliated Hospital of Dalian Medical University, and the First hospital affiliated with the Xi'an Transportation University. The average score for the four hospitals surveyed in this study was 66.6, which varied from 46.1 to 79.7. The main factors influencing the scores were the multiple choices of blood-glucose meters, and the quality control assessment. Our data indicates that the real world use of the POCT system in hospital settings in China needs more closer adherence to a quality management framework.

Bringing the Real World in: Reflection on Building a Virtual Learning Environment

Science.gov (United States)

Mundkur, Anuradha; Ellickson, Cara

2012-01-01

We reflect on translating participatory and experiential learning methodologies into an online teaching environment through a Virtual Learning Environment (VLE) that simulates the "real-world" contexts of international development in order to develop an applied critical understanding of gender analysis and gender mainstreaming. Rather than being…

Web Browser History Detection as a Real-World Privacy Threat

CERN Document Server

Janc, A

2010-01-01

Web browser history detection using CSS $visited$ styles has long been dismissed as an issue of marginal impact. However, due to recent changes in Web usage patterns, coupled with browser performance improvements, the long-standing issue has now become a significant threat to the privacy of Internet users. In this paper we analyze the impact of CSS-based history detection and demonstrate the feasibility of conducting practical attacks with minimal resources. We analyze Web browser behavior and detectability of content loaded via standard protocols and with various HTTP response codes. We develop an algorithm for efficient examination of large link sets and evaluate its performance in modern browsers. Compared to existing methods our approach is up to 6 times faster, and is able to detect up to 30,000 visited links per second. We present a novel Web application capable of effectively detecting clients’ browsing histories and discuss real-world results obtained from 271,576 Internet users. Our results indicat...

Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes.

Science.gov (United States)

Guest, Julian F; Fuller, Graham W; Vowden, Peter

2018-02-01

The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing diabetic foot ulcers (DFUs) in clinical practice by the UK's National Health Service (NHS), and the associated costs of patient management. This was a retrospective cohort analysis of the records of 130 patients with a newly diagnosed DFU in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015-2016 prices. Patients were predominantly managed in the community by nurses, with minimal clinical involvement of specialist physicians. 5% of patients saw a podiatrist, and 5% received a pressure-offloading device. Additionally, 17% of patients had at least one amputation within the first 12 months from initial presentation of their DFU. 14% of DFUs were documented as being clinically infected at initial presentation, although an additional 31% of patients were prescribed an antimicrobial dressing at the time of presentation. Of all the DFUs, 35% healed within 12 months, and the mean time to healing was 4·4 months. Over the study period, 48% of all patients received at least one prescription for a compression system, but significantly more patients healed if they never received compression (67% versus 16%; P cost of wound care over 12 months was an estimated £7800 per DFU (of which 13% was attributable to amputations), ranging from £2140 to £8800 per healed and unhealed DFU, respectively, and £16 900 per amputated wound. Consolidated medical records from a primary care held database provided 'real-world evidence' highlighting the consequences of inefficient and inadequate management of DFUs in clinical practice in the UK. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (i) wound prevention, (ii) improving wound-healing rates

Hyperbolicity measures democracy in real-world networks

Science.gov (United States)

Borassi, Michele; Chessa, Alessandro; Caldarelli, Guido

2015-09-01

In this work, we analyze the hyperbolicity of real-world networks, a geometric quantity that measures if a space is negatively curved. We provide two improvements in our understanding of this quantity: first of all, in our interpretation, a hyperbolic network is "aristocratic", since few elements "connect" the system, while a non-hyperbolic network has a more "democratic" structure with a larger number of crucial elements. The second contribution is the introduction of the average hyperbolicity of the neighbors of a given node. Through this definition, we outline an "influence area" for the vertices in the graph. We show that in real networks the influence area of the highest degree vertex is small in what we define "local" networks (i.e., social or peer-to-peer networks), and large in "global" networks (i.e., power grid, metabolic networks, or autonomous system networks).

The long-term effects of undertaking a research course on clinical practice.

Science.gov (United States)

Hazel, Rangeley; Joyce, Arthurs

2004-03-01

Purpose. The aim of the study was to examine the students perceptions of the long-term effectiveness of the English National Board (ENB) 870 course (Understanding and Application of Research). Method. Both quantitative and qualitative strategies examined four objectives focusing on: research utilisation, usefulness of the course in the "real world", factors affecting research use and student support. A total sample comprised all 315 students from 1995 to 1998. Data were collected by postal questionnaires and by two focus group interviews. The responding sample of nurses, midwives and health visitors, all with a minimum of one years practice since completing the course totaled 145, achieving a response rate of 45%. Results. Evidence identified that practitioners were using research at a variety of levels to inform everyday practice. The skills developed in the course had transferred well to real life practice and a critical, confident, proactive approach within and across professional boundaries was demonstrated. A generally supportive culture was identified in the workplace but a lack of time and staff had prevented optimum utilisation of the new skills. A much more positive approach to research-based care was reported and many respondents stated that they had become more autonomous, accountable and better practitioners.

Research on Social Work Practice in Egypt and the Arab World

Science.gov (United States)

Megahead, Hamido A.

2017-01-01

This article aims at introducing the research on social work practice in Egypt and the Arab World as a thematic topic. It has started with the essence of the current Arab World and its definition. Social work practice and models of social work intervention in this specific region have been described in terms of its specific and topographic nature.…

Impact of sacubitril/valsartan on heart failure admissions: insights from real-world patient prescriptions.

Science.gov (United States)

Martens, Pieter; Lambeets, Seppe; Lau, Chirikwah; Dupont, Matthias; Mullens, Wilfried

2018-06-17

Sacubitril/valsartan reduced heart failure (HF)-admissions and cardiovascular mortality in the PARADIGM-HF-trial. However, real-world patients are often frailer and less able to tolerate high doses of sacubitril/valsartan. We performed a retrospective analysis of consecutive patients prescribed sacubitril/valsartan in a single tertiary HF-clinic between December 2016 and January 2018. HF-admissions were assessed in a paired fashion, comparing the amount of antecedent HF-episodes with incident HF-episodes after the initiation. Baseline risk for adverse events was assessed by the EMPHASIS-HF-risk-score Results: A total of 201-HF-patients were retrospectively identified (age = 68 ± 11 years, ejection fraction = 29 ± 8%). Real world patients were older, had higher serum creatinine and a higher New-York Heart-Association (NYHA)-class (p sacubitril/valsartan a total of 23-individual patients experienced at least one HF-episodes. Over the same time period preceding initiation of sacubitril/valsartan, 51 individual patients experienced a HF-episodes (p Sacubitril/valsartan significantly reduced the rate of incident vs. antecedent HF-admissions, in patients with low or high baseline NYHA-class (II vs. III and IV; p value = 0.019 respectively p = .004) or patients with an EMPHASIS-HF risk score below or above the mean (p = .002 respectively p = .016). Patients older than 75-years exhibited a trend towards HF-reduction. Higher doses of sacubitril/valsartan were associated with more reduction in incident versus antecedent HF-episodes. Despite being frailer and older, real-world patients exhibit a significant and early reduction in incident HF-hospitalisations following initiation of sacubitril/valsartan. Higher doses might be associated with more reduction in HF-admissions, underscoring the importance of dose uptitration.

A modified harmony search method for environmental/economic load dispatch of real-world power systems

International Nuclear Information System (INIS)

Jeddi, Babak; Vahidinasab, Vahid

2014-01-01

Highlights: • A combined economic and emission load dispatch (CEELD) model is proposed. • The proposed model considers practical constraints of real-world power systems. • A new modified harmony search algorithm proposed to solve non-convex CEELD. • The proposed algorithm is tested by applying it to solve seven test systems. - Abstract: Economic load dispatch (ELD) problem is one of the basic and important optimization problems in a power system. However, considering practical constraints of real-world power systems such as ramp rate limits, prohibited operating zones, valve loading effects, multi-fuel options, spinning reserve and transmission system losses in ELD problem makes it a non-convex optimization problem, which is a challenging one and cannot be solved by traditional methods. Moreover, considering environmental issues, results in combined economic and emission load dispatch (CEELD) problem that is a multiobjective optimization model with two non-commensurable and contradictory objectives. In this paper, a modified harmony search algorithm (MHSA) proposed and applied to solve ELD and CEELD problem considering the abovementioned constraints. In the proposed MHSA, a new improvising method based on wavelet mutation together with a new memory consideration scheme based on the roulette wheel mechanism are proposed which improves the accuracy, convergence speed, and robustness of the classical HSA. Performance of the proposed algorithm is investigated by applying it to solve various test systems having non-convex solution spaces. To Show the effectiveness of the proposed method, obtained results compared with classical harmony search algorithm (HSA) and some of the most recently published papers in the area

Comparison of real-world and certification emission rates for light duty gasoline vehicles.

Science.gov (United States)

Khan, Tanzila; Frey, H Christopher

2018-05-01

U.S. light duty vehicles are subject to the U.S. Environmental Protection Agency (EPA) emission standards. Emission compliance is determined by certification testing of selected emissions from representative vehicles on standard driving cycles using chassis dynamometers. Test results are also used in many emission inventories. The dynamometer based emission rates are adjusted to provide the certification levels (CL), which must be lower than the standards for compliance. Although standard driving cycles are based on specific observations of real-world driving, they are not necessarily real-world representative. A systematic comparison of the real-world emission rates of U.S. light duty gasoline vehicles (LDGVs) versus CL, and emission standards has not been previously reported. The purpose of this work is to compare regulatory limits (both CLs and emission standards) and the real-world emissions of LDGVs. The sensitivity of the comparisons to cold start emission was assessed. Portable Emission Measurement Systems (PEMS) were used to measure hot stabilized exhaust emissions of 122 LDGVs on a specified 110 mile test route. Cold start emissions were measured with PEMS for a selected vehicle sample of 32 vehicles. Emissions were measured for carbon dioxide (CO 2 ), carbon monoxide (CO), hydrocarbons (HC) and nitrogen oxides (NO x ). For each vehicle, a Vehicle Specific Power (VSP) modal emission rate model was developed. The VSP modal rates were weighted by the standard driving cycles and real-world driving cycles to estimate the respective cycle average emission rates (CAERs). Measured vehicles were matched with certification test vehicles for comparison. For systematic trends in comparison, vehicles were classified into four groups based on the Tier 1 and Tier 2 emission regulation, and the vehicle type such as passenger car and passenger truck. Depending on the cycle-pollutant and the vehicle groups, hot stabilized CAERs are on average either statistically

Medical Device Integrated Vital Signs Monitoring Application with Real-Time Clinical Decision Support.

Science.gov (United States)

Moqeem, Aasia; Baig, Mirza; Gholamhosseini, Hamid; Mirza, Farhaan; Lindén, Maria

2018-01-01

This research involves the design and development of a novel Android smartphone application for real-time vital signs monitoring and decision support. The proposed application integrates market available, wireless and Bluetooth connected medical devices for collecting vital signs. The medical device data collected by the app includes heart rate, oxygen saturation and electrocardiograph (ECG). The collated data is streamed/displayed on the smartphone in real-time. This application was designed by adopting six screens approach (6S) mobile development framework and focused on user-centered approach and considered clinicians-as-a-user. The clinical engagement, consultations, feedback and usability of the application in the everyday practices were considered critical from the initial phase of the design and development. Furthermore, the proposed application is capable to deliver rich clinical decision support in real-time using the integrated medical device data.

Treatment of allergic rhinitis using mobile technology with real-world data: The MASK observational pilot study.

Science.gov (United States)

Bousquet, J; Devillier, P; Arnavielhe, S; Bedbrook, A; Alexis-Alexandre, G; van Eerd, M; Murray, R; Canonica, G W; Illario, M; Menditto, E; Passalacqua, G; Stellato, C; Triggiani, M; Carreiro-Martins, P; Fonseca, J; Morais Almeida, M; Nogueira-Silva, L; Pereira, A M; Todo Bom, A; Bosse, I; Caimmi, D; Demoly, P; Fontaine, J F; Just, J; Onorato, G L; Kowalski, M L; Kuna, P; Samolinski, B; Anto, J M; Mullol, J; Valero, A; Tomazic, P V; Bergmann, K C; Keil, T; Klimek, L; Mösges, R; Shamai, S; Zuberbier, T; Murphy, E; McDowall, P; Price, D; Ryan, D; Sheikh, A; Chavannes, N H; Fokkens, W J; Kvedariene, V; Valiulis, A; Bachert, C; Hellings, P W; Kull, I; Melen, E; Wickman, M; Bindslev-Jensen, C; Eller, E; Haahtela, T; Papadopoulos, N G; Annesi-Maesano, I; Bewick, M; Bosnic-Anticevich, S; Cruz, A A; De Vries, G; Gemicioglu, B; Larenas-Linnemann, D; Laune, D; Mathieu-Dupas, E; O'Hehir, R E; Pfaar, O; Portejoie, F; Siroux, V; Spranger, O; Valovirta, E; VandenPlas, O; Yorgancioglu, A

2018-01-15

Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect "real-world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis (AR) using mobile technology. A mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries. A total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control). This study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses. © 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Trastuzumab for metastatic breast cancer: Real world outcomes from an Australian whole-of-population cohort (2001-2016).

Science.gov (United States)

Daniels, Benjamin; Kiely, Belinda E; Lord, Sarah J; Houssami, Nehmat; Lu, Christine Y; Ward, Robyn L; Pearson, Sallie-Anne

2018-04-01

Outcomes for patients treated in clinical trials may not reflect the experience in routine clinical care. We aim to describe the real-world treatment patterns and overall survival (OS) for women receiving trastuzumab for metastatic breast cancer (MBC). Retrospective, whole-of-population cohort study using demographic, dispensing, and medical services data for women in the Herceptin Program for HER2+MBC. We estimated time on trastuzumab and OS from first dispensing of trastuzumab for MBC and rates of cardiac monitoring prior to and during treatment. We stratified outcomes by two groups based on year of initiation: 2001-2008 and 2009-2015. We benchmarked outcomes to two key trastuzumab clinical trials: H0648g (median OS 25 months) and CLEOPATRA (control group median OS 41 months). Median age of the 5899 women at first trastuzumab dispensing was 57 years (interquartile range [IQR]: 48-66). Median time on trastuzumab increased from 15 months (7-33) in Group One to 18 months (8-42) in Group Two. Median OS increased from 27 months (12-57) in Group One to 38 months (16-83) in Group Two. Rates of cardiac monitoring increased at baseline (52%-76%), and on-treatment (47%-67%), in Group One and Two, respectively. OS, duration of trastuzumab, and frequency of cardiac monitoring increased over the study period. Outcomes for trastuzumab in this heterogeneous real world population were reassuringly comparable to those from clinical trials, with the median OS > 3 years in Group Two and 25% of patients living 7 years or longer. Copyright © 2017 Elsevier Ltd. All rights reserved.

Real-world innovation in rural South Africa

CSIR Research Space (South Africa)

Mulder, I

2008-08-01

Full Text Available stream_source_info Mulder_2008.pdf.txt stream_content_type text/plain stream_size 46126 Content-Encoding UTF-8 stream_name Mulder_2008.pdf.txt Content-Type text/plain; charset=UTF-8 The Electronic Journal for Virtual... Organizations and Networks Volume 10, “Special Issue on Living Labs”, August 2008 REAL-WORLD INNOVATION IN RURAL SOUTH AFRICA Ingrid Mulder1,2, Walter Bohle3, Shela Boshomane4, Chris Morris4, Hugo Tempelman5, & Daan Velthausz1,6 1Telematica Instituut...

The impact of gender on asthma in the daily clinical practice.

Science.gov (United States)

Ciprandi, Giorgio; Gallo, Fabio

2018-03-01

It is up-to-date to consider the potential gender impact on a disease. There are few data about gender difference in asthma. Therefore, the present cross-sectional study tested this hypothesis in a real-life setting to investigate possible difference between genders. This study was cross-sectional, considering 554 consecutive outpatients suspected of asthma, who were referred for a first specialist visit. Clinical and functional parameters were evaluated. Females with asthma could have a worse perception of asthma control, assessed by asthma control test (ACT), and more anxiety than asthmatic males. However, there was no difference regarding asthma control grading, asthma severity, and asthma medication use between genders; the differences in lung function were without clinical relevance. In the daily clinical practice, it is relevant to consider gender in the management of asthma.

Real-world and specific to vehicle driving cycles for measuring car pollutant emissions

OpenAIRE

ANDRE, M; JOUMARD, R

2004-01-01

In the frame of the European research project ARTEMIS, a set of representative real-world driving cycles has been developed, to ensure a coherency between the pollutant emissions measurements conducted in the frame of the ARTEMIS project and of on-going national campaigns and to enable the integration of all the resulting emission data in the European systems of emission inventory. The 3 real-world ARTEMIS driving cycles (urban, rural road and motorway) represent the observed European drivi...

Clinical education - place and part for becoming a practically trained radiographer

International Nuclear Information System (INIS)

Shangova, M.; Stavreva, E.; Panamska, K.; Bozhkova, M.

2015-01-01

Full text: The aim is to present the crucial role of clinical education for becoming a practically trained radiographer. It's been put on review and analysis the role of the clinic practice and pre-graduate practice into the education of the future specialist. It's presenting in detail every component of the program for study and the contribution of every module in it - image diagnostic, nuclear medicine and radiotherapy. the clinical education lasts six semesters in real working environment. The gradual increase of working hours creates conditions for higher educational quality. Students gradually master techniques, acquire skills and precision at working in an X-ray department, nuclear medicine units and radiotherapy, master communication techniques and acquire teamwork skills. the clinical education provides professional training, quick adaptation to realization and facilitates starting a job

The 'bookshelf illusion'--a real-world Zöllner-type illusion?

Science.gov (United States)

MacLin, Otto H; Peterson, Dwight J

2010-01-01

We discovered an interesting perceptual distortion in our office where an upright lamp in front of a bookshelf was noticeably curved to form several subtle S-shaped bends. We realized that the books in the bookshelf fell in a particular manner, leaning in alternative directions, which caused the straight lamp to appear bent, creating what may be a real-world example of the Zöllner illusion. Evidence for the production of the illusion diagrammatically and an explanation for the effect are provided.

Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education.

Science.gov (United States)

Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven

2017-08-07

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

3D Interactions between Virtual Worlds and Real Life in an E-Learning Community

Directory of Open Access Journals (Sweden)

Ulrike Lucke

2011-01-01

Full Text Available Virtual worlds became an appealing and fascinating component of today's internet. In particular, the number of educational providers that see a potential for E-Learning in such new platforms increases. Unfortunately, most of the environments and processes implemented up to now do not exceed a virtual modelling of real-world scenarios. In particular, this paper shows that Second Life can be more than just another learning platform. A flexible and bidirectional link between the reality and the virtual world enables synchronous and seamless interaction between users and devices across both worlds. The primary advantages of this interconnection are a spatial extension of face-to-face and online learning scenarios and a closer relationship between virtual learners and the real world.

Real-world heart failure management in 10,910 patients with chronic heart failure in the Netherlands : Design and rationale of the Chronic Heart failure ESC guideline-based Cardiology practice Quality project (CHECK-HF) registry.

Science.gov (United States)

Brugts, J J; Linssen, G C M; Hoes, A W; Brunner-La Rocca, H P

2018-05-01

Data from patient registries give insight into the management of patients with heart failure (HF), but actual data from unselected real-world HF patients are scarce. Therefore, we performed a cross sectional study of current HF care in the period 2013-2016 among more than 10,000 unselected HF patients at HF outpatient clinics in the Netherlands. In 34 participating centres, all 10,910 patients with chronic HF treated at cardiology centres were included in the CHECK-HF registry. Of these, most (96%) were managed at a specific HF outpatient clinic. Heart failure was typically diagnosed according to the ESC guidelines 2012, based on signs, symptoms and structural and/or functional cardiac abnormalities. Information on diagnostics, treatment and co-morbidities were recorded, with specific focus on drug therapy and devices. In our cohort, the mean age was 73 years (SD 12) and 60% were male. Frequent co-morbidities reported in the patient records were diabetes mellitus 30%, hypertension 43%, COPD 19%, and renal insufficiency 58%. In 47% of the patients, ischaemia was the origin of HF. In our registry, the prevalence of HF with preserved ejection fraction was 21%. The CHECK-HF registry will provide insight into the current, real world management of patient with chronic HF, including HF with reduced ejection fraction, preserved ejection fraction and mid-range ejection fraction, that will help define ways to improve quality of care. Drug and device therapy and guideline adherence as well as interactions with age, gender and co-morbidities will receive specific attention.

A Coding of Real Null Four-Momenta into World-Sheet Co-ordinates

OpenAIRE

Fairlie, David B.

2008-01-01

The results of minimizing the action for string-like systems on a simply-connected world sheet are shown to encode the Cartesian components of real null momentum four-vectors into co-ordinates on the world sheet. This identification arises consistently from different approaches to the problem.

The Best of All Worlds: Immersive Interfaces for Art Education in Virtual and Real World Teaching and Learning Environments

Science.gov (United States)

Grenfell, Janette

2013-01-01

Selected ubiquitous technologies encourage collaborative participation between higher education students and educators within a virtual socially networked e-learning landscape. Multiple modes of teaching and learning, ranging from real world experiences, to text and digital images accessed within the Deakin studies online learning management…

Drawing the Ideal World and Real World: A Study of Lesbian, Labour and Social Inclusion

Directory of Open Access Journals (Sweden)

Henrique Luiz Caproni Neto

2014-12-01

Full Text Available In this paper, we analyze the experience of lesbian women in Juiz de Fora on the scope of work, society and the individual, from drawings made by them. Discussed the experience of sexuality and lesbophobia as aspects present in their lives and at work, considering that fall into a heteronormative context. So, we conducted a qualitative study with the preparation of drawings and interviews that allowed the construction of categories: being lesbian, inclusion and social integration, personal and professional development, and real world and the ideal world. These drawings are shown as a rich and interesting technique to provide access to their subjective and symbolic dimensions as to their social and work experiences. Finally, we advocate a reflective and humanistic stance both in society and in organizations about the socially constructed and valued patterns that can marginalize or stigmatize those fleeing them.

Mobile medical device connectivity: real world solutions.

Science.gov (United States)

Pettus, Dan

2004-01-01

Mobile medical devices, such as infusion pumps, provide an important therapeutic function. They are also valuable sources of information about treatment patterns at the point of care. However, these mobile devices have been independent islands of valuable information, unable to share the data they gather with other hospital information resources on a real time basis. Although data from these devices can provide significant improvements for medical safety and vital information needed for clinical best practice development, gathering that data poses significant challenges when interfacing with hospital information systems. Mobile medical devices move from place to place as independent actors, raising a series of security and identification issues when they need to be disconnected and reconnected using traditional tethered cable connections. The continuing lack of accepted communications protocol standards, in spite of the concentrated efforts of organizations like the IEEE and the Medical Information Bus (IEEE 1073) to establish them, has made integration into the hospital information system a complex and non-standard task. The rapid spread in availability and adoption of high-speed 802.11 wireless systems in hospitals offers a realistic connectivity solution for mobile medical devices. Inspite of this, the 802.11 standard is still evolving, and current security methods designed for user-based products like PDAs and laptop computers are not ideal for unmanned mobile medical devices because they assume the availability of a human operator to authenticate a wireless session. In the absence of accepted standards, manufacturers have created practical and innovative solutions to support the collection of clinical data from mobile medical devices and the integration of that data with hospital information systems. This paper will explore the potential benefits of integrating mobile medical devices into the hospital information system, and describe the challenges in

Clinical social work practice and technology: personal, practical, regulatory, and ethical considerations for the twenty-first century.

Science.gov (United States)

Dombo, Eileen A; Kays, Lisa; Weller, Katelyn

2014-10-01

The world that social work exists in is no longer defined by traditional physical settings and boundaries, such as schools, agencies, or even offices. With the advent of the Internet and digital communications, social work now exists in a far more complex reality, with clients and social workers engaging across multiple platforms, and sometimes even unintentionally and without one another's awareness. The implications of this can be ethical, practical, regulatory, and personal. This article explores these areas of concern and suggests strategies professionals can use to navigate these complex issues related to technology and clinical practice.

Effects of Integrating an Active Learning-Promoting Mechanism into Location-Based Real-World Learning Environments on Students' Learning Performances and Behaviors

Science.gov (United States)

Hwang, Gwo-Jen; Chang, Shao-Chen; Chen, Pei-Ying; Chen, Xiang-Ya

2018-01-01

Engaging students in real-world learning contexts has been identified by educators as being an important way of helping them learn to apply what they have learned from textbooks to practical problems. The advancements in mobile and image-processing technologies have enabled students to access learning resources and receive learning guidance in…

Investigating Comprehension in Real World Tasks: Understanding Jury Instructions.

Science.gov (United States)

Charrow, Veda R.; Charrow, Robert

This paper discusses the results of part of an ongoing project studying an aspect of real world language usage, the comprehension of standard jury instructions. Problems in the comprehension of these instructions include the memory load that they impose, the fact that most instructions are read only once, and the fact that instructions are written…

Students without Borders: Global Collaborative Learning Connects School to the Real World

Science.gov (United States)

Bickley, Mali; Carleton, Jim

2009-01-01

Kids can't help but get engaged when they're collaborating with peers across the globe to solve real-life problems. Global collaborative learning is about connecting students in communities of learners around the world so they can work together on projects that make a difference locally and globally. It is about building relationships and…

Exploring methods for comparing the real-world effectiveness of treatments for osteoporosis: adjusted direct comparisons versus using patients as their own control.

Science.gov (United States)

Karlsson, Linda; Mesterton, Johan; Tepie, Maurille Feudjo; Intorcia, Michele; Overbeek, Jetty; Ström, Oskar

2017-09-21

Using Swedish and Dutch registry data for women initiating bisphosphonates, we evaluated two methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for differences in patient baseline characteristics. Each method has advantages and disadvantages; both are potential complements to clinical trial analyses. We evaluated methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for both observed and unobserved confounding. Swedish and Dutch registry data for women initiating zoledronate or oral bisphosphonates (OBPs; alendronate/risedronate) were used; the primary outcome was fracture. In adjusted direct comparisons (ADCs), regression and matching techniques were used to account for baseline differences in known risk factors for fracture (e.g., age, previous fracture, comorbidities). In an own-control analysis (OCA), for each treatment, fracture incidence in the first 90 days following treatment initiation (the baseline risk period) was compared with fracture incidence in the 1-year period starting 91 days after treatment initiation (the treatment exposure period). In total, 1196 and 149 women initiating zoledronate and 14,764 and 25,058 initiating OBPs were eligible in the Swedish and Dutch registries, respectively. Owing to the small Dutch zoledronate sample, only the Swedish data were used to compare fracture incidences between treatment groups. ADCs showed a numerically higher fracture incidence in the zoledronate than in the OBPs group (hazard ratio 1.09-1.21; not statistically significant, p > 0.05). For both treatment groups, OCA showed a higher fracture incidence in the baseline risk period than in the treatment exposure period, indicating a treatment effect. OCA showed a similar or greater effect in the zoledronate group compared with the OBPs group. ADC and OCA each possesses advantages and disadvantages. Combining both methods may provide an estimate of real-world

A Dynamic Speech Comprehension Test for Assessing Real-World Listening Ability.

Science.gov (United States)

Best, Virginia; Keidser, Gitte; Freeston, Katrina; Buchholz, Jörg M

2016-07-01

Many listeners with hearing loss report particular difficulties with multitalker communication situations, but these difficulties are not well predicted using current clinical and laboratory assessment tools. The overall aim of this work is to create new speech tests that capture key aspects of multitalker communication situations and ultimately provide better predictions of real-world communication abilities and the effect of hearing aids. A test of ongoing speech comprehension introduced previously was extended to include naturalistic conversations between multiple talkers as targets, and a reverberant background environment containing competing conversations. In this article, we describe the development of this test and present a validation study. Thirty listeners with normal hearing participated in this study. Speech comprehension was measured for one-, two-, and three-talker passages at three different signal-to-noise ratios (SNRs), and working memory ability was measured using the reading span test. Analyses were conducted to examine passage equivalence, learning effects, and test-retest reliability, and to characterize the effects of number of talkers and SNR. Although we observed differences in difficulty across passages, it was possible to group the passages into four equivalent sets. Using this grouping, we achieved good test-retest reliability and observed no significant learning effects. Comprehension performance was sensitive to the SNR but did not decrease as the number of talkers increased. Individual performance showed associations with age and reading span score. This new dynamic speech comprehension test appears to be valid and suitable for experimental purposes. Further work will explore its utility as a tool for predicting real-world communication ability and hearing aid benefit. American Academy of Audiology.

RealWorld evaluation: working under budget, time, data, and political constraints

National Research Council Canada - National Science Library

Bamberger, Michael; Rugh, Jim; Mabry, Linda

2012-01-01

This book addresses the challenges of conducting program evaluations in real-world contexts where evaluators and their clients face budget and time constraints and where critical data may be missing...

Augmented Virtuality: A Real-time Process for Presenting Real-world Visual Sensory Information in an Immersive Virtual Environment for Planetary Exploration

Science.gov (United States)

McFadden, D.; Tavakkoli, A.; Regenbrecht, J.; Wilson, B.

2017-12-01

Virtual Reality (VR) and Augmented Reality (AR) applications have recently seen an impressive growth, thanks to the advent of commercial Head Mounted Displays (HMDs). This new visualization era has opened the possibility of presenting researchers from multiple disciplines with data visualization techniques not possible via traditional 2D screens. In a purely VR environment researchers are presented with the visual data in a virtual environment, whereas in a purely AR application, a piece of virtual object is projected into the real world with which researchers could interact. There are several limitations to the purely VR or AR application when taken within the context of remote planetary exploration. For example, in a purely VR environment, contents of the planet surface (e.g. rocks, terrain, or other features) should be created off-line from a multitude of images using image processing techniques to generate 3D mesh data that will populate the virtual surface of the planet. This process usually takes a tremendous amount of computational resources and cannot be delivered in real-time. As an alternative, video frames may be superimposed on the virtual environment to save processing time. However, such rendered video frames will lack 3D visual information -i.e. depth information. In this paper, we present a technique to utilize a remotely situated robot's stereoscopic cameras to provide a live visual feed from the real world into the virtual environment in which planetary scientists are immersed. Moreover, the proposed technique will blend the virtual environment with the real world in such a way as to preserve both the depth and visual information from the real world while allowing for the sensation of immersion when the entire sequence is viewed via an HMD such as Oculus Rift. The figure shows the virtual environment with an overlay of the real-world stereoscopic video being presented in real-time into the virtual environment. Notice the preservation of the object