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Sample records for real-world clinical practice-the

  1. 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...

  2. Real-world Data for Clinical Evidence Generation in Oncology.

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    Khozin, Sean; Blumenthal, Gideon M; Pazdur, Richard

    2017-11-01

    Conventional cancer clinical trials can be slow and costly, often produce results with limited external validity, and are difficult for patients to participate in. Recent technological advances and a dynamic policy landscape in the United States have created a fertile ground for the use of real-world data (RWD) to improve current methods of clinical evidence generation. Sources of RWD include electronic health records, insurance claims, patient registries, and digital health solutions outside of conventional clinical trials. A definition focused on the original intent of data collected at the point of care can distinguish RWD from conventional clinical trial data. When the intent of data collection at the point of care is research, RWD can be generated using experimental designs similar to those employed in conventional clinical trials, but with several advantages that include gains in efficient execution of studies with an appropriate balance between internal and external validity. RWD can support active pharmacovigilance, insights into the natural history of disease, and the development of external control arms. Prospective collection of RWD can enable evidence generation based on pragmatic clinical trials (PCTs) that support randomized study designs and expand clinical research to the point of care. PCTs may help address the growing demands for access to experimental therapies while increasing patient participation in cancer clinical trials. Conducting valid real-world studies requires data quality assurance through auditable data abstraction methods and new incentives to drive electronic capture of clinically relevant data at the point of care. Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US.

  3. [Discussion on solutions to ethical issues of clinical researches in a real world].

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    Wang, Si-Cheng; Liu, Bao-Yan; Xiong, Ning-Ning; Xie, Qi; Zhang, Run-Shun; Zhou, Xue-Zhong; Qiao, Jie

    2013-04-01

    The paradigm of a real world study has become the frontiers of clinical researches, especially in the field of Chinese medicine, all over the world in recent years. In this paper, ethical issues which probably exist in real-world studies are raised and reviewed. Moreover, some preliminary solutions to these issues such as protecting subjects during the process of real-world studies and performing ethical review are raised based on recent years' practices to enhance the scientificity and ethical level of real-world studies.

  4. Experience inheritance from famous specialists based on real-world clinical research paradigm of traditional Chinese medicine.

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    Song, Guanli; Wang, Yinghui; Zhang, Runshun; Liu, Baoyan; Zhou, Xuezhong; Zhou, Xiaji; Zhang, Hong; Guo, Yufeng; Xue, Yanxing; Xu, Lili

    2014-09-01

    The current modes of experience inheritance from famous specialists in traditional Chinese medicine (TCM) include master and disciple, literature review, clinical-epidemiology-based clinical research observation, and analysis and data mining via computer and database technologies. Each mode has its advantages and disadvantages. However, a scientific and instructive experience inheritance mode has not been developed. The advent of the big data era as well as the formation and practice accumulation of the TCM clinical research paradigm in the real world have provided new perspectives, techniques, and methods for inheriting experience from famous TCM specialists. Through continuous exploration and practice, the research group proposes the innovation research mode based on the real-world TCM clinical research paradigm, which involves the inheritance and innovation of the existing modes. This mode is formulated in line with its own development regularity of TCM and is expected to become the main mode of experience inheritance in the clinical field.

  5. [Exploration and demonstration study on drug combination from clinical real world].

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    Xie, Yan-ming; Wang, Lian-xin; Wang, Yong-yan

    2014-09-01

    Drug combination is extensive in the clinical real world,which is an important part and the inherent requirements of the post-marketing evaluation of traditional Chinese medicine (TCM). The key issues and technology include multi-domain and multi-disciplinary such as the rationality, efficacy and safety evaluation of combination drug starting from clinical real world, study on component in vivo and mechanism of combination drug, the risk/benefit assessment and cost-benefit evaluation of combination drug and so on. The topic has been studied as clinical demonstration on combination therapy of variety of diseases such as coronary heart disease, stroke, insomnia, depression, hepatitis, herpes zoster, psoriasis and ectopic pregnancy. Meanwhile, multi-disciplinary dynamic innovation alliance of clinical drug combination has been presented, which can promote the academic development and improving service ability and level of TCM.

  6. Sacubitril/Valsartan: From Clinical Trials to Real-world Experience.

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    Joly, Joanna M; Desai, Akshay S

    2018-04-23

    Compared to enalapril, use of angiotensin-receptor blocker and neprilysin inhibitor sacubitril/valsartan to treat patients with heart failure and reduced ejection fraction (HFrEF) is associated with substantial reductions in both cardiovascular mortality and heart failure progression. The purpose of this review is to discuss the real-world experience of sacubitril/valsartan. In the years following the publication of the landmark PARADIGM-HF trial in 2014 and its subsequent FDA approval, a growing evidence base supports the safety and efficacy of sacubitril/valsartan in a broad spectrum of patients with HFrEF. Updated clinical practice guidelines have embraced the use of sacubitril/valsartan in preference to ACE inhibitors or ARBs in selected patients. In this review, we highlight the clinical trials that led to these key updates to clinical guidelines, offer practical strategies for patient selection and utilization in clinical practice, and identify important areas of uncertainty that require future research.

  7. 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.

  8. 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. 

  9. Using Digital Technologies in Clinical HIV Research: Real-World Applications and Considerations for Future Work.

    Science.gov (United States)

    Andriesen, Jessica; Bull, Sheana; Dietrich, Janan; Haberer, Jessica E; Van Der Pol, Barbara; Voronin, Yegor; Wall, Kristin M; Whalen, Christopher; Priddy, Frances

    2017-07-31

    Digital technologies, especially if used in novel ways, provide a number of potential advantages to clinical research in trials related to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and may greatly facilitate operations as well as data collection and analysis. These technologies may even allow answering questions that are not answerable with older technologies. However, they come with a variety of potential concerns for both the participants and the trial sponsors. The exact challenges and means for alleviation depend on the technology and on the population in which it is deployed, and the rapidly changing landscape of digital technologies presents a challenge for creating future-proof guidelines for technology application. The aim of this study was to identify and summarize some common themes that are frequently encountered by researchers in this context and highlight those that should be carefully considered before making a decision to include these technologies in their research. In April 2016, the Global HIV Vaccine Enterprise surveyed the field for research groups with recent experience in novel applications of digital technologies in HIV clinical research and convened these groups for a 1-day meeting. Real-world uses of various technologies were presented and discussed by 46 attendees, most of whom were researchers involved in the design and conduct of clinical trials of biomedical HIV prevention and treatment approaches. After the meeting, a small group of organizers reviewed the presentations and feedback obtained during the meeting and categorized various lessons-learned to identify common themes. A group of 9 experts developed a draft summary of the findings that was circulated via email to all 46 attendees for review. Taking into account the feedback received, the group finalized the considerations that are presented here. Meeting presenters and attendees discussed the many successful applications of digital

  10. 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....

  11. The Real World.

    Science.gov (United States)

    Tanner, John Sears

    1981-01-01

    Relates personal experiences about what constitutes the "real world." Shows how experiences from philosophy, history, literature, art, and the movies add meaning to "reality." Stresses a compromise of imagination and sensation to make the real world palatable. (RL)

  12. 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.

  13. Omalizumab in children with uncontrolled allergic asthma: Review of clinical trial and real-world experience.

    Science.gov (United States)

    Chipps, Bradley E; Lanier, Bob; Milgrom, Henry; Deschildre, Antoine; Hedlin, Gunilla; Szefler, Stanley J; Kattan, Meyer; Kianifard, Farid; Ortiz, Benjamin; Haselkorn, Tmirah; Iqbal, Ahmar; Rosén, Karin; Trzaskoma, Benjamin; Busse, William W

    2017-05-01

    Asthma is one of the most common chronic diseases of childhood. Allergen sensitization and high frequencies of comorbid allergic diseases are characteristic of severe asthma in children. Omalizumab, an anti-IgE mAb, is the first targeted biologic therapeutic approved for the treatment of moderate-to-severe persistent allergic asthma (AA) that remains uncontrolled despite high-dose inhaled corticosteroids plus other controller medications. Since its initial licensing for use in adults and adolescents 12 years of age and older, the clinical efficacy, safety, and tolerability of omalizumab have been demonstrated in several published clinical trials in children aged 6 to less than 12 years with moderate-to-severe AA. These studies supported the approval of the pediatric indication (use in children aged ≥6 years) by the European Medicines Agency in 2009 and the US Food and Drug Administration in 2016. After this most recent change in licensing, we review the outcomes from clinical trials in children with persistent AA receiving omalizumab therapy and observational studies from the past 7 years of clinical experience in Europe. Data sources were identified by using PubMed in 2016. Guidelines and management recommendations and materials from the recent US Food and Drug Administration's Pediatric Advisory Committee meeting are also reviewed. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Worsening heart failure in 'real-world' clinical practice: predictors and prognostic impact.

    Science.gov (United States)

    AlFaleh, Hussam; Elasfar, Abdelfatah A; Ullah, Anhar; AlHabib, Khalid F; Hersi, Ahmad; Mimish, Layth; Almasood, Ali; Al Ghamdi, Saleh; Ghabashi, Abdullah; Malik, Asif; Hussein, Gamal A; Al-Murayeh, Mushabab; Abuosa, Ahmed; Al Habeeb, Waleed; Kashour, Tarek

    2017-08-01

    The aim of this study was to compare the clinical features, predictors, and clinical outcomes of patients hospitalized with acute heart failure (AHF), with and without worsening heart failure (WHF). We used data from a multicentre prospective registry of AHF patients created in Saudi Arabia. WHF was defined as recurrence of heart failure symptoms or signs-with or without cardiogenic shock. In-hospital short- and long-term outcomes, as well as predictors of WHF are described. Of the 2609 AHF patients enrolled, 33.8% developed WHF. WHF patients were more likely to have a history of heart failure and ischaemic heart disease. Use of intravenous vasodilators, inotropic agents, furosemide infusions, and discharge beta-blockers was significantly higher in WHF patients, while use of discharge ACE inhibitors was higher in patients without WHF. Length of hospital stay was significantly longer for WHF patients than for those without WHF [median (interquartile range) 13 (14) vs. 7 (7) days, P world clinical practice, WHF during hospitalization for AHF is a strong predictor for short- and intermediate-term mortality, and a cause for longer hospital stays. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. MANAGEMENT OF HYPERTENSION- INSIGHTS INTO REAL-WORLD CLINICAL PRACTICE FOR DIFFERENTIAL USAGE OF CALCIUM CHANNEL BLOCKERS (CCBS

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    Arup Dasbiswas

    2017-05-01

    Full Text Available BACKGROUND Calcium channel blockers (CCB like amlodipine, S (- amlodipine and cilnidipine, etc. have established place in the treatment of hypertension (HTN. As perceived by most of the physicians, they have comparative antihypertensive efficacy. However, available evidences suggest varied differences in incidence of pedal oedema. Aim- This survey was planned to understand real-world clinical practice pattern of Indian physicians for usage of various antihypertensive agents with emphasis on CCBs and whether differential incidence of oedema with CCBs is encountered in their clinical practice. MATERIALS AND METHODS Survey questionnaire consisting of 10 questions about preferred antihypertensive choice for different subsets of patients with HTN and efficacy and safety of S (- amlodipine was prepared and validated in small group of physicians. Overall, 494 general physicians and cardiologists practising in India were approached for seeking their opinion on usage of various CCBs. Statistical Analysis- Data were expressed in percentage. Design- Prospective, cross sectional, questionnaire-based survey. RESULTS Amongst various anti-hypertensive agents, majority of the physicians preferred CCB as their initial drug of choice for patients with HTN (53.8%, HTN with CKD (41.1%, elderly (55.3%, and young (30.8% patients. Though amlodipine was preferred by 75.7% physicians, pedal oedema was observed in >10% patients by 40.5% physicians. Most of the physicians rated S (- amlodipine to have better efficacy (79.4% and safety profile (88.3% with decreased incidence of pedal oedema than racemic Amlodipine. CONCLUSION Available evidences suggest comparative efficacy of S (- amlodipine and racemic amlodipine with varied differences in incidence of pedal oedema. However, our survey suggests better efficacy and safety of S (- amlodipine over racemic amlodipine as opined by most of the physicians of India. The survey findings need to be further evaluated in randomised

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

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    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.

  1. 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...

  2. 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.

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    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).

  3. Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.

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    Bonilauri Ferreira, Ana Paula Ribeiro; Ferreira, Rodrigo Fernando; Rajgor, Dimple; Shah, Jatin; Menezes, Andrea; Pietrobon, Ricardo

    2010-04-20

    Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. FOUR MAIN THEMES WERE IDENTIFIED: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.

  4. Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.

    Directory of Open Access Journals (Sweden)

    Ana Paula Ribeiro Bonilauri Ferreira

    Full Text Available BACKGROUND: Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. METHOD: This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. RESULTS: FOUR MAIN THEMES WERE IDENTIFIED: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. DISCUSSION: Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.

  5. 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

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    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

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. Connecting Technological Innovation in Artificial Intelligence to Real-world Medical Practice through Rigorous Clinical Validation: What Peer-reviewed Medical Journals Could Do

    Science.gov (United States)

    2018-01-01

    Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.

  11. Connecting Technological Innovation in Artificial Intelligence to Real-world Medical Practice through Rigorous Clinical Validation: What Peer-reviewed Medical Journals Could Do.

    Science.gov (United States)

    Park, Seong Ho; Kressel, Herbert Y

    2018-05-28

    Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.

  12. A modern optical character recognition system in a real world clinical setting: some accuracy and feasibility observations.

    Science.gov (United States)

    Biondich, Paul G; Overhage, J Marc; Dexter, Paul R; Downs, Stephen M; Lemmon, Larry; McDonald, Clement J

    2002-01-01

    Advances in optical character recognition (OCR) software and computer hardware have stimulated a reevaluation of the technology and its ability to capture structured clinical data from preexisting paper forms. In our pilot evaluation, we measured the accuracy and feasibility of capturing vitals data from a pediatric encounter form that has been in use for over twenty years. We found that the software had a digit recognition rate of 92.4% (95% confidence interval: 91.6 to 93.2) overall. More importantly, this system was approximately three times as fast as our existing method of data entry. These preliminary results suggest that with further refinements in the approach and additional development, we may be able to incorporate OCR as another method for capturing structured clinical data.

  13. 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

  14. Real-world clinical applicability of pathogenicity predictors assessed on SERPINA1 mutations in alpha-1-antitrypsin deficiency.

    Science.gov (United States)

    Giacopuzzi, Edoardo; Laffranchi, Mattia; Berardelli, Romina; Ravasio, Viola; Ferrarotti, Ilaria; Gooptu, Bibek; Borsani, Giuseppe; Fra, Annamaria

    2018-06-07

    The growth of publicly available data informing upon genetic variations, mechanisms of disease and disease sub-phenotypes offers great potential for personalised medicine. Computational approaches are likely required to assess large numbers of novel genetic variants. However, the integration of genetic, structural and pathophysiological data still represents a challenge for computational predictions and their clinical use. We addressed these issues for alpha-1-antitrypsin deficiency, a disease mediated by mutations in the SERPINA1 gene encoding alpha-1-antitrypsin. We compiled a comprehensive database of SERPINA1 coding mutations and assigned them apparent pathological relevance based upon available data. 'Benign' and 'Pathogenic' mutations were used to assess performance of 31 pathogenicity predictors. Well-performing algorithms clustered the subset of variants known to be severely pathogenic with high scores. Eight new mutations identified in the ExAC database and achieving high scores were selected for characterisation in cell models and showed secretory deficiency and polymer formation, supporting the predictive power of our computational approach. The behaviour of the pathogenic new variants and consistent outliers were rationalised by considering the protein structural context and residue conservation. These findings highlight the potential of computational methods to provide meaningful predictions of the pathogenic significance of novel mutations and identify areas for further investigation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Bridging the gap between the randomised clinical trial world and the real world by combination of population-based registry and electronic health record data : A case study in haemato-oncology

    NARCIS (Netherlands)

    Kibbelaar, R E; Oortgiesen, B E; van der Wal-Oost, A M; Boslooper, K; Coebergh, J W; Veeger, N J G M; Joosten, P; Storm, H; van Roon, E N; Hoogendoorn, M

    2017-01-01

    Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies

  16. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis.

    Science.gov (United States)

    Kalkhoran, Sara; Glantz, Stanton A

    2016-02-01

    Smokers increasingly use e-cigarettes for many reasons, including attempts to quit combustible cigarettes and to use nicotine where smoking is prohibited. We aimed to assess the association between e-cigarette use and cigarette smoking cessation among adult cigarette smokers, irrespective of their motivation for using e-cigarettes. PubMed and Web of Science were searched between April 27, 2015, and June 17, 2015. Data extracted included study location, design, population, definition and prevalence of e-cigarette use, comparison group (if applicable), cigarette consumption, level of nicotine dependence, other confounders, definition of quitting smoking, and odds of quitting smoking. The primary endpoint was cigarette smoking cessation. Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed using a random effects meta-analysis. A modification of the ACROBAT-NRSI tool and the Cochrane Risk of Bias Tool were used to assess bias. This meta-analysis is registered with PROSPERO (number CRD42015020382). 38 studies (of 577 studies identified) were included in the systematic review; all 20 studies with control groups (15 cohort studies, three cross-sectional studies, and two clinical trials) were included in random effects meta-analysis and sensitivity analyses. Odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes (odds ratio [OR] 0·72, 95% CI 0·57-0·91). Association of e-cigarette use with quitting did not significantly differ among studies of all smokers using e-cigarettes (irrespective of interest in quitting cigarettes) compared with studies of only smokers interested in cigarette cessation (OR 0·63, 95% CI 0·45-0·86 vs 0·86, 0·60-1·23; p=0·94). Other study characteristics (design, population, comparison group, control variables, time of exposure assessment, biochemical verification of abstinence, and definition of e-cigarette use

  17. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis

    Science.gov (United States)

    Kalkhoran, Sara; Glantz, Stanton A

    2016-01-01

    Summary Background Smokers increasingly use e-cigarettes for many reasons, including attempts to quit combustible cigarettes and to use nicotine where smoking is prohibited. We aimed to assess the association between e-cigarette use and cigarette smoking cessation among adult cigarette smokers, irrespective of their motivation for using e-cigarettes. Methods PubMed and Web of Science were searched between April 27, 2015, and June 17, 2015. Data extracted included study location, design, population, definition and prevalence of e-cigarette use, comparison group (if applicable), cigarette consumption, level of nicotine dependence, other confounders, definition of quitting smoking, and odds of quitting smoking. The primary endpoint was cigarette smoking cessation. Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed using a random effects meta-analysis. A modification of the ACROBAT-NRSI tool and the Cochrane Risk of Bias Tool were used to assess bias. This meta-analysis is registered with PROSPERO (number CRD42015020382). Findings 38 studies (of 577 studies identified) were included in the systematic review; all 20 studies with control groups (15 cohort studies, three cross-sectional studies, and two clinical trials) were included in random effects meta-analysis and sensitivity analyses. Odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes (odds ratio [OR] 0·72, 95% CI 0·57–0·91). Association of e-cigarette use with quitting did not significantly differ among studies of all smokers using e-cigarettes (irrespective of interest in quitting cigarettes) compared with studies of only smokers interested in cigarette cessation (OR 0·63, 95% CI 0·45–0·86 vs 0·86, 0·60–1·23; p=0·94). Other study characteristics (design, population, comparison group, control variables, time of exposure assessment, biochemical verification of

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. Safety and Effectiveness of Mirabegron in Patients with Overactive Bladder in a Real-World Clinical Setting: A Japanese Post-Marketing Study.

    Science.gov (United States)

    Nozawa, Yumiko; Kato, Daisuke; Tabuchi, Hiromi; Kuroishi, Kentarou

    2018-05-01

    To provide real-world data on Japanese patients with overactive bladder (OAB) initiating treatment with the β 3 -adrenoceptor agonist, mirabegron. This study examined prescribing patterns, adverse drug reaction (ADR) incidence, and treatment effectiveness. Full medical histories, including prior/concomitant drug use, were collected before initiating mirabegron treatment. After 12 weeks mirabegron, physicians assessed ADR incidence and treatment effectiveness. Residual urine volume was assessed and patients completed the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score-Quality of Life (I-PSS QoL) surveys at Baseline and 12 weeks. Data were collected between April 2012 and July 2014. Of 9795 OAB patients (46.8% male; 80.8% ≥65 years), 71.7% had coexisting disease [notably benign prostatic hyperplasia (BPH, 32.4%), hypertension (31.9%), and diabetes mellitus (9.4%)] and 53.4% reported concomitant drug use (27.8% α 1 -antagonists, 6.3% anticholinergics). The incidence of total ADRs was 6.07% [including constipation (0.97%), thirst (0.47%), and dysuria (0.44%)], of serious ADRs, 0.21%, of cardiovascular ADRs, 0.48% and of urinary retention, 0.31%. Incidence of total ADRs in patients with concomitant cardiovascular disease was 10.09% and of those related to urinary retention in men with untreated BPH, 0.88%. After 12 weeks treatment, physicians judged mirabegron as "effective" in 80.7% of patients, 63.6% of patients achieved the three-point minimal clinically important change from Baseline in the mean OABSS, and the I-PSS QoL decreased significantly from Baseline (-2.1 ± 1.77; P effective treatment for Japanese patients with OAB. © 2016 Astellas Pharma Inc. LUTS: Lower Urinary Tract Symptoms published by John Wiley & Sons Australia, Ltd.

  3. 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 ...

  4. 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)…

  5. 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

  6. 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…

  7. Real-World Clinical Effectiveness and Cost Savings of Liraglutide Versus Sitagliptin in Treating Type 2 Diabetes for 1 and 2 Years.

    Science.gov (United States)

    Li, Qian; Ganguly, Rahul; Ganz, Michael L; Gamble, Cory; Dang-Tan, Tam

    2018-06-01

    This study compared the clinical and economic outcomes of long-term use of liraglutide versus sitagliptin for the treatment of type 2 diabetes (T2DM) in real-world practice in the USA. We identified adult patients (≥ 18 years old) with T2DM who initiated liraglutide or sitagliptin in 2010-2014 using a large claims database. Quarterly glycemic control measures and annual healthcare costs were assessed during the 1st and 2nd years of persistent medication use. Their associations with medication use (liraglutide or sitagliptin) were estimated using multivariable regression models adjusted for patient demographic and clinical characteristics. A total of 3113 patients persistently used liraglutide (N = 493) or sitagliptin (N = 2620) for ≥ 1 year [mean age (standard deviation, SD): 53 (8.5) vs. 56 (9.7) years; 48.3% vs. 62.3% males; both p < 0.05]; 911 (including 113 liraglutide users) were persistent users for ≥ 2 years. During the 1st-year follow-up, liraglutide users (versus sitagliptin users, after adjustment) experienced larger glycated hemoglobin (HbA1c) reductions from baseline (ranging from 0.34%-point in quarter 1 to 0.21%-point in quarter 4); higher likelihoods of obtaining HbA1c reductions of ≥ 1%-points or ≥ 2%-points [odds ratios (ORs) range 1.47-2.04]; and higher likelihoods of reaching HbA1c goals of < 6.5% or < 7% (ORs range 1.51-2.12) (all p < 0.05). Liraglutide users also experienced HbA1c reductions from baseline in the 2nd-year follow-up (0.53-0.33%-point, all p < 0.05). Although liraglutide users incurred higher healthcare costs than sitagliptin users during the 1st-year follow-up, they had $2674 (per patient) lower all-cause medical costs (adjusted cost ratio: 0.67, p < 0.05) and similar total costs (all-cause and diabetes-related) in the 2nd year. Long-term use of liraglutide for 1 or 2 years was associated with better glycemic control than using sitagliptin. Savings in medical costs

  8. Treatment patterns and real world clinical outcomes in ER+/HER2- post-menopausal metastatic breast cancer patients in the United States.

    Science.gov (United States)

    Zanotti, Giovanni; Hunger, Matthias; Perkins, Julia J; Horblyuk, Ruslan; Martin, Monique

    2017-06-02

    With several new therapies becoming available, treatment of metastatic breast cancer (mBC) is evolving. The objective of this study is to describe patient characteristics, treatment patterns and real-world clinical outcomes in post-menopausal women with ER+, HER2- mBC and to obtain insight into patient outcomes and potential unmet needs with current therapies. The current study is a physician survey followed by a retrospective chart review of patient medical records by physicians in the US between March and April 2015. One hundred three physicians were asked to complete an online survey aiming to understand their satisfaction and expectations with current available treatments and potential areas of unmet need for mBC patients. Medical records from 178 females were extracted for the chart review. Using these data from medical records, patient characteristics and treatment patterns were analyzed descriptively. Time to progression (TTP) on first line, and progression-free survival (PFS) on second and third line of therapy were analyzed using the Kaplan-Meier method. Sixty-seven percent (n = 119) of patients had metastatic disease at initial diagnosis of breast cancer. Mean age at chart data extraction was 65.8 (SD: 9.4) years. Aromatase inhibitors (AIs) were prescribed for 58% and around 13% of patients in first line and second line, respectively. Chemotherapy was prescribed to 14% in first line and 31% in second line. Median TTP on first line therapy was 12 months for patients receiving AIs as compared to 7.9 months for patients receiving chemotherapy. Across all treatment lines, bone pain and fatigue were reported as the main symptoms associated with disease progression which had an impact on patient quality of life. Physicians expressed that prolonging life was deemed the most important treatment goal, followed by preservation or improvement of quality of life. In this study the majority of patients received endocrine therapy as first line treatment and current

  9. 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.

  10. Bridging the gap between the randomised clinical trial world and the real world by combination of population-based registry and electronic health record data: A case study in haemato-oncology.

    Science.gov (United States)

    Kibbelaar, R E; Oortgiesen, B E; van der Wal-Oost, A M; Boslooper, K; Coebergh, J W; Veeger, N J G M; Joosten, P; Storm, H; van Roon, E N; Hoogendoorn, M

    2017-11-01

    Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented. In this approach, a PBR is combined with an advanced EHR, providing high-quality data for observational studies and support of best practice development. This PBR + EHR approach opens a perspective on randomised registry trials. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. 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…

  12. 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.

  13. 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.

  14. 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...

  15. 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

  16. 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.

  17. 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.

  18. Safety and Effectiveness of Once-Daily Tadalafil (5 mg Therapy in Korean Men with Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms in a Real-World Clinical Setting: Results from a Post- Marketing Surveillance Study

    Directory of Open Access Journals (Sweden)

    Ji Eon Won

    2018-05-01

    Full Text Available Purpose: The aim of this study was to investigate the safety and effectiveness of tadalafil 5 mg once daily (quaque die [everyday], QD among Korean men with benign prostatic hyperplasia (BPH/lower urinary tract symptoms (LUTS in a real-world clinical setting. Materials and Methods: This was a single-country, prospective, observational cohort study in which patients newly prescribed tadalafil 5 mg QD for the treatment of BPH/LUTS were followed-up for 12±2 or 24±2 weeks, or to the last treatment, during post-marketing surveillance. Safety was evaluated in terms of the frequency of treatment-emergent adverse events (TEAEs and serious adverse events (SAEs. Effectiveness was assessed by changes in the International Prostate Symptom Score (IPSS from baseline to each endpoint. Results: All patients receiving ≥1 dose of tadalafil 5 mg QD (N=637 were included in the safety population. Two percent of patients (n=13 experienced 15 TEAEs of mild (n=10; 66.7% or moderate (n=5; 33.3% severity. No severe TEAEs and no SAEs were reported. Effectiveness evaluations included all patients receiving tadalafil who had both baseline and endpoint observations (12-week, N=265; 24-week, N=44. Compared with baseline, the mean IPSS total score (±standard error significantly improved by 4.7±0.3 and 6.4±0.7 points at the 12- and 24-week endpoints, respectively (p<0.0001, with significant improvements also observed on the storage, voiding, and quality of life subscores. In total, 69.1% of the patients had a clinically meaningful ≥3-point improvement in the IPSS total score. Conclusions: Tadalafil 5 mg QD was well tolerated and effective in Korean men with BPH/LUTS in a real-world clinical setting.

  19. Understanding the Value of Real-World Evidence

    DEFF Research Database (Denmark)

    Camm, A John; Coleman, Craig I; Larsen, Torben Bjerregaard

    2018-01-01

    importance, there may be challenges in understanding the relevance of the differing study designs, endpoints and populations. Here, we summarize the value of real-world evidence and considerations pertinent to their use in clinical research. Owing to the variety of analyses being conducted using real...

  20. 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.

  1. Safety and Effectiveness of Once-Daily Tadalafil (5 mg) Therapy in Korean Men with Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms in a Real-World Clinical Setting: Results from a Post-Marketing Surveillance Study.

    Science.gov (United States)

    Won, Ji Eon; Chu, Ji Yeon; Choi, Hyunah Caroline; Chen, Yun; Park, Hyun Jun; Dueñas, Héctor José

    2018-05-01

    The aim of this study was to investigate the safety and effectiveness of tadalafil 5 mg once daily (quaque die [everyday], QD) among Korean men with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) in a real-world clinical setting. This was a single-country, prospective, observational cohort study in which patients newly prescribed tadalafil 5 mg QD for the treatment of BPH/LUTS were followed-up for 12±2 or 24±2 weeks, or to the last treatment, during post-marketing surveillance. Safety was evaluated in terms of the frequency of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). Effectiveness was assessed by changes in the International Prostate Symptom Score (IPSS) from baseline to each endpoint. All patients receiving ≥1 dose of tadalafil 5 mg QD (N=637) were included in the safety population. Two percent of patients (n=13) experienced 15 TEAEs of mild (n=10; 66.7%) or moderate (n=5; 33.3%) severity. No severe TEAEs and no SAEs were reported. Effectiveness evaluations included all patients receiving tadalafil who had both baseline and endpoint observations (12-week, N=265; 24-week, N=44). Compared with baseline, the mean IPSS total score (±standard error) significantly improved by 4.7±0.3 and 6.4±0.7 points at the 12- and 24-week endpoints, respectively (peffective in Korean men with BPH/LUTS in a real-world clinical setting. Copyright © 2018 Korean Society for Sexual Medicine and Andrology.

  2. Using 'WeChat' online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis.

    Science.gov (United States)

    Zhang, TianHong; Xu, LiHua; Tang, YingYing; Cui, HuiRu; Li, HuiJun; Wei, YanYan; Xu, YangYang; Jiang, LiJuan; Zhu, YiKang; Li, ChunBo; Jiang, KaiDa; Xiao, ZePing; Wang, JiJun

    2018-04-01

    The argument surrounding the safety and effectiveness of interventions for the population of individuals at a clinical high risk of developing psychosis has been ongoing for the past 30 years. However, few studies have assessed the needs of this special young population, who are struggling with the recent onset of psychotic symptoms. The sample consisted of 171 family members of 108 clinical high-risk individuals included from the ShangHai at Risk for Psychosis research programme. A 'WeChat' group was established to provide mutual support. There were 22,007 valid messages sent within the group between 1 April 2015 and 27 June 2016. Chat records were subsequently analysed to determine the needs of families during intervention at the early stages of psychosis. Families of clinical high-risk individuals were highly involved in the entire medical process, and the major concerns of the families of clinical high-risk individuals focused on both functional recovery and medication. The themes of 'take medication', 'go to school' and 'study in school' were often discussed within the group. A family-focused intervention targeting functional recovery and real-time professional explanations of medication would meet the major needs of families of Chinese clinical high-risk individuals.

  3. 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

    OpenAIRE

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

    2016-01-01

    Background 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. Methods The data source for this post hoc research...

  4. Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings

    Directory of Open Access Journals (Sweden)

    Sunderajan Prabha

    2009-01-01

    Full Text Available Abstract Background Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources for the change and strategies to implement and maintain new systems. Methods To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners participated across five sites, accruing over 300 outpatient visits on 168 patients. Results Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping. Conclusion The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.

  5. Use of the Prostate Core Mitomic Test in Repeated Biopsy Decision-Making: Real-World Assessment of Clinical Utility in a Multicenter Patient Population.

    Science.gov (United States)

    Legisi, Lorena; DeSa, Elise; Qureshi, M Nasar

    2016-12-01

    Prostate cancer is the most common cancer diagnosed in men in developed countries. Using molecular testing may help to improve outcomes in this clinically challenging group. Since 2011, the Prostate Core Mitomic Test (PCMT), which quantifies a 3.4-kb mitochondrial DNA deletion strongly associated with prostate cancer, has been used by more than 50 urology practices accessing pathology services through our laboratory in New Jersey. However, the use of a molecular test can only be beneficial if it affects patient management and improves outcomes. To determine whether repeated biopsy decision-making was affected in a quantifiable manner through the adjunct use of molecular testing with the PCMT. In this observational study we conducted 2 independent, structured query language database queries of our patient records at our laboratory, QDx Pathology Services, in Cranford, NJ. Query 1 included all men who had a negative prostate biopsy and a negative PCMT between February 1, 2011, and June 30, 2013. Men with a previous diagnosis of cancer were excluded. Query 2 included all men who had a negative prostate biopsy and a repeated biopsy between February 1, 2011, and September 30, 2013. The data exported for each query included the unique specimen number for an index biopsy, the interval between biopsies where present, the unique specimen number for a follow-up biopsy where present, histopathology for all biopsies, the biopsy procedure dates, the patient's date of birth, and the PCMT result when utilized. The patient rebiopsy rates and intervals were compared between the patients who were using PCMT and those who were not to assess whether the adjunct use of the PCMT impacted the rebiopsy decision-making process. Query 1 identified 644 men who had a negative biopsy and a negative PCMT result within the study period. Query 2 identified 823 men with a repeat biopsy after the initial negative index biopsy within the study period. Of these men, 132 had PCMT to inform their care

  6. The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry

    Directory of Open Access Journals (Sweden)

    Francesco Nicolini

    2017-01-01

    Full Text Available The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p<0.0001, cardiac-related mortality (p<0.0001, incidence of acute myocardial infarction (p=0.01, and stroke rates (p<0.0001. Patients < 60 years required repeated revascularization more frequently than older patients (p=0.05. Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.

  7. Prediction of overall survival for metastatic pancreatic cancer: Development and validation of a prognostic nomogram with data from open clinical trial and real-world study.

    Science.gov (United States)

    Hang, Junjie; Wu, Lixia; Zhu, Lina; Sun, Zhiqiang; Wang, Ge; Pan, Jingjing; Zheng, Suhua; Xu, Kequn; Du, Jiadi; Jiang, Hua

    2018-06-01

    It is necessary to develop prognostic tools of metastatic pancreatic cancer (MPC) for optimizing therapeutic strategies. Thus, we tried to develop and validate a prognostic nomogram of MPC. Data from 3 clinical trials (NCT00844649, NCT01124786, and NCT00574275) and 133 Chinese MPC patients were used for analysis. The former 2 trials were taken as the training cohort while NCT00574275 was used as the validation cohort. In addition, 133 MPC patients treated in China were taken as the testing cohort. Cox regression model was used to investigate prognostic factors in the training cohort. With these factors, we established a nomogram and verified it by Harrell's concordance index (C-index) and calibration plots. Furthermore, the nomogram was externally validated in the validation cohort and testing cohort. In the training cohort (n = 445), performance status, liver metastasis, Carbohydrate antigen 19-9 (CA19-9) log-value, absolute neutrophil count (ANC), and albumin were independent prognostic factors for overall survival (OS). A nomogram was established with these factors to predict OS and survival probabilities. The nomogram showed an acceptable discrimination ability (C-index: .683) and good calibration, and was further externally validated in the validation cohort (n = 273, C-index: .699) and testing cohort (n = 133, C-index: .653).The nomogram total points (NTP) had the potential to stratify patients into 3-risk groups with median OS of 11.7, 7.0 and 3.7 months (P < .001), respectively. In conclusion, the prognostic nomogram with NTP can predict OS for patients with MPC with considerable accuracy. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  8. Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study.

    Science.gov (United States)

    Banerjee, Amitava; Lane, Deirdre A; Torp-Pedersen, Christian; Lip, Gregory Y H

    2012-03-01

    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 risk of stroke and thromboembolism gain the greatest benefit from OAC with warfarin. There are no data for the new OACs, that is, dabigatran, rivaroxaban and apixaban, as yet. We calculated the net clinical benefit balancing IS against ICH using data from the Danish National Patient Registry on patients with non-valvular AF between 1997-2008, for dabigatran, rivaroxaban and apixaban on the basis of recent clinical trial outcome data for these new OACs. In patients with CHADS(2)=0 but at high bleeding risk, apixaban and dabigatran 110 mg bid had a positive net clinical benefit. At CHA(2)DS(2)-VASc=1, apixaban and both doses of dabigatran (110 mg and 150 mg bid) had a positive net clinical benefit. In patients with CHADS(2) score≥1 or CHA(2)DS(2)-VASc≥2, the three new OACs (dabigatran, rivaroxaban and apixaban) appear superior to warfarin for net clinical benefit, regardless of risk of bleeding. When risk of bleeding and stroke are both high, all three new drugs appear to have a greater net clinical benefit than warfarin. In the absence of head-to-head trials for these new OACs, our analysis may help inform decision making processes when all these new OACs become available to clinicians for stroke prevention 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.

  9. 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)

  10. 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…

  11. 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.

  12. 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…

  13. Achieving simplified disease activity index remission in patients with active rheumatoid arthritis is associated with subsequent good functional and structural outcomes in a real-world clinical setting under a treat-to-target strategy.

    Science.gov (United States)

    Hirano, Fumio; Yokoyama, Waka; Yamazaki, Hayato; Amano, Koichi; Kawakami, Atsushi; Hayashi, Taichi; Tamura, Naoto; Yasuda, Shinsuke; Dobashi, Hiroaki; Fujii, Takao; Ito, Satoshi; Kaneko, Yuko; Matsui, Toshihiro; Okuda, Yasuaki; Saito, Kazuyoshi; Suzuki, Fumihito; Yoshimi, Ryusuke; Sakai, Ryoko; Koike, Ryuji; Kohsaka, Hitoshi; Miyasaka, Nobuyuki; Harigai, Masayoshi

    2017-09-01

    To verify predictive validity of simplified disease activity index (SDAI) remission for subsequent functional and structural outcomes in real-world clinical settings under a treat-to-target strategy (T2T). In this multicenter, prospective cohort study, T2T was implemented in rheumatoid arthritis (RA) patients with moderate-to-high disease activity. SDAI or clinical disease activity index (CDAI) was assessed every 12 weeks, and treatment was adjusted to achieve clinical remission or low disease activity (LDA). Multivariate logistic regression models were used to examine the associations of SDAI remission (≤3.3) at week 24 with the health assessment questionnaire-disability index (HAQ-DI) ≤ 0.5 or with the delta van der Heijde-modified total Sharp score (ΔvdH-mTSS) clinical settings.

  14. Real-world variability in ranibizumab treatment and associated clinical, quality of life, and safety outcomes over 24 months in patients with neovascular age-related macular degeneration: the HELIOS study

    Directory of Open Access Journals (Sweden)

    Rakic JM

    2013-09-01

    Full Text Available Jean-Marie Rakic,1 Anita Leys,2 Heidi Brié,3 Kris Denhaerynck,4 Christy Pacheco,4 Stefaan Vancayzeele,3 Christine Hermans,3 Karen MacDonald,4 Ivo Abraham4,5 1Department of Ophthalmology, Centre Hospitalier Universitaire de Liège, Site du Sart Tilman, Liège, Belgium; 2Leuven University Eye Hospital, Leuven, Belgium; 3Novartis Pharma, Vilvoorde, Belgium; 4Matrix45, Tucson, AZ, USA; 5Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA Introduction: The aim of this study was to examine ranibizumab treatment patterns in "real-world" practice and clinical settings, as well as to assess quality of life outcomes over a 24-month period. Materials and methods: This was a prospective, observational, multicenter, open-label study of 0.5 mg of ranibizumab administered intravitreally. Patients were followed over 24 ± 3 months with intermediate data points at 6 ± 2 months and 12 ± 2 months, and a limited data point at 2.5 ± 1 month that coincided with the end of the loading phase. Outcomes included visual acuity (Early Treatment Diabetic Retinopathy Study, visual function (National Eye Institute Visual Function Questionnaire-25 [NEI VFQ-25], quality of life (Health Utilities Index Mark III [HUI3], and safety. Results: A total of 267 patients with wet age-related macular degeneration (mean ± standard deviation [SD] age = 78.5 ± 7.3 years; 62.4% were female; 34.5% with dual eye involvement; 74.9% were treatment-naïve were treated (309 eyes were treated. The mean ± SD Early Treatment Diabetic Retinopathy Study score at baseline was 56.3 ± 14.3 letters. The mean ± SD number of injections over 24 months was 7.6 ± 4.1, including 2.5 ± 0.7 and 5.9 ± 3.6 during the loading and maintenance phases, respectively, with corresponding treatment intervals of 4.8 ± 1.4 weeks and 11.5 ± 9.5 weeks, respectively. Improvements in visual acuity over baseline were reached at 2.5 months and maintained at 6 months (both P

  15. Sunitinib in mRCC: A systematic review of UK Real World Data

    Directory of Open Access Journals (Sweden)

    David Andrew Montgomery

    2015-08-01

    Full Text Available BackgroundReal world data are increasingly used to inform drug reimbursement decisions, but it is unclear how well outcomes from real world studies compare to those of clinical trials. This systematic review seeks to compare outcomes for sunitinib in routine UK clinical practice with the sunitinib registrational and expanded access program clinical trials. MethodSystematic review of the real world published literature was undertaken. UK observational studies recording first or second line sunitinib efficacy were included. A qualitative summary of the results and comparison to the controlled clinical trials was conducted. 15 real world studies were included, 14 of which were only available as posters/presentations. ResultsReal world study reporting quality was generally low, making comparisons with the clinical trials difficult. Practice relating to starting dose, dose modification, timing of therapy initiation and other factors varied between centres. Median progression free survival and adverse events were generally comparable to the clinical trial outcomes, but overall survival was not. ConclusionsThere are few published data on sunitinib use in UK clinical practice. Studies are characterised by lack of peer reviewed publication and heterogeneity in design, reporting and analysis. For use of real world data in the reimbursement setting, data collection and reporting will need to improve.

  16. 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)

  17. 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

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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...

  3. Science writing in the real world

    Directory of Open Access Journals (Sweden)

    Mike Mentis

    2014-02-01

    Full Text Available The objective of this contribution is to consider guides to technical writing. Since the professional writes what he does and does what he writes, guides to how you execute the one relate to how you perform the other, so this article is about more than just writing. While there is need for idiosyncrasy and individualism, there are some rules. Documents must have an explicit purpose stated at the outset. By their nature, documents in the applied sciences and business address real-world problems, but elsewhere activity may be laissez faire for which the cost-effectiveness in yielding innovations is contestable. A hallmark of written science and technology is that every statement is capable of being tested and capable of being shown to be wrong, and that methods yield repeatable results. Caution should be observed in requiring authoritative referencing for every notion, partly because of the unsatisfying infinite regress in searching for ultimate sources, and partly to avoid squashing innovation. It is not only the content of messages that matters, but reliability too. Probability theory must be built into design to assure that strong inference can be drawn from outcomes. Research, business and infrastructure projects must substitute the frequent optimistic ‘everything goes according to plan’ (EGAP with a more realistic ‘most likely development’ (MLD and the risks of even that not happening. A cornerstone of science and technology is parsimony. No description, experiment, explanation, hypothesis, idea, instrument, machine, method, model, prediction, statement, technique, test or theory should be more elaborate than necessary to satisfy its purpose. Antifragility – the capacity to survive and benefit from shocks – must be designed into project and organizational structure and function by manipulating such factors as complexity and interdependency to evade failure in a turbulent and unpredictable world. The role of writing is to integrate

  4. 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.

  5. 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

  6. Discussion of solutions to ethical issues in real-world study.

    Science.gov (United States)

    Wang, Sicheng; Liu, Baoyan; Xiong, Ningning; Xie, Qi; Zhang, Runshun; Zhou, Xuezhong; Qiao, Jie

    2014-09-01

    In recent years, the paradigm of real-world study (RWS) has been at the forefront of clinical research worldwide, particularly in the field of traditional Chinese medicine. In this paper, basic features and nature of real-world clinical studies are discussed, and ethical issues in different stages of RWS are raised and reviewed. Moreover, some preliminary solutions to these issues, such as protecting subjects during the process of RWS and performing ethical review, are presented based on recent practices and basic ethical rules to improve the scientific validity and ethical level of RWS.

  7. Safety and efficacy of ipragliflozin in Japanese patients with type 2 diabetes in real-world clinical practice: interim results of the STELLA-LONG TERM post-marketing surveillance study.

    Science.gov (United States)

    Nakamura, Ichiro; Maegawa, Hiroshi; Tobe, Kazuyuki; Tabuchi, Hiromi; Uno, Satoshi

    2018-02-01

    Data regarding the efficacy and safety of sodium-glucose cotransporter 2 inhibitors in the real-world setting in Japan are limited. The STELLA-LONG TERM study is an ongoing 3-year post-marketing surveillance study of ipragliflozin in type 2 diabetes (T2D) patients. Here, we report the interim results (including 3-, 12-, and 24-month data). All Japanese patients with T2D who were first prescribed ipragliflozin between 17 July 2014 and 16 October 2015 at participating centers in Japan were registered in STELLA-LONG TERM. At 3, 12, and 24 months, the safety analysis set comprised 11,053, 5475, and 138 patients, respectively; the efficacy analysis set comprised 8757 patients. Ipragliflozin treatment resulted in statistically significant improvements versus baseline in hemoglobin A1c, fasting plasma glucose concentration, body weight, blood pressure, heart rate, and serum concentrations of low-density lipoprotein cholesterol and triglycerides. The adverse drug reaction incidence rate was 10.71%, the most common reactions being renal and urinary disorders (5.06%), infections and infestations (1.24%), and skin and subcutaneous tissue disorders (1.14%). Ipragliflozin was well tolerated and effective in Japanese patients with T2D; no new safety issues were identified.

  8. BOOK REVIEW: Physics in the Real World

    Science.gov (United States)

    Jardine, Jim

    2000-05-01

    Listeners to science programmes on Canadian radio were invited to submit questions which were then answered, on air, by the author of this wee book. Its purpose, he says, is `to indicate that there are many questions in the real world to which there are no perfect answers' but most of the answers given `contain the essence, if not the whole truth, of the solution to the problem.' The questions, many of which are old chestnuts, range from the mythical - Why might Rudolph be red-nosed? Are high-flying larks harbingers of a hot summer? - through the mundane - Why does the glass handle of a cup of hot coffee stay cool? Is it easier to pull or push a wheelbarrow? - to the mystifying - How is it possible to walk barefoot on red-hot coals? - Is it true that when you take a shower large electric fields can be set up or chloroform released? As the answers were originally given on radio programmes and intended for `educated laypeople' they contain few references to mathematics and no equations! Nevertheless many of the problems are discussed in detail and most readers will find at least some of them fascinating and informative. Many of the answers will be of interest and value to science teachers. In this short book the questions and answers fill only 60 pages but there is a lengthy contents section at the beginning and, at the end, a glossary of many of the terms used throughout. At £8.99 for the UK edition it is pricy - so `feel the quality' of these sections! Outdoors contains questions such as: How is artificial snow created? Can fish really give an electric shock? Why do skates glide along ice? How can blowing on your hands sometimes cool them and sometimes warm them? Theoretical. Here questions on exponential growth, global warming, magnetic poles and energy consumption are answered. Home & Kitchen. Can clothes be whiter than white? How can you tell if an egg is boiled or not? How can a ketchup bottle explode? Why do leaves in a cup of tea collect in the centre

  9. 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

  10. Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in "real-world" clinical practice. A propensity-matched analysis of 76,940 patients.

    Science.gov (United States)

    Li, Xiaoyan Shawn; Deitelzweig, Steve; Keshishian, Allison; Hamilton, Melissa; Horblyuk, Ruslan; Gupta, Kiran; Luo, Xuemei; Mardekian, Jack; Friend, Keith; Nadkarni, Anagha; Pan, Xianying; Lip, Gregory Y H

    2017-06-02

    The ARISTOTLE trial showed a risk reduction of stroke/systemic embolism (SE) and major bleeding in non-valvular atrial fibrillation (NVAF) patients treated with apixaban compared to warfarin. This retrospective study used four large US claims databases (MarketScan, PharMetrics, Optum, and Humana) of NVAF patients newly initiating apixaban or warfarin from January 1, 2013 to September 30, 2015. After 1:1 warfarin-apixaban propensity score matching (PSM) within each database, the resulting patient records were pooled. Kaplan-Meier curves and Cox proportional hazards models were used to estimate the cumulative incidence and hazard ratios (HRs) of stroke/SE and major bleeding (identified using the first listed diagnosis of inpatient claims) within one year of therapy initiation. The study included a total of 76,940 (38,470 warfarin and 38,470 apixaban) patients. Among the 38,470 matched pairs, 14,563 were from MarketScan, 7,683 were from PharMetrics, 7,894 were from Optum, and 8,330 were from Humana. Baseline characteristics were balanced between the two cohorts with a mean (standard deviation [SD]) age of 71 (12) years and a mean (SD) CHA 2 DS 2 -VASc score of 3.2 (1.7). Apixaban initiators had a significantly lower risk of stroke/SE (HR: 0.67, 95 % CI: 0.59-0.76) and major bleeding (HR: 0.60, 95 % CI: 0.54-0.65) than warfarin initiators. Different types of stroke/SE and major bleeding - including ischaemic stroke, haemorrhagic stroke, SE, intracranial haemorrhage, gastrointestinal bleeding, and other major bleeding - were all significantly lower for apixaban compared to warfarin treatment. Subgroup analyses (apixaban dosage, age strata, CHA 2 DS 2 -VASc or HAS-BLED score strata, or dataset source) all show consistently lower risks of stroke/SE and major bleeding associated with apixaban as compared to warfarin treatment. This is the largest "real-world" study on apixaban effectiveness and safety to date, showing that apixaban initiation was associated with

  11. 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-.

  12. 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.

  13. 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

  14. Privacy-preserving record linkage on large real world datasets.

    Science.gov (United States)

    Randall, Sean M; Ferrante, Anna M; Boyd, James H; Bauer, Jacqueline K; Semmens, James B

    2014-08-01

    Record linkage typically involves the use of dedicated linkage units who are supplied with personally identifying information to determine individuals from within and across datasets. The personally identifying information supplied to linkage units is separated from clinical information prior to release by data custodians. While this substantially reduces the risk of disclosure of sensitive information, some residual risks still exist and remain a concern for some custodians. In this paper we trial a method of record linkage which reduces privacy risk still further on large real world administrative data. The method uses encrypted personal identifying information (bloom filters) in a probability-based linkage framework. The privacy preserving linkage method was tested on ten years of New South Wales (NSW) and Western Australian (WA) hospital admissions data, comprising in total over 26 million records. No difference in linkage quality was found when the results were compared to traditional probabilistic methods using full unencrypted personal identifiers. This presents as a possible means of reducing privacy risks related to record linkage in population level research studies. It is hoped that through adaptations of this method or similar privacy preserving methods, risks related to information disclosure can be reduced so that the benefits of linked research taking place can be fully realised. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. 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...

  16. 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.

  17. Communities of clinical practice: the social organization of clinical learning.

    Science.gov (United States)

    Egan, Tony; Jaye, Chrystal

    2009-01-01

    The social organization of clinical learning is under-theorized in the sociological literature on the social organization of health care. Professional scopes of practice and jurisdictions are formally defined by professional principles and standards and reflected in legislation; however, these are mediated through the day-to-day clinical activities of social groupings of clinical teams. The activities of health service providers typically occur within communities of clinical practice. These are also major sites for clinical curriculum delivery, where clinical students learn not only clinical skills but also how to be health professionals. In this article, we apply Wenger's model of social learning within organizations to curriculum delivery within a health service setting. Here, social participation is the basis of learning. We suggest that it offers a powerful framework for recognizing and explaining paradox and incongruence in clinical teaching and learning, and also for recognizing opportunities, and devising means, to add value to students' learning experiences.

  18. 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.

  19. 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.

  20. 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...

  1. 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...

  2. 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

  3. 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)

  4. 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…

  5. 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…

  6. 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…

  7. 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...

  8. 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,…

  9. 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.

  10. Interreality in practice: bridging virtual and real worlds in the treatment of posttraumatic stress disorders.

    Science.gov (United States)

    Riva, Giuseppe; Raspelli, Simona; Algeri, Davide; Pallavicini, Federica; Gorini, Alessandra; Wiederhold, Brenda K; Gaggioli, Andrea

    2010-02-01

    The use of new technologies, particularly virtual reality, is not new in the treatment of posttraumatic stress disorders (PTSD): VR is used to facilitate the activation of the traumatic event during exposure therapy. However, during the therapy, VR is a new and distinct realm, separate from the emotions and behaviors experienced by the patient in the real world: the behavior of the patient in VR has no direct effects on the real-life experience; the emotions and problems experienced by the patient in the real world are not directly addressed in the VR exposure. In this article, we suggest that the use of a new technological paradigm, Interreality, may improve the clinical outcome of PTSD. The main feature of Interreality is a twofold link between the virtual and real worlds: (a) behavior in the physical world influences the experience in the virtual one; (b) behavior in the virtual world influences the experience in the real one. This is achieved through 3D shared virtual worlds; biosensors and activity sensors (from the real to the virtual world); and personal digital assistants and/or mobile phones (from the virtual world to the real one). We describe different technologies that are involved in the Interreality vision and its clinical rationale. To illustrate the concept of Interreality in practice, a clinical scenario is also presented and discussed: Rosa, a 55-year-old nurse, involved in a major car accident.

  11. Clinical decision-making and health-related quality of life during first-line and maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC): findings from a real-world setting.

    Science.gov (United States)

    Sztankay, Monika; Giesinger, Johannes Maria; Zabernigg, August; Krempler, Elisabeth; Pall, Georg; Hilbe, Wolfgang; Burghuber, Otto; Hochmair, Maximilian; Rumpold, Gerhard; Doering, Stephan; Holzner, Bernhard

    2017-08-23

    Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients' health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients' and physicians' reasons leading to clinical decisions on MT. Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients' and physicians' reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models. Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT. Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients' and physicians

  12. 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. ...

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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...

  4. 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

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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....

  11. 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...

  12. Real-World Switching to Riociguat: Management and Practicalities in Patients with PAH and CTEPH.

    Science.gov (United States)

    Gall, Henning; Vachiéry, Jean-Luc; Tanabe, Nobuhiro; Halank, Michael; Orozco-Levi, Mauricio; Mielniczuk, Lisa; Chang, MiKyung; Vogtländer, Kai; Grünig, Ekkehard

    2018-06-01

    A proportion of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) do not achieve treatment goals or experience side effects on their current therapy. In such cases, switching patients to a new drug while discontinuing the first may be a viable and appropriate treatment option. CAPTURE was designed to investigate how physicians manage the switching of patients to riociguat in real-world clinical practice. Observations from the study were used to assess whether recommendations in the riociguat prescribing information are reflected in clinical practice. CAPTURE was an international, multicenter, uncontrolled, retrospective chart review that collected data from patients with PAH or inoperable or persistent/recurrent CTEPH who switched to riociguat from another pulmonary hypertension (PH)-targeted medical therapy. The primary objective of the study was to understand the procedure undertaken in real-world clinical practice for patients switching to riociguat. Of 127 patients screened, 125 were enrolled in CAPTURE. The majority of patients switched from a phosphodiesterase type 5 inhibitor (PDE5i) to riociguat and the most common reason for switching was lack of efficacy. Physicians were already using the recommended treatment-free period when switching patients to riociguat from sildenafil, but a slightly longer period than recommended for tadalafil. In line with the contraindication, the majority of patients did not receive riociguat and PDE5i therapy concomitantly. Physicians also followed the recommended dose-adjustment procedure for riociguat. Switching to riociguat from another PH-targeted therapy may be feasible in real-world clinical practice in the context of the current recommendations.

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

    Science.gov (United States)

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

    2015-12-10

    Novel therapies need to be evaluated in normal clinical practice to allow a true representation of the treatment effectiveness in real-world settings. 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 μg or 200 μg)/vilanterol 25 μg in a novel dry-powder inhaler, versus existing asthma maintenance therapy. The study was initiated before this investigational treatment was licensed and conducted in real-world clinical practice to consider adherence, co-morbidities, polypharmacy, and real-world factors. Asthma Control Test at week 24; safety endpoints include the incidence of serious pneumonias. The study utilises the Salford electronic medical record, which allows near to real-time collection and monitoring of safety data. The Salford Lung Study is the world's first pragmatic randomised controlled trial of a pre-licensed medication in asthma. Use of patients' linked electronic health records to collect clinical endpoints offers minimal disruption to patients and investigators, and also ensures patient safety. This highly innovative study will complement standard double-blind randomised controlled trials in order to improve our understanding of the risk/benefit profile of fluticasone furoate/vilanterol in patients with asthma in real-world settings. Clinicaltrials.gov, NCT01706198; 04 October 2012.

  14. Comparing Expert Driving Behavior in Real World and Simulator Contexts

    Directory of Open Access Journals (Sweden)

    Hiran B. Ekanayake

    2013-01-01

    Full Text Available Computer games are increasingly used for purposes beyond mere entertainment, and current hi-tech simulators can provide quite, naturalistic contexts for purposes such as traffic education. One of the critical concerns in this area is the validity or transferability of acquired skills from a simulator to the real world context. In this paper, we present our work in which we compared driving in the real world with that in the simulator at two levels, that is, by using performance measures alone, and by combining psychophysiological measures with performance measures. For our study, we gathered data using questionnaires as well as by logging vehicle dynamics, environmental conditions, video data, and users' psychophysiological measurements. For the analysis, we used several novel approaches such as scatter plots to visualize driving tasks of different contexts and to obtain vigilance estimators from electroencephalographic (EEG data in order to obtain important results about the differences between the driving in the two contexts. Our belief is that both experimental procedures and findings of our experiment are very important to the field of serious games concerning how to evaluate the fitness of driving simulators and measure driving performance.

  15. Automatic guidance of attention during real-world visual search.

    Science.gov (United States)

    Seidl-Rathkopf, Katharina N; Turk-Browne, Nicholas B; Kastner, Sabine

    2015-08-01

    Looking for objects in cluttered natural environments is a frequent task in everyday life. This process can be difficult, because the features, locations, and times of appearance of relevant objects often are not known in advance. Thus, a mechanism by which attention is automatically biased toward information that is potentially relevant may be helpful. We tested for such a mechanism across five experiments by engaging participants in real-world visual search and then assessing attentional capture for information that was related to the search set but was otherwise irrelevant. Isolated objects captured attention while preparing to search for objects from the same category embedded in a scene, as revealed by lower detection performance (Experiment 1A). This capture effect was driven by a central processing bottleneck rather than the withdrawal of spatial attention (Experiment 1B), occurred automatically even in a secondary task (Experiment 2A), and reflected enhancement of matching information rather than suppression of nonmatching information (Experiment 2B). Finally, attentional capture extended to objects that were semantically associated with the target category (Experiment 3). We conclude that attention is efficiently drawn towards a wide range of information that may be relevant for an upcoming real-world visual search. This mechanism may be adaptive, allowing us to find information useful for our behavioral goals in the face of uncertainty.

  16. Automatic guidance of attention during real-world visual search

    Science.gov (United States)

    Seidl-Rathkopf, Katharina N.; Turk-Browne, Nicholas B.; Kastner, Sabine

    2015-01-01

    Looking for objects in cluttered natural environments is a frequent task in everyday life. This process can be difficult, as the features, locations, and times of appearance of relevant objects are often not known in advance. A mechanism by which attention is automatically biased toward information that is potentially relevant may thus be helpful. Here we tested for such a mechanism across five experiments by engaging participants in real-world visual search and then assessing attentional capture for information that was related to the search set but was otherwise irrelevant. Isolated objects captured attention while preparing to search for objects from the same category embedded in a scene, as revealed by lower detection performance (Experiment 1A). This capture effect was driven by a central processing bottleneck rather than the withdrawal of spatial attention (Experiment 1B), occurred automatically even in a secondary task (Experiment 2A), and reflected enhancement of matching information rather than suppression of non-matching information (Experiment 2B). Finally, attentional capture extended to objects that were semantically associated with the target category (Experiment 3). We conclude that attention is efficiently drawn towards a wide range of information that may be relevant for an upcoming real-world visual search. This mechanism may be adaptive, allowing us to find information useful for our behavioral goals in the face of uncertainty. PMID:25898897

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. Classification versus inference learning contrasted with real-world categories.

    Science.gov (United States)

    Jones, Erin L; Ross, Brian H

    2011-07-01

    Categories are learned and used in a variety of ways, but the research focus has been on classification learning. Recent work contrasting classification with inference learning of categories found important later differences in category performance. However, theoretical accounts differ on whether this is due to an inherent difference between the tasks or to the implementation decisions. The inherent-difference explanation argues that inference learners focus on the internal structure of the categories--what each category is like--while classification learners focus on diagnostic information to predict category membership. In two experiments, using real-world categories and controlling for earlier methodological differences, inference learners learned more about what each category was like than did classification learners, as evidenced by higher performance on a novel classification test. These results suggest that there is an inherent difference between learning new categories by classifying an item versus inferring a feature.

  3. Real-World Sorting of RHIC Superconducting Magnets

    International Nuclear Information System (INIS)

    Wei, J.; Gupta, R.; Harrison, M.; Jain, A.; Peggs, S.; Thompson, P.; Trbojevic, D.; Wanderer, P.

    1999-01-01

    During the seven-year construction of the Relativistic Heavy Ion Collider (RHIC), more than 1700 superconducting dipoles, quadrupoles, sextupoles, and multi-layer correctors have been constructed and installed. These magnets have been sorted at several production stages to optimize their performance and reliability. For arc magnets, priorities have bene put first on quench performance and operational risk minimization, second on field transfer function and other first-order quantities, and finally on nonlinear field errors which were painstakingly optimized at design. For Interaction-Region (IR) magnets, sorting is applied to select the best possible combination of magnets for the low-β interaction points (IP). This paper summarizes the history of this real-world sorting process

  4. 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).

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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...

  10. Harnessing real world data from wearables and self-monitoring devices: feasibility, confounders and ethical considerations

    Directory of Open Access Journals (Sweden)

    Uttam Barick

    2016-07-01

    Full Text Available The increasing usage of smart phones has compelled mobile technology to become a universal part of everyday life. From wearable gadgets to sophisticated implantable medical devices, the advent of mobile technology has completely transformed the healthcare delivery scenario. Self-report measures enabled by mobile technology are increasingly becoming a more time and cost efficient method of assessing real world health outcomes. But, amidst all the optimism, there are concerns also on adopting this technology as regulations and ethical considerations on privacy legislations of end users are unclear. In general, the healthcare industry functions on some stringent regulations and compliances to ensure the safety and protection of patient information. A couple of the most common regulations are Health Insurance Portability Accountability Act (HIPPA and Health Information Technology for Economic and Clinical Health (HITECH. To harness the true potential of mobile technology to empower stakeholders and provide them a common platform which seamlessly integrates healthcare delivery and research, it is imperative that challenges and drawbacks in the sphere are identified and addressed. In this age of information and technology, no stones should be left unturned to ensure that the human race has access to the best healthcare services without an intrusion into his/her confidentiality. This article is an overview of the role of tracking and self-monitoring devices in data collection for real world evidence/observational studies in context to feasibility, confounders and ethical considerations.

  11. 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.

  12. Real world financing opportunities for energy conservation projects

    Energy Technology Data Exchange (ETDEWEB)

    Tramonte, D.J.

    1988-01-01

    Do you have the resources, dollars, people expertise and general know-how to do all the energy conservation measures. If you have the funds, do it yourself. Historically you would save more if you hired a private concern because that is the only job the contractor does for you. You have other hats to wear and fires to put out. Using third-party financing can be a good decision based on your specific needs. Procrastination is not the answer - the cost of delay is extensive. Financing energy conservation measures is no different from financing your automobile or home. If the benefits outweigh the negatives, the answer is obvious. Remember, in any case of using private sector financing, your are joining a partnership arrangement. The only way to succeed is to be honest with each other on the front end. There need not be any surprises. Any reputable company will gladly have your attorney evaluate all agreements, amortization schedules, and attachments. Real world financing alternatives will continue to change as the market matures. It's not too good to be true. It is no more than a vehicle to make the efforts of capital improvements streamlined. The money or financing is the catalyst to the project and makes the other areas meld.

  13. Performance of the "CCS Algorithm" in real world patients.

    Science.gov (United States)

    LaHaye, Stephen A; Olesen, Jonas B; Lacombe, Shawn P

    2015-06-01

    With the publication of the 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation, the Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee has introduced a new triage and management algorithm; the so-called "CCS Algorithm". The CCS Algorithm is based upon expert opinion of the best available evidence; however, the CCS Algorithm has not yet been validated. Accordingly, the purpose of this study is to evaluate the performance of the CCS Algorithm in a cohort of real world patients. We compared the CCS Algorithm with the European Society of Cardiology (ESC) Algorithm in 172 hospital inpatients who are at risk of stroke due to non-valvular atrial fibrillation in whom anticoagulant therapy was being considered. The CCS Algorithm and the ESC Algorithm were concordant in 170/172 patients (99% of the time). There were two patients (1%) with vascular disease, but no other thromboembolic risk factors, which were classified as requiring oral anticoagulant therapy using the ESC Algorithm, but for whom ASA was recommended by the CCS Algorithm. The CCS Algorithm appears to be unnecessarily complicated in so far as it does not appear to provide any additional discriminatory value above and beyond the use of the ESC Algorithm, and its use could result in under treatment of patients, specifically female patients with vascular disease, whose real risk of stroke has been understated by the Guidelines.

  14. Age differences in virtual environment and real world path integration

    Directory of Open Access Journals (Sweden)

    Diane E Adamo

    2012-09-01

    Full Text Available Accurate path integration requires the integration of visual, proprioceptive, and vestibular self-motion cues and age effects associated with alterations in processing information from these systems may contribute to declines in path integration abilities. The present study investigated age-related differences in path integration in conditions that varied as a function of available sources of sensory information. Twenty-two healthy, young (23.8 ± 3.0 yrs. and 16 older (70.1 ± 6.4 yrs. adults participated in distance reproduction and triangle completion tasks performed in a virtual environment and two real world conditions: guided walking and wheelchair propulsion. For walking and wheelchair propulsion conditions, participants wore a blindfold and wore noise-blocking headphones and were guided through the workspace by the experimenter. For the virtual environment (VE condition, participants viewed self-motion information on a computer monitor and used a joystick to navigate through the environment. For triangle completion tasks, older compared to younger individuals showed greater errors in rotation estimations performed in the wheelchair condition; and for rotation and distance estimations in the VE condition. Distance reproduction tasks, in contrast, did not show any age effects. These findings demonstrate that age differences in path integration vary as a function of the available sources of information and by the complexity of outbound pathway.

  15. Neural mechanisms tracking popularity in real-world social networks.

    Science.gov (United States)

    Zerubavel, Noam; Bearman, Peter S; Weber, Jochen; Ochsner, Kevin N

    2015-12-08

    Differences in popularity are a key aspect of status in virtually all human groups and shape social interactions within them. Little is known, however, about how we track and neurally represent others' popularity. We addressed this question in two real-world social networks using sociometric methods to quantify popularity. Each group member (perceiver) viewed faces of every other group member (target) while whole-brain functional MRI data were collected. Independent functional localizer tasks were used to identify brain systems supporting affective valuation (ventromedial prefrontal cortex, ventral striatum, amygdala) and social cognition (dorsomedial prefrontal cortex, precuneus, temporoparietal junction), respectively. During the face-viewing task, activity in both types of neural systems tracked targets' sociometric popularity, even when controlling for potential confounds. The target popularity-social cognition system relationship was mediated by valuation system activity, suggesting that observing popular individuals elicits value signals that facilitate understanding their mental states. The target popularity-valuation system relationship was strongest for popular perceivers, suggesting enhanced sensitivity to differences among other group members' popularity. Popular group members also demonstrated greater interpersonal sensitivity by more accurately predicting how their own personalities were perceived by other individuals in the social network. These data offer insights into the mechanisms by which status guides social behavior.

  16. Fitness networks for real world systems via modified preferential attachment

    Science.gov (United States)

    Shang, Ke-ke; Small, Michael; Yan, Wei-sheng

    2017-05-01

    Complex networks are virtually ubiquitous, and the Barabási and Albert model (BA model) has became an acknowledged standard for the modelling of these systems. The so-called BA model is a kind of preferential attachment growth model based on the intuitive premise that popularity is attractive. However, preferential attachment alone is insufficient to describe the diversity of complex networks observed in the real world. In this paper we first use the accuracy of a link prediction method, as a metric for network fitness. The link prediction method predicts the occurrence of links consistent with preferential attachment, the performance of this link prediction scheme is then a natural measure of the ;preferential-attachment-likeness; of a given network. We then propose several modification methods and modified BA models to construct networks which more accurately describe the fitness properties of real networks. We find that all features assortativity, degree distribution and rich-club formation can play significant roles for the network construction and eventual structure. Moreover, link sparsity and the size of a network are key factors for network reconstruction. In addition, we find that the structure of the network which is limited by geographic location (nodes are embedded in a Euclidean space and connectivity is correlated with distances) differs from other typical networks. In social networks, we observe that the high school contact network has similar structure as the friends network and so we speculate that the contact behaviours can reflect real friendships.

  17. Multiplicative Attribute Graph Model of Real-World Networks

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Myunghwan [Stanford Univ., CA (United States); Leskovec, Jure [Stanford Univ., CA (United States)

    2010-10-20

    Large scale real-world network data, such as social networks, Internet andWeb graphs, is ubiquitous in a variety of scientific domains. The study of such social and information networks commonly finds patterns and explain their emergence through tractable models. In most networks, especially in social networks, nodes also have a rich set of attributes (e.g., age, gender) associatedwith them. However, most of the existing network models focus only on modeling the network structure while ignoring the features of nodes in the network. Here we present a class of network models that we refer to as the Multiplicative Attribute Graphs (MAG), which naturally captures the interactions between the network structure and node attributes. We consider a model where each node has a vector of categorical features associated with it. The probability of an edge between a pair of nodes then depends on the product of individual attributeattribute similarities. The model yields itself to mathematical analysis as well as fit to real data. We derive thresholds for the connectivity, the emergence of the giant connected component, and show that the model gives rise to graphs with a constant diameter. Moreover, we analyze the degree distribution to show that the model can produce networks with either lognormal or power-law degree distribution depending on certain conditions.

  18. Tackling field-portable Raman spectroscopy of real world samples

    Science.gov (United States)

    Shand, Neil C.

    2008-10-01

    A major challenge confronting first responders, customs authorities and other security-related organisations is the accurate, rapid, and safe identification of potentially hazardous chemicals outside a laboratory environment. Currently, a range of hand portable Raman equipment is commercially available that is low cost and increasingly more sophisticated. These systems are generally based on the 785nm Stokes shifted Raman technique with many using dispersive grating spectrometers. This technique offers a broad range of capabilities including the ability to analyse illicit drugs, explosives, chemical weapons and pre-cursors but still has some fundamental constraints. 'Real world' samples, such as those found at a crime scene, will often not be presented in the most accessible manner. Simple issues such as glass fluorescence can make an otherwise tractable sample impossible to analyse in-situ. A new generation of portable Raman equipment is currently being developed to address these issues. Consideration is given to the use of longer wavelength for fluorescence reduction. Alternative optical designs are being tested to compensate for the signal reduction incurred by moving to longer wavelengths. Furthermore, the use of anti-Stokes spectroscopy is being considered as well as investigating the robustness and portability of traditional Fourier Transform interferometer designs along with future advances in detector technology and ultra small spectrometers.

  19. Real-world scenarios help improve selection of radiology employees.

    Science.gov (United States)

    Kline, C L; Groff, K; Phillips, M

    1998-01-01

    Choosing the right candidate through the interview process is critical, particularly in light of rapidly changing skills in various technologies. The authors have changed the interviewing process at Jeanes Hospital in Philadelphia in order to examine and evaluate multiple objectives simultaneously. To do this, they created an instrument that elicits impromptu responses to real-world radiology situations. Such responses help assess a potential candidate's training, emotional strength, technical experience and growth potential. They also determine how much additional training the potential candidate will need to be effective in the department. Using the instrument helps sharpen the assessment of candidate traits such as face-to-face communication skills and response time. The impact on hiring is positive. Quality staff, improved patient care and improved patient safety are only some of the results. Many of the questions included on the instrument come from past problem situations and help the interviewers to determine whether a candidate understands underlying issues and the seriousness of situations. The goal is to ensure that patient care and productivity are not hampered by unusual situations. When a concrete difference is detected between a candidate's response and the department's needs, it is possible to assess the cost-effectiveness of training for the discrepancy. For entry-level candidates, the question is whether the person is trainable. Consistently using this interview document forces hiring managers to identify specific abilities, traits and experience desirable in the workplace.

  20. Field Balancing in the Real World: Part 2

    International Nuclear Information System (INIS)

    Bracher, R.K.; Surrett, C.L.

    1999-01-01

    This paper is a follow-up to an earlier paper, Field Balancing in the Real World, which was presented at CSI Reliability Week 1997 in Nashville. Case studies of excessive vibrations on fans at ORNL will be discussed. Except for a few small sections from the earlier paper, this paper is entirely new. The case studies are new. As in the first paper, all fans are rigid-rotor type fans. Normal operation, therefore, is at less than the shaft's first critical speed. The presentation of case studies with root cause problems other than unbalance is a major departure from the first paper. We believe they belong here, since unbalance is suspected most of the time when a fan is vibrating excessively, even when it is not the root cause. In reality, unbalance is the underlying cause of the excess vibration on fans we have fixed at ORNL only about half the time. Furthermore, the analyst's credibility could be called into question upon an unsuccessful attempt at field balancing when underlying causes are later discovered and fixed. A demonstration will follow the case study presentation. The additional tests described in this paper to confirm centrifugal force (probable unbalance) will be performed

  1. Load Disaggregation Technologies: Real World and Laboratory Performance

    Energy Technology Data Exchange (ETDEWEB)

    Mayhorn, Ebony T.; Sullivan, Greg P.; Petersen, Joseph M.; Butner, Ryan S.; Johnson, Erica M.

    2016-09-28

    Low cost interval metering and communication technology improvements over the past ten years have enabled the maturity of load disaggregation (or non-intrusive load monitoring) technologies to better estimate and report energy consumption of individual end-use loads. With the appropriate performance characteristics, these technologies have the potential to enable many utility and customer facing applications such as billing transparency, itemized demand and energy consumption, appliance diagnostics, commissioning, energy efficiency savings verification, load shape research, and demand response measurement. However, there has been much skepticism concerning the ability of load disaggregation products to accurately identify and estimate energy consumption of end-uses; which has hindered wide-spread market adoption. A contributing factor is that common test methods and metrics are not available to evaluate performance without having to perform large scale field demonstrations and pilots, which can be costly when developing such products. Without common and cost-effective methods of evaluation, more developed disaggregation technologies will continue to be slow to market and potential users will remain uncertain about their capabilities. This paper reviews recent field studies and laboratory tests of disaggregation technologies. Several factors are identified that are important to consider in test protocols, so that the results reflect real world performance. Potential metrics are examined to highlight their effectiveness in quantifying disaggregation performance. This analysis is then used to suggest performance metrics that are meaningful and of value to potential users and that will enable researchers/developers to identify beneficial ways to improve their technologies.

  2. WIPP Waste Characterization: Implementing Regulatory Requirements in the Real World

    International Nuclear Information System (INIS)

    Cooper Wayman, J.D.; Goldstein, J.D.

    1999-01-01

    It is imperative to ensure compliance of the Waste Isolation Pilot Project (WIPP) with applicable statutory and regulatory requirements. In particular, compliance with the waste characterization requirements of the Resource Conservation and Recovery Act (RCRA) and its implementing regulation found at 40 CFR Parts 262,264 and 265 for hazardous and mixed wastes, as well as those of the Atomic Energy Act of 1954, as amended, the Reorganization Plan No. 3 of 1970, the Nuclear Waste Policy Act of 1982, as amended, and the WIPP Land Withdrawal Act, as amended, and their implementing regulations found at 40 CFR Parts 191 and 194 for non-mixed radioactive wastes, are often difficult to ensure at the operational level. For example, where a regulation may limit a waste to a certain concentration, this concentration may be difficult to measure. For example, does the definition of transuranic waste (TRU) as 100 nCi/grain of alpha-emitting transuranic isotopes per gram of waste mean that the radioassay of a waste must show a reading of 100 plus the sampling and measurement error for the waste to be a TRU waste? Although the use of acceptable knowledge to characterize waste is authorized by statute, regulation and DOE Orders, its implementation is similarly beset with difficulty. When is a document or documents sufficient to constitute acceptable knowledge? What standard can be used to determine if knowledge is acceptable for waste characterization purposes? The inherent conflict between waste characterization regulatory requirements and their implementation in the real world, and the resolution of this conflict, will be discussed

  3. 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.

  4. Neurocognitive systems related to real-world prospective memory.

    Directory of Open Access Journals (Sweden)

    Grégoria Kalpouzos

    Full Text Available BACKGROUND: Prospective memory (PM denotes the ability to remember to perform actions in the future. It has been argued that standard laboratory paradigms fail to capture core aspects of PM. METHODOLOGY/PRINCIPAL FINDINGS: We combined functional MRI, virtual reality, eye-tracking and verbal reports to explore the dynamic allocation of neurocognitive processes during a naturalistic PM task where individuals performed errands in a realistic model of their residential town. Based on eye movement data and verbal reports, we modeled PM as an iterative loop of five sustained and transient phases: intention maintenance before target detection (TD, TD, intention maintenance after TD, action, and switching, the latter representing the activation of a new intention in mind. The fMRI analyses revealed continuous engagement of a top-down fronto-parietal network throughout the entire task, likely subserving goal maintenance in mind. In addition, a shift was observed from a perceptual (occipital system while searching for places to go, to a mnemonic (temporo-parietal, fronto-hippocampal system for remembering what actions to perform after TD. Updating of the top-down fronto-parietal network occurred at both TD and switching, the latter likely also being characterized by frontopolar activity. CONCLUSION/SIGNIFICANCE: Taken together, these findings show how brain systems complementary interact during real-world PM, and support a more complete model of PM that can be applied to naturalistic PM tasks and that we named PROspective MEmory DYnamic (PROMEDY model because of its dynamics on both multi-phase iteration and the interactions of distinct neurocognitive networks.

  5. Real-World Evidence: Useful in the Real World of US Payer Decision Making? How? When? And What Studies?

    Science.gov (United States)

    Malone, Daniel C; Brown, Mary; Hurwitz, Jason T; Peters, Loretta; Graff, Jennifer S

    2018-03-01

    To examine how real-world evidence (RWE) is currently perceived and used in managed care environments, especially to inform pharmacy and therapeutic (P&T) committee decisions, to assess which study factors (e.g., data, design, and funding source) contribute to RWE utility in decisions, and to identify barriers to consideration of RWE studies in P&T decision making. We conducted focus groups/telephone-based interviews and surveys to understand perceptions of RWE and assess awareness, quality, and relevance of two high-profile examples of published RWE studies. A purposive sample comprised 4 physicians, 15 pharmacists, and 1 researcher representing 18 US health plans and health system organizations. Participants reported that RWE was generally used, or useful, to inform safety monitoring, utilization management, and cost analysis, but less so to guide P&T decisions. Participants were not aware of the two sample RWE studies but considered both studies to be valuable. Relevant research questions and outcomes, transparent methods, study quality, and timely results contribute to the utility of published RWE. Perceived organizational barriers to the use of published RWE included lack of skill, training, and timely study results. Payers recognize the value of RWE, but use of such studies to inform P&T decisions varies from organization to organization and is limited. Relevance to payers, timeliness, and transparent methods were key concerns with RWE. Participants recognized the need for continuing education on evaluating and using RWE to better understand the study methods, findings, and applicability to their organizations. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Real-World Multicenter Registry of Patients with Severe Coronary Artery Calcification Undergoing Orbital Atherectomy.

    Science.gov (United States)

    Lee, Michael S; Shlofmitz, Evan; Kaplan, Barry; Alexandru, Dragos; Meraj, Perwaiz; Shlofmitz, Richard

    2016-08-01

    We evaluated the safety and efficacy of orbital atherectomy in real-world patients with severe coronary artery calcification (CAC). The presence of severe CAC increases the complexity of percutaneous coronary intervention as it may impede stent delivery and optimal stent expansion. Atherectomy may be an indispensable tool for uncrossable or undilatable lesions by modifying severe CAC. Although the ORBIT I and II trials report that orbital atherectomy was safe and effective for the treatment of severe CAC, patients with kidney disease, recent myocardial infarction, long diffuse disease, severe left ventricular dysfunction, and unprotected left main disease were excluded. This retrospective study included 458 consecutive patients with severe CAC who underwent orbital atherectomy followed by stenting from October 2013 to December 2015 at 3 centers. The primary endpoint of major adverse cardiac and cerebrovascular events at 30 days was 1.7%. Low rates of 30-day all-cause mortality (1.3%), myocardial infarction (1.1%), target vessel revascularization (0%), stroke (0.2%), and stent thrombosis (0.9%) were observed. Angiographic complications were low: perforation was 0.7%, dissection 0.9%, and no-reflow 0.7%. Emergency coronary artery bypass graft surgery was performed in 0.2% of patients. In the largest real-world study of patients who underwent orbital atherectomy, including high-risk patients who were not surgical candidates as well as those with very complex coronary anatomy, acute and short-term adverse clinical event rates were low. A randomized clinical trial is needed to identify the ideal treatment strategy for patients with severe CAC. © 2016 The Authors. Journal of Interventional Cardiology Published by Wiley Periodicals, Inc.

  7. 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…

  8. 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…

  9. 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…

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. "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,...

  15. 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...

  16. A System for Automatic Detection of Partially Occluded Objects from Real-World Images

    National Research Council Canada - National Science Library

    Neskovic, Predrag; Wu, Liang; Cooper, Leon N

    2006-01-01

    In this work we consider the Bayesian Integrate And Shift (BIAS) model for learning object categories and test its performance on learning and recognizing different object categories from real-world images...

  17. 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...

  18. Food for Thought: Cross-Classification and Category Organization in a Complex Real-World Domain.

    Science.gov (United States)

    Ross, Brian H.; Murphy, Gregory L.

    1999-01-01

    Seven studies involving 256 undergraduates examined how people represent, access, and make inferences about the real-world category domain, foods. Results give a detailed picture of the use of cross-classification in a complex domain. (SLD)

  19. 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.

  20. 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...

  1. 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.

  2. Real-world approach to actinic keratosis management

    DEFF Research Database (Denmark)

    Dirschka, Thomas; Gupta, Girish; Micali, Giuseppe

    2017-01-01

    Actinic keratosis (AK) is a chronic skin disease in which multiple clinical and subclinical lesions co-exist across large areas of sun-exposed skin, resulting in field cancerisation. Lesions require treatment because of their potential to transform into invasive squamous cell carcinoma. This arti......Actinic keratosis (AK) is a chronic skin disease in which multiple clinical and subclinical lesions co-exist across large areas of sun-exposed skin, resulting in field cancerisation. Lesions require treatment because of their potential to transform into invasive squamous cell carcinoma...

  3. 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.

  4. Standards of care issues with anticoagulation in real-world populations.

    Science.gov (United States)

    2015-01-01

    Current guidelines recommend anticoagulants for reducing the risk of stroke in appropriate patients with nonvalvular atrial fibrillation (NVAF) and for the acute treatment of venous thromboembolism (VTE) and the prevention of recurrent VTE. Warfarin is the standard of care for both NVAF and VTE, yet International Normalized Ratio (INR) control remains suboptimal, even in the clinical trial setting. Maintaining INR within the recommended therapeutic range is associated with better outcomes in these distinct populations. In VTE, high rates of recurrence have been reported during the first few weeks of treatment, emphasizing the importance of surveillance during this time and of early optimization of anticoagulation therapy. The NVAF population tends to have more comorbidities and requires longer-term therapy. It is important to keep in mind that real-world patient populations are more complex than those in controlled studies. Patients with multiple comorbidities are particularly challenging, and physicians may focus on clinically urgent issues rather than anticoagulation optimization. Despite the many complexities associated with the use of warfarin, it remains a mainstay of anticoagulation therapy. Aligning financial incentives and improving care coordination are important factors in moving toward better outcomes for patients who need anticoagulation therapy. The increased focus on value-based care and evolving approaches to patient treatment could lead more physicians and payers to consider alternatives to warfarin, including the use of novel oral anticoagulants.

  5. Effectiveness of Palivizumab in Preventing RSV Hospitalization in High Risk Children: A Real-World Perspective

    Directory of Open Access Journals (Sweden)

    Nusrat Homaira

    2014-01-01

    Full Text Available Infection with respiratory syncytial virus (RSV is one of the major causes globally of childhood respiratory morbidity and hospitalization. Palivizumab, a humanized monoclonal antibody, has been recommended for high risk infants to prevent severe RSV-associated respiratory illness. This recommendation is based on evidence of efficacy when used under clinical trial conditions. However the real-world effectiveness of palivizumab outside of clinical trials among different patient populations is not well established. We performed a systematic review focusing on postlicensure observational studies of the protective effect of palivizumab prophylaxis for reducing RSV-associated hospitalizations in infants and children at high risk of severe infection. We searched studies published in English between 1 January 1999 and August 2013 and identified 420 articles, of which 20 met the inclusion criteria. This review supports the recommended use of palivizumab for reducing RSV-associated hospitalization rates in premature infants born at gestational age < 33 weeks and in children with chronic lung and heart diseases. Data are limited to allow commenting on the protective effect of palivizumab among other high risk children, including those with Down syndrome, cystic fibrosis, and haematological malignancy, indicating further research is warranted in these groups.

  6. 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

  7. Real world data on primary treatment for mantle cell lymphoma

    DEFF Research Database (Denmark)

    Abrahamsson, Anna; Albertsson-Lindblad, Alexandra; Brown, Peter N

    2014-01-01

    to prognostic factors and first-line treatment in patients with MCL in a population-based data set. Data were collected from the Swedish and Danish Lymphoma Registries from the period of 2000 to 2011. A total of 1389 patients were diagnosed with MCL. During this period, age-standardized incidence MCL increased...... analysis. Hence, by a population-based approach, we were able to provide novel data on prognostic factors and primary treatment of MCL, applicable to routine clinical practice....

  8. Series: Pragmatic trials and real world evidence: Paper 1. Introduction.

    Science.gov (United States)

    Zuidgeest, Mira G P; Goetz, Iris; Groenwold, Rolf H H; Irving, Elaine; van Thiel, Ghislaine J M W; Grobbee, Diederick E

    2017-08-01

    This is the introductory paper in a series of eight papers. In this series, we integrate the theoretical design options with the practice of conducting pragmatic trials. For most new market-approved treatments, the clinical evidence is insufficient to fully guide physicians and policy makers in choosing the optimal treatment for their patients. Pragmatic trials can fill this gap, by providing evidence on the relative effectiveness of a treatment strategy in routine clinical practice, already in an early phase of development, while maintaining the strength of randomized controlled trials. Selecting the setting, study population, mode of intervention, comparator, and outcome are crucial in designing pragmatic trials. In combination with monitoring and data collection that does not change routine care, this will enable appropriate generalization to the target patient group in clinical practice. To benefit from the full potential of pragmatic trials, there is a need for guidance and tools in designing these studies while ensuring operational feasibility. This paper introduces the concept of pragmatic trial design. The complex interplay between pragmatic design options, feasibility, stakeholder acceptability, validity, precision, and generalizability will be clarified. In this way, balanced design choices can be made in pragmatic trials with an optimal chance of success in practice. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  9. [Characteristics and drug analysis associated with vertigo disease in real world].

    Science.gov (United States)

    Xie, Qian; Li, Yuan-Yuan; Xie, Yan-Ming; Yang, Wei; Zhao, Wei; Zhuang, Yan; Wang, Yong-Yan

    2014-09-01

    To explore the characteristics and influenced factors associated with the onset of vertigo disease, analysis of 3 719 cases of hospitalized patients with vertigo disease from the real world. Analysis the date of patients diagnosed with vertigo disease from the hospital information system of 19 grade-III class-A hospital from 2004 to 2011, include general information, the doctor's advice, other diseases combined, diagnostic information and the relationship with the onset of 24 solar terms, and the treatment drugs. The median age of hospitalized patients with vertigo disease was 59, the number of women (65.91%) was more than men (34.09%), manual workers (85.32%) were the majority career, most patients (81.63%) condition were general by the time they were hospital admission, patients more like admitted to neurologist (70.34%) when they first time to outpatient serves, hospitalization days were in 8-14 days (46.65%), 46.04% of the patients in the hospital total cost is in 5 000 RMB to 10 000 RMB, 73.86% of patients paid by National Health Medical Insurance. Hypertension (20.79%) was the most common underlying health problems, The most common syndromes was deficiency of liver-Yin and kidney-Yin(44. 21%) , followed by hyperactivity of liver-yang, disease of phlegm turbidity in mongolia and deficiency of Qi and blood. There were more deficiency syndrome and less excess syndrome. The highest rate of hospital admission solar terms in 2009 was the insects awaken throttle (5.21%), In 2010, the highest rate solar terms of hospital admission was the rain throttle (6.14%). The most frequently used traditional Chinese medicine was gastrodine injection (20.55%), the most frequently used western medicine for betahistine (10.19%), gastrodine injection was the most traditional Chinese medicine that combination with other western medicine. Hypertension was the most underlying health problems in the patients with vertigo disease in the real world, although the mental factors should

  10. An exploratory investigation of real-world reasoning in paranoia.

    Science.gov (United States)

    Huddy, V; Brown, G P; Boyd, T; Wykes, T

    2014-03-01

    Paranoid thinking has been linked to greater availability in memory of past threats to the self. However, remembered experiences may not always closely resemble events that trigger paranoia, so novel explanations must be elaborated for the likelihood of threat to be determined. We investigated the ability of paranoid individuals to construct explanations for everyday situations and whether these modulate their emotional impact. Twenty-one participants experiencing paranoia and 21 healthy controls completed a mental simulation task that yields a measure of the coherence of reasoning in everyday situations. When responses featured positive content, clinical participants produced less coherent narratives in response to paranoid themed scenarios than healthy controls. There was no significant difference between the groups when responses featured negative content. The current study suggests that difficulty in scenario construction may exacerbate paranoia by reducing access to non-threatening explanations for everyday events, and this consequently increases distress. © 2012 The British Psychological Society.

  11. 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.

  12. 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.

  13. Real-World Dosing Patterns of Atomoxetine in Adults with Attention-Deficit/Hyperactivity Disorder.

    Science.gov (United States)

    Kabul, Samaneh; Alatorre, Carlos; Montejano, Leslie B; Farr, Amanda M; Clemow, David B

    2015-12-01

    The aim was to investigate the dosing patterns of atomoxetine monotherapy in adult patients with attention-deficit/hyperactivity disorder (ADHD) in a retrospective analysis. Adult (≥ 18 years) patients with ADHD newly initiated on atomoxetine with ≥ 1 outpatient pharmacy claim for atomoxetine between January 2006 and December 2011 were selected from the Truven Health MarketScan(®) Commercial database. After a 30-day titration period, dosing patterns of atomoxetine monotherapy were analyzed in the 12 months following initiation. In addition, patient demographic and clinical characteristics were compared to identify characteristics associated with suboptimal versus recommended dosing. Of the 12,412 adult patients with ADHD newly initiated on atomoxetine, 4548 (36.6%) were suboptimally dosed, whereas 3323 (26.7%) were treated at recommended dose. Overall, study patients were treated at a mean (standard deviation [SD]) dose of 68.5 (44.9) mg/day. The suboptimal dosing cohort included significantly more females (54% vs. 44%, P atomoxetine therapy in a real-world setting are often dosed suboptimally. Increasing the awareness on optimal dosing strategy among clinicians and patients is warranted to maximize the therapeutic benefits of atomoxetine among adult patients with ADHD. © 2015 Eli Lilly and Company. CNS Neuroscience and Therapeutics published by John Wiley & Sons Ltd.

  14. Real-World Impact of Neurocognitive Deficits in Acute and Early HIV Infection

    Science.gov (United States)

    Doyle, Katie L.; Morgan, Erin E.; Morris, Sheldon; Smith, Davey M.; Little, Susan; Iudicello, Jennifer E.; Blackstone, Kaitlin; Moore, David J.; Grant, Igor; Letendre, Scott L.; Woods, Steven Paul

    2013-01-01

    The acute and early period of HIV-1 infection (AEH) is characterized by neuroinflammatory and immunopathogenic processes that can alter the integrity of neural systems and neurocognitive functions. However, the extent to which central nervous system changes in AEH confer increased risk of real-world functioning (RWF) problems is not known. In the present study, 34 individuals with AEH and 39 seronegative comparison participants completed standardized neuromedical, psychiatric, and neurocognitive research evaluations, alongside a comprehensive assessment of RWF that included cognitive symptoms in daily life, basic and instrumental activities of daily living, clinician-rated global functioning, and employment. Results showed that AEH was associated with a significantly increased risk of dependence in RWF, which was particularly elevated among AEH persons with global neurocognitive impairment (NCI). Among those with AEH, NCI (i.e., deficits in learning and information processing speed), mood disorders (i.e., Bipolar Disorder), and substance dependence (e.g., methamphetamine dependence) were all independently predictive of RWF dependence. Findings suggest that neurocognitively impaired individuals with AEH are at notably elevated risk of clinically significant challenges in normal daily functioning. Screening for neurocognitive, mood, and substance use disorders in AEH may facilitate identification of individuals at high risk of functional dependence who may benefit from psychological and medical strategies to manage their neuropsychiatric conditions. PMID:24277439

  15. Stress and burnout in anaesthesia: a real world problem?

    Science.gov (United States)

    Rama-Maceiras, Pablo; Jokinen, Johanna; Kranke, Peter

    2015-04-01

    Stress and burnout have arisen as relevant problems to the healthcare workers and the health systems themselves. As anaesthesiologists work in stressful areas of the hospitals, we are exposed to these problems. In this review, we summarize recent studies regarding stress and burnout, exploring possible solutions. Almost 50% of anaesthesiologists scored positive for some of the burnout domains in different surveys, with one-third reporting high levels. The management of this problem not only needs an institutional but also an individual approach. Some recent randomized clinical trials and longitudinal studies suggest that there is some benefit of using several techniques to control stress, although benefits are still modest and most of the studies are based on transversal surveys and self-reported questionnaires. There is a lack of definitive evidence to guide the management of stress and burnout in medical professions in general and in anaesthesiology in particular. Longitudinal and interventional studies are needed to better determine ways of action. In the meantime, creating a positive work climate and institutional support as well as promoting control over one's job and the autonomy of employees are the most recommended strategies. Workers should also learn how to cope with stressors and practice personal strategies of wellness and resilience to fight against burnout.

  16. Growth hormone treatment in Turner's syndrome: A real world experience

    Directory of Open Access Journals (Sweden)

    Vijay Sheker Reddy Danda

    2017-01-01

    Full Text Available Objective: Short stature is a universal clinical feature of Turner's syndrome (TS. Growth failure begins in fetal life, and adults with TS are on an average 20 cm shorter than the normal female population. Since there is a paucity of data from India regarding the effect of growth hormone (GH on TS patients, we retrospectively analyzed the data of TS patients who are on GH treatment. Methods: This hospital-based observational retrospective study was conducted in a tertiary care hospital of Hyderabad. The data such as height, weight, and bone age of 16 patients who are diagnosed with TS on GH therapy for at least 6 months were included in the study. All the patients were treated with human recombinant GH at the dose of 0.3 mg/kg/week administered as daily subcutaneous injections. Results: The mean age at diagnosis was 12.7 years. The mean height at the start of GH therapy was 1.26 m, and mean height standard deviation score (HSDS was-0.61 when compared to Turner's specific reference data. With a mean duration of GH therapy of 25 months, the mean height at the end of therapy was 1.37 m and the mean height as per HSDS was + 0.37 resulting in a mean height gain of + 0.99 HSDS. Conclusion: Our observation shows that girls with TS benefit from early diagnosis and initiation of treatment with GH.

  17. 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.

  18. The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

    Science.gov (United States)

    Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

    2015-01-01

    Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

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

    Science.gov (United States)

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

    2017-04-05

    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. 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 the Cardio-STEMI Sanremo registry between February 2011 and June 2013. Cases and controls were defined according to P2Y 12 inhibitors, correcting the bias due to lack of randomization by propensity score analysis. Ticagrelor was introduced in 2012 in both in-hospital and pre-hospital settings independently of this study. Of the 416 patients enrolled in the Cardio-STEMI registry, 401 with a definite diagnosis of STEMI were included in this study. One hundred forty-two patients received ticagrelor and 259 received clopidogrel. Regarding clinical presentation and procedural data, those in the ticagrelor group had lower CRUSADE scores (23 [14-36] vs 27 [18-38]; p = 0.015] but a higher proportion of radial access (33% vs 14%; p word propensity score analysis, ticagrelor did not affect the risk of MACE during the hospital phase, or the incidence of hospital bleeding in patients with STEMI. However, in this mono-centric experience, ticagrelor resulted in improved 1-year survival, even after correction by propensity score.

  20. 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...

  1. Is Real-World Evidence Used in P&T Monographs and Therapeutic Class Reviews?

    Science.gov (United States)

    Hurwitz, Jason T; Brown, Mary; Graff, Jennifer S; Peters, Loretta; Malone, Daniel C

    2017-06-01

    Payers are faced with making coverage and reimbursement decisions based on the best available evidence. Often these decisions apply to patient populations, provider networks, and care settings not typically studied in clinical trials. Treatment effectiveness evidence is increasingly available from electronic health records, registries, and administrative claims. However, little is known about when and what types of real-world evidence (RWE) studies inform pharmacy and therapeutic (P&T) committee decisions. To evaluate evidence sources cited in P&T committee monographs and therapeutic class reviews and assess the design features and quality of cited RWE studies. A convenience sample of representatives from pharmacy benefit management, health system, and health plan organizations provided recent P&T monographs and therapeutic class reviews (or references from such documents). Two investigators examined and grouped references into major categories (published studies, unpublished studies, and other/unknown) and multiple subcategories (e.g., product label, clinical trials, RWE, systematic reviews). Cited comparative RWE was reviewed to assess design features (e.g., population, data source, comparators) and quality using the Good ReseArch for Comparative Effectiveness (GRACE) Checklist. Investigators evaluated 565 references cited in 27 monographs/therapeutic class reviews from 6 managed care organizations. Therapeutic class reviews mostly cited published clinical trials (35.3%, 155/439), while single-product monographs relied most on manufacturer-supplied information (42.1%, 53/126). Published RWE comprised 4.8% (21/439) of therapeutic class review references, and none (0/126) of the monograph references. Of the 21 RWE studies, 12 were comparative and assessed patient care settings and outcomes typically not included in clinical trials (community ambulatory settings [10], long-term safety [8]). RWE studies most frequently were based on registry data (6), conducted in

  2. 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.

  3. 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.

  4. Pulmonary hypertension: Real-world data from a Portuguese expert referral centre.

    Science.gov (United States)

    Gomes, A; Cruz, C; Rocha, J; Ricardo, M; Vicente, M; Melo, A; Santos, M; Carvalho, L; Gonçalves, F; Reis, A

    2018-04-16

    Pulmonary hypertension (PH) is a heterogeneous, debilitating condition with highly relevant impact on functional capacity, quality of life, and life-expectancy. This study aims to provide long-term data on the Portuguese PH population, by characterising the clinical presentation, evolution, and outcomes of PH patients in a specialised referral centre. Retrospective analysis of a cohort of 101 patients with pre-capillary PH (pcPH) referenced to an expert tertiary care referral centre in northern Portugal from 2002 to 2013. Diagnosis was confirmed by right heart catheterisation (RHC). PH classification followed consensus criteria from the 5th World Symposium in Nice, 2013. The most frequent causes of pcPH were Group 1 PH - pulmonary arterial hypertension (PAH) (54.4%) and Group 4 PH - Chronic thromboembolic pulmonary hypertension (CTEPH) (25.7%); importantly, 17.8% of patients presented PH associated with multiple aetiologies. Targeted therapy was used in 91.1% of patients (48.5% combination therapy). 1-, 3-, and 5-year survival was estimated at 86.6%, 76.7%, and 64.1%, respectively. Survival was significantly better for those ≤40 years old (10.5 vs. 6.4 years; P=0.003) and for women with I/HPAH (9.3 vs. 4.5 years; P=0.039). This study provides long-term, real-world data for the management of PAH and CTEPH in Portugal and demonstrates the importance of dedicated electronic medical records and well defined clinical management protocols for better patient outcomes. Patients presented mostly with intermediate or high risk of mortality, which suggests delayed diagnosis and highlights the need to increase awareness among clinicians. Copyright © 2018 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  5. 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.

  6. 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.

  7. How successful is secondary prevention for coronary artery disease (CAD) in the real world

    International Nuclear Information System (INIS)

    Rauf, M.A.; Khan, N.; Khan, N.; Khan, I.; Hafizullah, M.; Mahmood, N.

    2012-01-01

    Objective: To document the effects of secondary prevention on different risk factors in the real world situation. Methodology: It was a cross sectional comparative study carried out at a referral cardiac clinic in Peshawar from January 2010 to December 2010. Study subjects presenting with at least 6 months follow up were included from different parts of Khyber Pukhtunkhawa. All patients with positive history or objective evidence of CAD were enrolled. Study subjects were divided in two groups based on the fact that either taking or had stopped medication for the duration of the study period. Study variables were levels of lipids, glucose, blood pressure (BP), smoking and obesity. Results: A total of 843 patients were included in the study. Males were 70.4 % (593). Mean age was 58.74 +- 10.6 years. Patients taking regular medicine were 69.03% while 30.97% had stopped their medicine for at least three months. Diabetics, hypertensive and positive family history for CAD were 33.4%, 50.25% and 24% respectively. When compared to patient who had stopped medicine, mean systolic BP (p= 0.014), diastolic BP (p= 0.05), mean Cholesterol (p=0.000), mean LDL (p=0.000), mean HDL (p=0.000) and HbA1c% (p=0.049), was well controlled in patients who were taking medicine regularly. Mean BMI (p=0.786), triglycerides and smoking (p=0.761) had no significant difference between the two groups. Conclusion: Blood pressure, serum cholesterol, LDL, HDL, as well as HbA1c% were reduced with little effect on serum TGs, BMI and smoking in those who were taking medicine regularly compared to those who had stopped. (author)

  8. Real-world comparison of two molecular methods for detection of respiratory viruses

    Directory of Open Access Journals (Sweden)

    Miller E Kathryn

    2011-06-01

    Full Text Available Abstract Background Molecular polymerase chain reaction (PCR based assays are increasingly used to diagnose viral respiratory infections and conduct epidemiology studies. Molecular assays have generally been evaluated by comparing them to conventional direct fluorescent antibody (DFA or viral culture techniques, with few published direct comparisons between molecular methods or between institutions. We sought to perform a real-world comparison of two molecular respiratory viral diagnostic methods between two experienced respiratory virus research laboratories. Methods We tested nasal and throat swab specimens obtained from 225 infants with respiratory illness for 11 common respiratory viruses using both a multiplex assay (Respiratory MultiCode-PLx Assay [RMA] and individual real-time RT-PCR (RT-rtPCR. Results Both assays detected viruses in more than 70% of specimens, but there was discordance. The RMA assay detected significantly more human metapneumovirus (HMPV and respiratory syncytial virus (RSV, while RT-rtPCR detected significantly more influenza A. We speculated that primer differences accounted for these discrepancies and redesigned the primers and probes for influenza A in the RMA assay, and for HMPV and RSV in the RT-rtPCR assay. The tests were then repeated and again compared. The new primers led to improved detection of HMPV and RSV by RT-rtPCR assay, but the RMA assay remained similar in terms of influenza detection. Conclusions Given the absence of a gold standard, clinical and research laboratories should regularly correlate the results of molecular assays with other PCR based assays, other laboratories, and with standard virologic methods to ensure consistency and accuracy.

  9. HIIT in the Real World: Outcomes from a 12-Month Intervention in Overweight Adults.

    Science.gov (United States)

    Roy, Melyssa; Williams, Sheila M; Brown, Rachel C; Meredith-Jones, Kim A; Osborne, Hamish; Jospe, Michelle; Taylor, Rachael W

    2018-04-21

    Although high-intensity interval training (HIIT) and moderate-intensity continuous exercise have comparable health outcomes in the laboratory setting, effectiveness studies in real-world environments are lacking. The aim of this study was to determine the effectiveness of an unsupervised HIIT programme in overweight/obese adults over 12 months. 250 overweight/obese adults could choose HIIT or current exercise guidelines of 30 minutes/day moderate-intensity exercise. HIIT participants received a single training session and were advised to independently perform HIIT 3x/week utilizing a variety of protocols. Mixed models, with a random effect for participant, compared differences in weight, body composition, blood pressure, aerobic fitness, physical activity and blood indices at 12 months, adjusting for relevant baseline variables. Forty-two percent (n=104) of eligible participants chose HIIT in preference to current guidelines. At 12 months, there were no differences between exercise groups in weight (adjusted difference HIIT vs conventional; 95% CI: -0.44kg; -2.5, 1.6) or visceral fat (-103cm; -256, 49), although HIIT participants reported greater enjoyment of physical activity (p=0.01). Evidence of adherence to ≥2 sessions/week of unsupervised HIIT (from heart rate monitoring) declined from 60.8% at baseline to 19.6% by 12 months. Participants remaining adherent to HIIT over 12 months (23%) were more likely to be male (67% vs 36%, p=0.03), with greater reductions in weight (-2.7kg; -5.2 -0.2) and visceral fat (-292cm; -483, -101) than non-adherent participants. HIIT was well-accepted by overweight adults and opting for HIIT as an alternative to standard exercise recommendations led to no difference in health outcomes after 12 months. While regular participation in unsupervised HIIT declined rapidly, those apparently adherent to regular HIIT demonstrated beneficial weight loss and visceral fat reduction. Australian New Zealand Clinical Trials Registry (ACTRN

  10. Designing design exercises – from theory to creativity and real-world use

    CSIR Research Space (South Africa)

    Kotze, P

    2009-01-01

    Full Text Available This paper discusses a framework for design exercises for interaction design and HCI based on two theoretical frameworks and a set of knowledge transformers. The model scope design exercises on a continuum ranging from creativity to real-world use...

  11. 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...

  12. 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

  13. 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…

  14. Teaching Real-World Applications of Business Statistics Using Communication to Scaffold Learning

    Science.gov (United States)

    Green, Gareth P.; Jones, Stacey; Bean, John C.

    2015-01-01

    Our assessment research suggests that quantitative business courses that rely primarily on algorithmic problem solving may not produce the deep learning required for addressing real-world business problems. This article illustrates a strategy, supported by recent learning theory, for promoting deep learning by moving students gradually from…

  15. Making Real-World Issues Our Business: Critical Literacy in a Third-Grade Classroom.

    Science.gov (United States)

    Heffernan, Lee; Lewison, Mitzi

    2000-01-01

    Reflects on the events that occurred during a six-month period in a suburban classroom. Documents the transformation that took place in learning and teaching as students took part in a critical literacy curriculum. Examines the significant curricular changes that occur when the "real world" is allowed to enter classroom discussions and…

  16. Sharing skills and knowledge to confront real-world problems | CRDI ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Sharing skills and knowledge to confront real-world problems ... because 1.3 billion people cannot read English, and only 163 million people (a fraction ... childhood obesity in urban areas, caused by increases in junk food and lack of exercise.

  17. Robust Emission Management Strategy to Meet Real-World Emission Requirements for HD Diesel Engines

    NARCIS (Netherlands)

    Mentink, P.; Nieuwenhof, R. van den; Kupper, F.; Willems, F.; Kooijman, D.

    2015-01-01

    Heavy-duty diesel engines are used in different application areas, like long-haul, city distribution, dump truck and building and construction industry. For these wide variety of areas, the engine performance needs to comply with the real-world legislation limits and should simultaneously have a low

  18. Robust emission management strategy to meet real-world emission requirements for HD diesel engines

    NARCIS (Netherlands)

    Mentink, P.R.; Nieuwenhof, van den R.; Kupper, F.; Willems, F.P.T.; Kooijman, D.

    2015-01-01

    Heavy-duty diesel engines are used in different application areas, like long-haul, city distribution, dump truck and building and construction industry. For these wide variety of areas, the engine performance needs to comply with the real-world legislation limits and should simultaneously have a low

  19. Hop, Step, Step and Jump : Towards Real-World Complexity @ Delft University of Technology

    NARCIS (Netherlands)

    Pruyt, E.; Slinger, J.H.; Van Daalen, C.; Yucel, G.; Thissen, W.A.H.

    2009-01-01

    This paper deals with System Dynamics education at Delft University of Technology, the Netherlands. It focuses more specifically on the quadruple jump approach towards dealing with real-world dynamic complexity. The paper starts with an overview of the System Dynamics courses, situated within the

  20. Discontinuation risk comparison among 'real-world' newly anticoagulated atrial fibrillation patients

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Pan, Xianying; Kamble, Shital

    2018-01-01

    Discontinuation of oral anticoagulants may expose non-valvular atrial fibrillation (NVAF) patients to an increased risk of stroke. This study describes the real-world discontinuation rates and compared the risk of drug discontinuation among NVAF patients initiating apixaban, warfarin, dabigatran,...

  1. A real-world Case Study in Information Technology for Undergraduate Students

    NARCIS (Netherlands)

    Sikkel, Nicolaas; Spil, Antonius A.M.; van de Weg, R.L.W.

    1999-01-01

    Real-world case studies are important to complement the academic skills and knowledge acquired by computer science students. In this paper we relate our experiences with a course specifically designed to address this issue. The problem to be addressed is the replacement of a Hospital Information

  2. Building Real World Domain-Specific Social Network Websites as a Capstone Project

    Science.gov (United States)

    Yue, Kwok-Bun; De Silva, Dilhar; Kim, Dan; Aktepe, Mirac; Nagle, Stewart; Boerger, Chris; Jain, Anubha; Verma, Sunny

    2009-01-01

    This paper describes our experience of using Content Management Software (CMS), specifically Joomla, to build a real world domain-specific social network site (SNS) as a capstone project for graduate information systems and computer science students. As Web 2.0 technologies become increasingly important in driving business application development,…

  3. What Is Real-World Data? A Review of Definitions Based on Literature and Stakeholder Interviews

    NARCIS (Netherlands)

    Makady, Amr; de Boer, Anthonius; Hillege, Hans; Klungel, Olaf; Goettsch, Wim

    2017-01-01

    Background: Despite increasing recognition of the value of real-world data (RWD), consensus on the definition of RWD is lacking.  Objectives: To review definitions publicly available for RWD to shed light on similarities and differences between them.  Methods: A literature review and stakeholder

  4. Adapting to Change in a Master Level Real-World-Projects Capstone Course

    Science.gov (United States)

    Tappert, Charles C.; Stix, Allen

    2012-01-01

    Our mission of capstone computing courses for the past ten years has been to offer students experience with the development of real-world information technology projects. This experience has included both the hard and soft skills required for the work they could expect as industrial practitioners. Hard skills entail extending one's knowledge…

  5. Alternative Assessment--Can Real-World Skills Be Tested? Policy Briefs.

    Science.gov (United States)

    Simon, Karen; Gregg, Soleil

    Many educators are shifting their teaching strategies and approaches to include more emphasis on critical thinking skills, the communication of ideas, a variety of approaches to content emphasizing varied student learning styles, and the need to draw explicit connections among topics for retention of learning. Real-world assessment measures, then,…

  6. 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.

  7. 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

  8. 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.

  9. Cars and Kinetic Energy--Some Simple Physics with Real-World Relevance

    Science.gov (United States)

    Parthasarathy, Raghuveer

    2012-01-01

    Understanding energy usage is crucial to understanding modern civilization, as well as many of the challenges it faces. Energy-related issues also offer real-world examples of important physical concepts, and as such have been the focus of several articles in "The Physics Teacher" in the past few decades (e.g., Refs. 1-5, noted further below).…

  10. 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...

  11. Replacing a Hospital Information System: an example of a real-world case study

    NARCIS (Netherlands)

    Sikkel, Nicolaas; Spil, Antonius A.M.; van de Weg, R.L.W.

    Real-world case studies are important to complement the academic skills and knowledge acquired by computer science students. In this paper we relate our experiences with a course specifically designed to address this issue. The objectives of the course are threefold: to train management and

  12. 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"…

  13. 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…

  14. Stochastic Real-World Drive Cycle Generation Based on a Two Stage Markov Chain Approach

    NARCIS (Netherlands)

    Balau, A.E.; Kooijman, D.; Vazquez Rodarte, I.; Ligterink, N.

    2015-01-01

    This paper presents a methodology and tool that stochastically generates drive cycles based on measured data, with the purpose of testing and benchmarking light duty vehicles in a simulation environment or on a test-bench. The WLTP database, containing real world driving measurements, was used as

  15. Understanding the GOLD 2011 Strategy as applied to a real-world COPD population

    DEFF Research Database (Denmark)

    Vestbo, J.; Vogelmeier, C.; Small, M.

    2014-01-01

    Study objectives: The aim of this analysis was to understand the implications of the GOLD 2011 multidimensional system for the assessment and management of COPD, using data from a real-world observational study. Methods: Data were drawn from the Adelphi Respiratory Disease Specific Programme...

  16. Supporting Student Nurses Learning in and through Clinical Practice: The Role of the Clinical Guide.

    Science.gov (United States)

    Andrews, Margaret; Roberts, Debbie

    2003-01-01

    A clinical guide is an experienced nurse who supports nursing students throughout the program, particularly in clinical placements. More than a mentor, a guide is fully involved in promoting deep learning in clinical settings. (SK)

  17. 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

  18. Smartphone-based psychotherapeutic micro-interventions to improve mood in a real-world setting

    Directory of Open Access Journals (Sweden)

    Gunther Meinlschmidt

    2016-07-01

    %CI [0.124, 0.601], p=0.170. Discussion: Our findings provide evidence for the applicability of smartphone-based micro-interventions eliciting short-term mood changes, based on techniques used in psychotherapeutic approaches, such as mindfulness-based psychotherapy, transcendental meditation, and other contemplative therapies. The results encourage exploring these techniques' capability to improve mood in randomized controlled studies and patients. Smartphone-based micro-interventions are promising to modify mood in real-world settings, complementing other psychotherapeutic interventions, in line with the precision medicine approach. The here presented data were collected within a randomized trial, registered at ClinicalTrials.gov (Identifier: NCT01921088 https://clinicaltrials.gov/ct2/show/NCT01921088.

  19. 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.

  20. 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.

  1. Comparison of carotid endarterectomy and stenting in real world practice using a regional quality improvement registry

    Science.gov (United States)

    Nolan, Brian W.; De Martino, Randall R.; Goodney, Philip P.; Schanzer, Andres; Stone, David H.; Butzel, David; Kwolek, Christopher J.; Cronenwett, Jack L.

    2013-01-01

    Objective Carotid artery stenting (CAS) vs endarterectomy (CEA) remains controversial and has been the topic of recent randomized controlled trials. The purpose of this study was to compare the practice and outcomes of CAS and CEA in a real world setting. Methods This is a retrospective analysis of 7649 CEA and 430 CAS performed at 17 centers from 2003 to 2010 within the Vascular Study Group of New England (VSGNE). The primary outcome measures were (1) any in-hospital stroke or death and (2) any stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction with cardiac surgery were excluded. Multivariate logistic regression was performed to identify predictors of stroke or death in patients undergoing CAS. Results CEA was performed in 17 centers by 111 surgeons, while CAS was performed in 6 centers by 30 surgeons and 8 interventionalists. Patient characteristics varied by procedure. Patients undergoing CAS had a higher prevalence of coronary artery disease, congestive heart failure, diabetes, and prior ipsilateral CEA. Embolic protection was used in 97% of CAS. Shunts were used in 48% and patches in 86% of CEA. The overall in-hospital stroke or death rate was higher among patients undergoing CAS (2.3% vs 1.1%; P = .03). Overall stroke, death, or MI (2.8% CAS vs 2.1% CEA; P = .32) were not different. Asymptomatic patients had similar rates of stroke or death (CAS 0.73% vs CEA 0.89%; P = .78) and stroke, death, or MI (CAS 1.1% vs CEA 1.8%; P = .40). Symptomatic patients undergoing CAS had higher rates of stroke or death (5.1% vs 1.6%; P = .001), and stroke, death, or MI (5.8% vs 2.7%; P = .02). By multivariate analysis, major stroke (odds ratio, 4.5; 95% confidence interval [CI], 1.9–10.8), minor stroke (2.7; CI, 1.5–4.8), prior ipsilateral CEA (3.2, CI, 1.7–6.1), age >80 (2.1; CI, 1.3–3.4), hypertension (2.6; CI, 1.0–6.3), and a history of chronic obstructive pulmonary disease (1.6; CI, 1.0–2.4) were predictors of stroke or death

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. The Map in Our Head Is Not Oriented North: Evidence from a Real-World Environment.

    Directory of Open Access Journals (Sweden)

    Tad T Brunyé

    Full Text Available Like most physical maps, recent research has suggested that cognitive maps of familiar environments may have a north-up orientation. We demonstrate that north orientation is not a necessary feature of cognitive maps and instead may arise due to coincidental alignment between cardinal directions and the built and natural environment. Experiment 1 demonstrated that pedestrians have difficulty pointing north while navigating a familiar real-world environment with roads, buildings, and green spaces oriented oblique to cardinal axes. Instead, north estimates tended to be parallel or perpendicular to roads. In Experiment 2, participants did not demonstrate privileged memory access when oriented toward north while making relative direction judgments. Instead, retrieval was fastest and most accurate when orientations were aligned with roads. In sum, cognitive maps are not always oriented north. Rather, in some real-world environments they can be oriented with respect to environment-specific features, serving as convenient reference systems for organizing and using spatial memory.

  9. Effects of an Online Rational Emotive Curriculum on Primary School Students' Tendencies for Online and Real-World Aggression

    Science.gov (United States)

    Liu, Eric Zhi-Feng; Ho, H. C.; Song, Y. J.

    2011-01-01

    This study investigated the relationship between online and real-world aggressive behavior among primary school students as well as the effects of an online rational emotive curriculum on reducing the tendency of students to display aggression online and in the real-world. We developed an online information literacy course integrated with rational…

  10. 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…

  11. A Qualitative Approach to Understanding Real-World Electronic Cigarette Use: Implications for Measurement and Regulation

    OpenAIRE

    Maria Cooper, PhD; Melissa B. Harrell, PhD; Cheryl L. Perry, PhD

    2016-01-01

    Introduction An understanding of the real-world use of electronic cigarettes (e-cigarettes) is needed to inform surveillance efforts and future state and federal regulation. This study investigates the behavioral aspects of e-cigarette use. Methods We used qualitative methods to examine salient characteristics of e-cigarette use. The lead investigator (M.C.) conducted in-depth, semistructured individual interviews to explore patterns and behaviors associated with e-cigarette use a...

  12. SYSTEMATIC ANALYSIS OF REAL-WORLD DRIVING BEHAVIOR FOLLOWING FOCAL BRAIN LESIONS

    OpenAIRE

    Thompson, Kelsey; Read, Katherine; Anderson, Steven; Rizzo, Matthew

    2011-01-01

    Many patients with circumscribed brain injuries, such as those caused by stroke or focal trauma, return to driving after a period of acute recovery. These persons often have chronic residual cognitive deficits that may impact on driving safety, but little is known about their driving behavior in the real world. Extant studies tend to rely on driving simulators or controlled on-road drives. These methods of observation are not able to capture the complexities of the typical driving environment...

  13. 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...

  14. The Pharmacogenomics Research Network Translational Pharmacogenetics Program: Overcoming Challenges of Real-World Implementation

    Science.gov (United States)

    Shuldiner, AR; Relling, MV; Peterson, JF; Hicks, JK; Freimuth, RR; Sadee, W; Pereira, NL; Roden, DM; Johnson, JA; Klein, TE

    2013-01-01

    The pace of discovery of potentially actionable pharmacogenetic variants has increased dramatically in recent years. However, the implementation of this new knowledge for individualized patient care has been slow. The Pharmacogenomics Research Network (PGRN) Translational Pharmacogenetics Program seeks to identify barriers and develop real-world solutions to implementation of evidence-based pharmacogenetic tests in diverse health-care settings. Dissemination of the resulting toolbox of “implementation best practices” will prove useful to a broad audience. PMID:23588301

  15. 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.

  16. 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.

  17. 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.

  18. Chidamide in relapsed or refractory peripheral T cell lymphoma: a multicenter real-world study in China

    Directory of Open Access Journals (Sweden)

    Yuankai Shi

    2017-03-01

    Full Text Available Abstract The efficacy and safety of chidamide, a new subtype-selective histone deacetylase (HDAC inhibitor, have been demonstrated in a pivotal phase II clinical trial, and chidamide has been approved by the China Food and Drug Administration (CFDA as a treatment for relapsed or refractory peripheral T cell lymphoma (PTCL. This study sought to further evaluate the real-world utilization of chidamide in 383 relapsed or refractory PTCL patients from April 2015 to February 2016 in mainland China. For patients receiving chidamide monotherapy (n = 256, the overall response rate (ORR and disease control rate (DCR were 39.06 and 64.45%, respectively. The ORR and DCR were 51.18 and 74.02%, respectively, for patients receiving chidamide combined with chemotherapy (n = 127. For patients receiving chidamide monotherapy and chidamide combined with chemotherapy, the median progression-free survival (PFS was 129 (95% CI 82 to 194 days for the monotherapy group and 152 (95% CI 93 to 201 days for the combined therapy group (P = 0.3266. Most adverse events (AEs were of grade 1 to 2. AEs of grade 3 or higher that occurred in ≥5% of patients receiving chidamide monotherapy included thrombocytopenia (10.2% and neutropenia (6.2%. For patients receiving chidamide combined with chemotherapy, grade 3 to 4 AEs that occurred in ≥5% of patients included thrombocytopenia (18.1%, neutropenia (12.6%, anemia (7.1%, and fatigue (5.5%. This large real-world study demonstrates that chidamide has a favorable efficacy and an acceptable safety profile for refractory and relapsed PTCL patients. Chidamide combined with chemotherapy may be a new treatment choice for refractory and relapsed PTCL patients but requires further investigation.

  19. Patient value: its nature, measurement, and role in real world evidence studies and outcomes-based reimbursement.

    Science.gov (United States)

    McKenna, Stephen P; Wilburn, Jeanette

    2018-05-01

    The assessment of "patient value" is fundamental to clinical trials, real world evidence studies, and outcomes-based reimbursement schemes. Measures of health-related quality-of-life (HRQoL) are widely used in health research. Such measures are effective in determining the presence or absence of symptoms and functional ability. However, HRQoL measures were not intended, nor designed, to determine the value to patients of alternative health states. Functions have no intrinsic value-they are a means to fulfil human needs. However, needs can be met in a variety of ways, for example by adopting different functions or by the provision of social services. It is possible to analyze all functions in terms of the needs they satisfy. A needs model has been applied in health research since the 1990s. It is concerned with the extent to which human needs are fulfilled in the presence of disease and its treatment. It is argued that this is the major concern of the patient. Needs-based measures are patient-centric and produce a valid unidimensional index of outcome. Consequently, they provide a direct means of measuring patient value. This approach provides the possibility of evaluating health services in terms of the value they provide to consumers and payers. It also has a role to play in real-world evidence studies and outcomes-based reimbursement. It is recommended that greater attention is given in future to the development of patient-reported outcome measures that provide direct assessments of patient value.

  20. 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.

  1. How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review

    Science.gov (United States)

    Taylor, Deanna J; Hobby, Angharad E; Binns, Alison M; Crabb, David P

    2016-01-01

    Objectives To review systematically the evidence of age-related macular degeneration (AMD) affecting real-world visual ability and quality of life (QoL). To explore trends in specific topics within this body of the literature. Design Systematic review. Methods A systematic literature search was carried out using MEDLINE, EMBASE, CINAHL, PsycINFO, PsychARTICLES and Health and Psychosocial Instruments for articles published up to January 2015 for studies including people diagnosed with AMD, assessing real-world visual ability or QoL as an outcome. Two researchers screened studies for eligibility. Details of eligible studies including study design, characteristics of study population and outcomes measured were recorded in a data extraction table. All included studies underwent quality appraisal using the Mixed Methods Appraisal Tool 2011 Version (MMAT). Results From 5284 studies, 123 were eligible for inclusion. A range of approaches were identified, including performance-based methods, quantitative and qualitative patient-reported outcome measures (PROMs). AMD negatively affects tasks including mobility, face recognition, perception of scenes, computer use, meal preparation, shopping, cleaning, watching TV, reading, driving and, in some cases, self-care. There is evidence for higher rates of depression among people with AMD than among community dwelling elderly. A number of adaptation strategies have been associated with AMD of varying duration. Much of the research fails to report the type of AMD studied (59% of included studies) or the duration of disease in participants (74%). Of those that do report type studied, the breakdown is as follows: wet AMD 20%, dry AMD 4% and both types 17%. Conclusions There are many publications highlighting the negative effects of AMD in various domains of life. Future research should focus on delivering some of this research knowledge into patient management and clinical trials and differentiating between the types of AMD. PMID

  2. 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.

  3. 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.

  4. Learning from Mistakes --- A Comprehensive Study on Real World Concurrency Bug Characteristics

    International Nuclear Information System (INIS)

    Shan Lu; Soyeon Park; Eunsoo Seo; Yuanyuan Zhou

    2008-01-01

    The reality of multi-core hardware has made concurrent programs pervasive. Unfortunately, writing correct concurrent programs is difficult. Addressing this challenge requires advances in multiple directions, including concurrency bug detection, concurrent program testing, concurrent programming model design, etc. Designing effective techniques in all these directions will significantly benefit from a deep understanding of real world concurrency bug characteristics. This paper provides the first (to the best of our knowledge) comprehensive real world concurrency bug characteristic study. Specifically, we have carefully examined concurrency bug patterns, manifestation, and fix strategies of 105 randomly selected real world concurrency bugs from 4 representative server and client opensource applications (MySQL, Apache, Mozilla and OpenOffice). Our study reveals several interesting findings and provides useful guidance for concurrency bug detection, testing, and concurrent programming language design. Some of our findings are as follows: (1) Around one third of the examined non-deadlock concurrency bugs are caused by violation to programmers order intentions, which may not be easily expressed via synchronization primitives like locks and transactional memories; (2) Around 34% of the examined non-deadlock concurrency bugs involve multiple variables, which are not well addressed by existing bug detection tools; (3) About 92% of the examined concurrency bugs can be reliably triggered by enforcing certain orders among no more than 4 memory accesses. This indicates that testing concurrent programs can target at exploring possible orders among every small groups of memory accesses, instead of among all memory accesses; (4) About 73% of the examined non-deadlock concurrency bugs were not fixed by simply adding or changing locks, and many of the fixes were not correct at the first try, indicating the difficulty of reasoning concurrent execution by programmers.

  5. 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.

  6. 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.

  7. Perils of using speed zone data to assess real-world compliance to speed limits.

    Science.gov (United States)

    Chevalier, Anna; Clarke, Elizabeth; Chevalier, Aran John; Brown, Julie; Coxon, Kristy; Ivers, Rebecca; Keay, Lisa

    2017-11-17

    Real-world driving studies, including those involving speeding alert devices and autonomous vehicles, can gauge an individual vehicle's speeding behavior by comparing measured speed with mapped speed zone data. However, there are complexities with developing and maintaining a database of mapped speed zones over a large geographic area that may lead to inaccuracies within the data set. When this approach is applied to large-scale real-world driving data or speeding alert device data to determine speeding behavior, these inaccuracies may result in invalid identification of speeding. We investigated speeding events based on service provider speed zone data. We compared service provider speed zone data (Speed Alert by Smart Car Technologies Pty Ltd., Ultimo, NSW, Australia) against a second set of speed zone data (Google Maps Application Programming Interface [API] mapped speed zones). We found a systematic error in the zones where speed limits of 50-60 km/h, typical of local roads, were allocated to high-speed motorways, which produced false speed limits in the speed zone database. The result was detection of false-positive high-range speeding. Through comparison of the service provider speed zone data against a second set of speed zone data, we were able to identify and eliminate data most affected by this systematic error, thereby establishing a data set of speeding events with a high level of sensitivity (a true positive rate of 92% or 6,412/6,960). Mapped speed zones can be a source of error in real-world driving when examining vehicle speed. We explored the types of inaccuracies found within speed zone data and recommend that a second set of speed zone data be utilized when investigating speeding behavior or developing mapped speed zone data to minimize inaccuracy in estimates of speeding.

  8. Real-world vehicle emission factors in Chinese metropolis city--Beijing.

    Science.gov (United States)

    Wang, Qi-dong; He, Ke-bin; Huo, Hong; Lents, James

    2005-01-01

    The dynamometer tests with different driving cycles and the real-world tests are presented. Results indicated the pollutants emission factors and fuel consumption factor with ECE15 + EUDC driving cycle usually take the lowest value and with real world driving cycle occur the highest value, and different driving cycles will lead to significantly different vehicle emission factors with the same vehicle. Relative to the ECE15 + EUDC driving cycle, the increasing rate of pollutant emission factors of CO, NOx and HC are - 0.42-2.99, -0.32-0.81 and -0.11-11 with FTP75 testing, 0.11-1.29, -0.77-0.64 and 0.47-10.50 with Beijing 1997 testing and 0.25-1.83, 0.09-0.75 and - 0.58-1.50 with real world testing. Compared to the carburetor vehicles, the retrofit and MPI + TWC vehicles' pollution emissionfactors decrease with different degree. The retrofit vehicle (Santana) will reduce 4.44%-58.44% CO, -4.95%-36.79% NOx, -32.32%-33.89% HC, and -9.39%-14.29% fuel consumption, and especially that the MPI + TWC vehicle will decrease CO by 82.48%-91.76%, NOx by 44.87%-92.79%, HC by 90.00%-93.89% and fuel consumption by 5.44%-10.55%. Vehicles can cause pollution at a very high rate when operated in high power modes; however, they may not often operate in these high power modes. In analyzing vehicle emissions, it describes the fraction of time that vehicles operate in various power modes. In Beijing, vehicles spend 90% of their operation in low power modes or decelerating.

  9. Real-world fuel economy and CO2 emissions of plug-in hybrid electric vehicles

    International Nuclear Information System (INIS)

    Ploetz, Patrick; Funke, Simon Arpad; Jochem, Patrick

    2015-01-01

    Plug-in hybrid electric vehicles (PHEV) combine electric propulsion with an internal combustion engine. Their potential to reduce transport related green-house gas emissions highly depends on their actual usage and electricity provision. Various studies underline their environmental and economic advantages, but are based on standardised driving cycles, simulations or small PHEV fleets. Here, we analyse real-world fuel economy of PHEV and the factors influencing it based on about 2,000 actual PHEV that have been observed over more than a year in the U.S. and Germany. We find that real-world fuel economy of PHEV differ widely among users. The main factors explaining this variation are the annual mileage, the regularity of daily driving, and the likelihood of long-distance trips. Current test cycle fuel economy ratings neglect these factors. Despite the broad range of PHEV fuel economies, the test cycle fuel economy ratings can be close to empiric PHEV fleet averages if the average annual mile-age is about 17,000 km. For the largest group of PHEV in our data, the Chevrolet Volt, we find the average fuel economy to be 1.45 litres/100 km at an average electric driving share of 78%. The resulting real-world tank-to-wheel CO 2 emissions of these PHEV are 42 gCO 2 /km and the annual CO 2 savings in the U.S. amount to about 50 Mt. In conclusion, the variance of empirical PHEV fuel economy is considerably higher than of conventional vehicles. This should be taken into account by future test cycles and high electric driving shares should be incentivised.

  10. 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

  11. 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.

  12. Real-World Solutions for Developing High-Quality PHP Frameworks and Applications

    CERN Document Server

    Bergmann, Sebastian

    2011-01-01

    Learn to develop high-quality applications and frameworks in PHP Packed with in-depth information and step-by-step guidance, this book escorts you through the process of creating, maintaining and extending sustainable software of high quality with PHP. World-renowned PHP experts present real-world case studies for developing high-quality applications and frameworks in PHP that can easily be adapted to changing business requirements. . They offer different approaches to solving  typical development and quality assurance problems that every developer needs to know and master.Details the process

  13. Replication protocol analysis: a method for the study of real-world design thinking

    DEFF Research Database (Denmark)

    Galle, Per; Kovacs, L. B.

    1996-01-01

    Given the brief of an architectural competition on site planning, and the design awarded the first prize, the first author (trained as an architect but not a participant in the competition) produced a line of reasoning that might have led from brief to design. In the paper, such ‘design replication......’ is refined into a method called ‘replication protocol analysis’ (RPA), and discussed from a methodological perspective of design research. It is argued that for the study of real-world design thinking this method offers distinct advantages over traditional ‘design protocol analysis’, which seeks to capture...

  14. Introducing a logic for real-world agents with degrees of belief

    CSIR Research Space (South Africa)

    Rens, GB

    2009-12-01

    Full Text Available stream_source_info Gens_2009.pdf.txt stream_content_type text/plain stream_size 3189 Content-Encoding UTF-8 stream_name Gens_2009.pdf.txt Content-Type text/plain; charset=UTF-8 Introducing a Logic for Real-world Agents... the world could be. A further step to capture uncertain knowledge is to assign a likelihood to each state considered possible so that degrees of belief can be captured. Now as the robot acts and observes while completing its tasks, it will change its...

  15. Casting a Wide Net for Innovation: Bringing Interdisciplinary Collaboration to Real World Problems

    Directory of Open Access Journals (Sweden)

    Robert Cherinka

    2014-08-01

    Full Text Available Federal agencies are seeking new ways to innovate, procure and enhance enterprise capabilities. Competitions are one tool that federal agencies can use to drive innovation and solve mission-centric problems—whether technical, scientific, or creative. In this paper we present an examination of several approaches to foster open innovation through challenges and competitions in support of key business operations in the workforce. We highlight specific examples of their use in "real world" environments and provide an assessment of applicability, benefits and challenges for implementation in large organizations.

  16. Real World NET, C#, and Silverlight Indispensible Experiences from 15 MVPs

    CERN Document Server

    Evjen, Bill; Balassy, Gyorgy; Gleeren, Gill; Giard, David; Golesh, Alex; Grossnicklaus, Kevin; Jenkins, Caleb; Juday, Jeffrey; Lele, Vishwas; Likness, Jeremy; Millett, Scott; Nagel, Christian; Yöndem , Daron; Weyer, Christian

    2011-01-01

    A team of MVP authors guides you through the .NET 4 Framework Written by a group of experienced MVPs, this unparalleled book delves into the intricate-and often daunting-world of .NET 4. Each author draws from a particular area of expertise to provide invaluable information on using the various .NET 4, C# 4, Silverlight 4, and Visual Studio tools in the real world. The authors break down the vast .NET 4 Framework into easily digestible portions to offer you a strong foundation on what makes .NET such a popular and successful framework for building a wide range of solutions.Breaks down the .NET

  17. 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...

  18. Programming and Tuning a Quantum Annealing Device to Solve Real World Problems

    Science.gov (United States)

    Perdomo-Ortiz, Alejandro; O'Gorman, Bryan; Fluegemann, Joseph; Smelyanskiy, Vadim

    2015-03-01

    Solving real-world applications with quantum algorithms requires overcoming several challenges, ranging from translating the computational problem at hand to the quantum-machine language to tuning parameters of the quantum algorithm that have a significant impact on the performance of the device. In this talk, we discuss these challenges, strategies developed to enhance performance, and also a more efficient implementation of several applications. Although we will focus on applications of interest to NASA's Quantum Artificial Intelligence Laboratory, the methods and concepts presented here apply to a broader family of hard discrete optimization problems, including those that occur in many machine-learning algorithms.

  19. Towards Porting a Real-World Seismological Application to the Intel MIC Architecture

    OpenAIRE

    V. Weinberg

    2014-01-01

    This whitepaper aims to discuss first experiences with porting an MPI-based real-world geophysical application to the new Intel Many Integrated Core (MIC) architecture. The selected code SeisSol is an application written in Fortran that can be used to simulate earthquake rupture and radiating seismic wave propagation in complex 3-D heterogeneous materials. The PRACE prototype cluster EURORA at CINECA, Italy, was accessed to analyse the MPI-performance of SeisSol on Intel Xeon Phi on both sing...

  20. Digital representations of the real world how to capture, model, and render visual reality

    CERN Document Server

    Magnor, Marcus A; Sorkine-Hornung, Olga; Theobalt, Christian

    2015-01-01

    Create Genuine Visual Realism in Computer Graphics Digital Representations of the Real World: How to Capture, Model, and Render Visual Reality explains how to portray visual worlds with a high degree of realism using the latest video acquisition technology, computer graphics methods, and computer vision algorithms. It explores the integration of new capture modalities, reconstruction approaches, and visual perception into the computer graphics pipeline.Understand the Entire Pipeline from Acquisition, Reconstruction, and Modeling to Realistic Rendering and ApplicationsThe book covers sensors fo

  1. 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

  2. New Teaching Environments Near Real-World-Like Laboratories for Power Engineering

    DEFF Research Database (Denmark)

    Holbøll, Joachim; Østergaard, Jacob

    2014-01-01

    , and operating real-world systems. The tool to be presented here is mainly establishment of teaching facilities at the Technical University of Denmark adjacent to the research facilities and where nearness to the ‘real world’ is essential and implemented by clearly visible research activities and by close......The Technical University of Denmark offers educations within power engineering at all levels: bachelor, master and PhD. Relevant bachelor programs use the CDIO educational framework, which allows the students to learn engineering fundaments in a context of conceiving, designing, implementing...

  3. Spontaneous mentalizing during an interactive real world task: an fMRI study.

    Science.gov (United States)

    Spiers, Hugo J; Maguire, Eleanor A

    2006-01-01

    There are moments in everyday life when we need to consider the thoughts and intentions of other individuals in order to act in a socially appropriate manner. Most of this mentalizing occurs spontaneously as we go about our business in the complexity of the real world. As such, studying the neural basis of spontaneous mentalizing has been virtually impossible. Here we devised a means to achieve this by employing a unique combination of functional magnetic resonance imaging (fMRI), a detailed and interactive virtual reality simulation of a bustling familiar city, and a retrospective verbal report protocol. We were able to provide insights into the content of spontaneous mentalizing events and identify the brain regions that underlie them. We found increased activity in a number of regions, namely the right posterior superior temporal sulcus, the medial prefrontal cortex and the right temporal pole associated with spontaneous mentalizing. Furthermore, we observed the right posterior superior temporal sulcus to be consistently active during several different subtypes of mentalizing events. By contrast, medial prefrontal cortex seemed to be particularly involved in thinking about agents that were visible in the environment. Our findings show that it is possible to investigate the neural basis of mentalizing in a manner closer to its true context, the real world, opening up intriguing possibilities for making comparisons with those who have mentalizing problems.

  4. Providing Geospatial Education and Real World Applications of Data across the Climate Initiative Themes

    Science.gov (United States)

    Weigel, A. M.; Griffin, R.; Bugbee, K.

    2015-12-01

    Various organizations such as the Group on Earth Observations (GEO) have developed a structure for general thematic areas in Earth science research, however the Climate Data Initiative (CDI) is addressing the challenging goal of organizing such datasets around core themes specifically related to climate change impacts. These thematic areas, which currently include coastal flooding, food resilience, ecosystem vulnerability, water, transportation, energy infrastructure, and human health, form the core of a new college course at the University of Alabama in Huntsville developed around real-world applications in the Earth sciences. The goal of this course is to educate students on the data available and scope of GIS applications in Earth science across the CDI climate themes. Real world applications and datasets serve as a pedagogical tool that provide a useful medium for instruction in scientific geospatial analysis and GIS software. With a wide range of potential research areas that fall under the rubric of "Earth science", thematic foci can help to structure a student's understanding of the potential uses of GIS across sub-disciplines, while communicating core data processing concepts. The learning modules and use-case scenarios for this course demonstrate the potential applications of CDI data to undergraduate and graduate Earth science students.

  5. Haptograph Representation of Real-World Haptic Information by Wideband Force Control

    Science.gov (United States)

    Katsura, Seiichiro; Irie, Kouhei; Ohishi, Kiyoshi

    Artificial acquisition and reproduction of human sensations are basic technologies of communication engineering. For example, auditory information is obtained by a microphone, and a speaker reproduces it by artificial means. Furthermore, a video camera and a television make it possible to transmit visual sensation by broadcasting. On the contrary, since tactile or haptic information is subject to the Newton's “law of action and reaction” in the real world, a device which acquires, transmits, and reproduces the information has not been established. From the point of view, real-world haptics is the key technology for future haptic communication engineering. This paper proposes a novel acquisition method of haptic information named “haptograph”. The haptograph visualizes the haptic information like photograph. The proposed haptograph is applied to haptic recognition of the contact environment. A linear motor contacts to the surface of the environment and its reaction force is used to make a haptograph. A robust contact motion and sensor-less sensing of the reaction force are attained by using a disturbance observer. As a result, an encyclopedia of contact environment is attained. Since temporal and spatial analyses are conducted to represent haptic information as the haptograph, it is possible to be recognized and to be evaluated intuitively.

  6. Incidence of real-world automotive parent and halogenated PAH in urban atmosphere.

    Science.gov (United States)

    Gao, Pan-Pan; Zhao, Yi-Bo; Ni, Hong-Gang

    2018-06-01

    This study reports results from a tunnel experiment impact of real-world traffic-related particle and gas parent and halogenated polycyclic aromatic hydrocarbons (PAHs and HPAHs) on urban air. The traffic related emission characteristics and subsequent environmental behavior of these compounds were investigated. To understand the significance of real-world transport emissions to the urban air, traffic-related mass emissions of PAHs and HPAHs were estimated based on measured emission factors. According to our results, PAHs and HPAHs emissions via particulate phase were greater than those via gaseous phase; particles in 2.1-3.3 μm size fraction, have the major contribution to particulate PAHs and HPAHs emissions. Over all, contribution of traffic-related emission of PAHs (only ∼3% of the total PAHs emission in China) is an overstated source of PAHs pollution in China. Actually, exhaust pipe emission contributed much less than the total traffic-related emission of pollutants. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Familiar real-world spatial cues provide memory benefits in older and younger adults.

    Science.gov (United States)

    Robin, Jessica; Moscovitch, Morris

    2017-05-01

    Episodic memory, future thinking, and memory for scenes have all been proposed to rely on the hippocampus, and evidence suggests that these all decline in healthy aging. Despite this age-related memory decline, studies examining the effects of context reinstatement on episodic memory have demonstrated that reinstating elements of the encoding context of an event leads to better memory retrieval in both younger and older adults. The current study was designed to test whether more familiar, real-world contexts, such as locations that participants visited often, would improve the detail richness and vividness of memory for scenes, autobiographical events, and imagination of future events in young and older adults. The predicted age-related decline in internal details across all 3 conditions was accompanied by persistent effects of contextual familiarity, in which a more familiar spatial context led to increased detail and vividness of remembered scenes, autobiographical events, and, to some extent, imagined future events. This study demonstrates that autobiographical memory, imagination of the future, and scene memory are similarly affected by aging, and all benefit from being associated with more familiar (real-world) contexts, illustrating the stability of contextual reinstatement effects on memory throughout the life span. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  8. Mid-level perceptual features distinguish objects of different real-world sizes.

    Science.gov (United States)

    Long, Bria; Konkle, Talia; Cohen, Michael A; Alvarez, George A

    2016-01-01

    Understanding how perceptual and conceptual representations are connected is a fundamental goal of cognitive science. Here, we focus on a broad conceptual distinction that constrains how we interact with objects--real-world size. Although there appear to be clear perceptual correlates for basic-level categories (apples look like other apples, oranges look like other oranges), the perceptual correlates of broader categorical distinctions are largely unexplored, i.e., do small objects look like other small objects? Because there are many kinds of small objects (e.g., cups, keys), there may be no reliable perceptual features that distinguish them from big objects (e.g., cars, tables). Contrary to this intuition, we demonstrated that big and small objects have reliable perceptual differences that can be extracted by early stages of visual processing. In a series of visual search studies, participants found target objects faster when the distractor objects differed in real-world size. These results held when we broadly sampled big and small objects, when we controlled for low-level features and image statistics, and when we reduced objects to texforms--unrecognizable textures that loosely preserve an object's form. However, this effect was absent when we used more basic textures. These results demonstrate that big and small objects have reliably different mid-level perceptual features, and suggest that early perceptual information about broad-category membership may influence downstream object perception, recognition, and categorization processes. (c) 2015 APA, all rights reserved).

  9. 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.

  10. One in the Dance: Musical Correlates of Group Synchrony in a Real-World Club Environment.

    Directory of Open Access Journals (Sweden)

    Melissa Ellamil

    Full Text Available Previous research on interpersonal synchrony has mainly investigated small groups in isolated laboratory settings, which may not fully reflect the complex and dynamic interactions of real-life social situations. The present study expands on this by examining group synchrony across a large number of individuals in a naturalistic environment. Smartphone acceleration measures were recorded from participants during a music set in a dance club and assessed to identify how group movement synchrony covaried with various features of the music. In an evaluation of different preprocessing and analysis methods, giving more weight to front-back movement provided the most sensitive and reliable measure of group synchrony. During the club music set, group synchrony of torso movement was most strongly associated with pulsations that approximate walking rhythm (100-150 beats per minute. Songs with higher real-world play counts were also correlated with greater group synchrony. Group synchrony thus appears to be constrained by familiarity of the movement (walking action and rhythm and of the music (song popularity. These findings from a real-world, large-scale social and musical setting can guide the development of methods for capturing and examining collective experiences in the laboratory and for effectively linking them to synchrony across people in daily life.

  11. One in the Dance: Musical Correlates of Group Synchrony in a Real-World Club Environment.

    Science.gov (United States)

    Ellamil, Melissa; Berson, Joshua; Wong, Jen; Buckley, Louis; Margulies, Daniel S

    2016-01-01

    Previous research on interpersonal synchrony has mainly investigated small groups in isolated laboratory settings, which may not fully reflect the complex and dynamic interactions of real-life social situations. The present study expands on this by examining group synchrony across a large number of individuals in a naturalistic environment. Smartphone acceleration measures were recorded from participants during a music set in a dance club and assessed to identify how group movement synchrony covaried with various features of the music. In an evaluation of different preprocessing and analysis methods, giving more weight to front-back movement provided the most sensitive and reliable measure of group synchrony. During the club music set, group synchrony of torso movement was most strongly associated with pulsations that approximate walking rhythm (100-150 beats per minute). Songs with higher real-world play counts were also correlated with greater group synchrony. Group synchrony thus appears to be constrained by familiarity of the movement (walking action and rhythm) and of the music (song popularity). These findings from a real-world, large-scale social and musical setting can guide the development of methods for capturing and examining collective experiences in the laboratory and for effectively linking them to synchrony across people in daily life.

  12. Network resilience to real-world disasters: Eyjafjallajökull and 9/11

    Science.gov (United States)

    Woolley, Olivia; Thiemann, Christian; Grady, Daniel; Brockmann, Dirk

    2011-03-01

    We investigate the resilience of the the world-wide air transportation network (WAN) to the 9/11 terrorist attacks and the recent eruption of the volcano Eyjafjallajökull. Although both disasters caused wide-spread disruption, the number of airports that were closed and the volume of interrupted traffic were well below the percolation threshold predicted by the classical theory. In order to quantify and visualize network deformation before breakdown, we introduce a framework based on the increase in shortest-path distance and homogenization of shortest-path structure. These real-world disasters are a new type of disruption because the removal of all vertices (airports) is geographically compact. Our framework incorporates the dual perspective of individual airports and geopolitical regions to capture how the impact interacts with the sub-network structure.We find that real-world events have an impact signature which is qualitatively different from that of random or high-centrality attacks. Furthermore, we find that the network is more resilient to the 9/11 disaster, although it removed more airports and traffic than the volcanic ash-cloud. This is due to the network roles of Europe and North America. We discuss how regional roles influence resilience to a region's removal.

  13. Allocating effort and anticipating pleasure in schizophrenia: Relationship with real world functioning.

    Science.gov (United States)

    Serper, M; Payne, E; Dill, C; Portillo, C; Taliercio, J

    2017-10-01

    Poor motivation to engage in goal-oriented behavior has been recognized as a hallmark feature of schizophrenia spectrum disorders (SZ). Low drive in SZ may be related to anticipating rewards as well as to poor working memory. However, few studies to date have examined beliefs about self-efficacy and satisfaction for future rewards (anticipatory pleasure). Additionally, few studies to date have examined how these deficits may impact SZ patients' real world functioning. The present study examined SZ patients' (n=57) anticipatory pleasure, working memory, self-efficacy and real world functioning in relation to their negative symptom severity. Results revealed that SZ patients' negative symptom severity was related to decisions in effort allocation and reward probability, working memory deficits, self-efficacy and anticipatory pleasure for future reward. Effort allocation deficits also predicted patients' daily functioning skills. SZ patients with high levels of negative symptoms are not merely effort averse, but have more difficulty effectively allocating effort and anticipating pleasure engaging in effortful activities. It may be the case that continuously failing to achieve reinforcement from engagement and participation may lead SZ patients to form certain negative beliefs about their abilities which contributes to amotivation and cognitive deficits. Lastly, our findings provide further support for a link between SZ patients functional daily living skills their effort allocation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. The effect of real-world personal familiarity on the speed of face information processing.

    Directory of Open Access Journals (Sweden)

    Benjamin Balas

    2007-11-01

    Full Text Available Previous studies have explored the effects of familiarity on various kinds of visual face judgments, yet the role of familiarity in face processing is not fully understood. Across different face judgments and stimulus sets, the data is equivocal as to whether or not familiarity impacts recognition processes.Here, we examine the effect of real-world personal familiarity in three simple delayed-match-to-sample tasks in which subjects were required to match faces on the basis of orientation (upright v. inverted, gender and identity. We find that subjects had a significant speed advantage with familiar faces in all three tasks, with large effects for the gender and identity matching tasks.Our data indicates that real-world experience with a face exerts a powerful influence on face processing in tasks where identity information is irrelevant, even in tasks that could in principle be solved via low-level cues. These results underscore the importance of experience in shaping visual recognition processes.

  15. Effective pollutant emission heights for atmospheric transport modelling based on real-world information

    International Nuclear Information System (INIS)

    Pregger, Thomas; Friedrich, Rainer

    2009-01-01

    Emission data needed as input for the operation of atmospheric models should not only be spatially and temporally resolved. Another important feature is the effective emission height which significantly influences modelled concentration values. Unfortunately this information, which is especially relevant for large point sources, is usually not available and simple assumptions are often used in atmospheric models. As a contribution to improve knowledge on emission heights this paper provides typical default values for the driving parameters stack height and flue gas temperature, velocity and flow rate for different industrial sources. The results were derived from an analysis of the probably most comprehensive database of real-world stack information existing in Europe based on German industrial data. A bottom-up calculation of effective emission heights applying equations used for Gaussian dispersion models shows significant differences depending on source and air pollutant and compared to approaches currently used for atmospheric transport modelling. - The comprehensive analysis of real-world stack data provides detailed default parameter values for improving vertical emission distribution in atmospheric modelling

  16. Paper based Flexible and Conformal SERS Substrate for Rapid Trace Detection on Real-world Surfaces

    Science.gov (United States)

    Singamaneni, Srikanth; Lee, Chang; Tian, Limei

    2011-03-01

    One of the important but often overlooked considerations in the design of surface enhanced Raman scattering (SERS) substrates for trace detection is the efficiency of sample collection. Conventional designs based on rigid substrates such as silicon, alumina, and glass resist conformal contact with the surface under investigation, making the sample collection inefficient. We demonstrate a novel SERS substrate based on common filter paper adsorbed with gold nanorods, which allows conformal contact with real-world surfaces, thus dramatically enhancing the sample collection efficiency compared to conventional rigid substrates. We demonstrate the detection of trace amounts of analyte (140 pg spread over 4 cm2) by simply swabbing the surface under investigation with the novel SERS substrate. The hierarchical fibrous structure of paper serves as a 3D vasculature for easy uptake and transport of the analytes to the electromagnetic hot spots in the paper. Simple yet highly efficient and cost effective SERS substrate demonstrated here brings SERS based trace detection closer to real-world applications. We acknowledge the financial support from Center for Materials Innovation at Washington University.

  17. Frontal theta EEG dynamics in a real-world air traffic control task.

    Science.gov (United States)

    Shou, Guofa; Ding, Lei

    2013-01-01

    Mental workload and time-on-task effect are two major factors expediting fatigue progress, which leads to performance decline and/or failure in real-world tasks. In the present study, electroencephalography (EEG) is applied to study mental fatigue development during an air traffic control (ATC) task. Specifically, the frontal theta EEG dynamics are firstly dissolved into a unique frontal independent component (IC) through a novel time-frequency independent component analysis (tfICA) method. Then the temporal fluctuations of the identified frontal ICs every minute are compared to workload (reflected by number of clicks per minute) and time-on-task effect by correlational analysis and linear regression analysis. It is observed that the frontal theta activity significantly increase with workload augment and time-on-task. The present study demonstrates that the frontal theta EEG activity identified by tfICA method is a sensitive and reliable metric to assess mental workload and time-on-task effect in a real-world task, i.e., ATC task, at the resolution of minute(s).

  18. MCTP Summer Research Internship Program. Research Presentation Day: Experience Mathematics and Science in the Real World

    Science.gov (United States)

    1996-01-01

    This paper presents the summaries of the MCTP Summer Research Internship Program. Technological areas discussed include: Mathematical curriculum development for real world problems; Rain effects on air-water gas exchange; multi-ring impact basins on mars; developing an interactive multimedia educational cd-rom on remote sensing; a pilot of an activity for for the globe program; fossils in maryland; developing children's programming for the american horticultural society at river farm; children's learning, educational programs of the national park service; a study of climate and student satisfaction in two summer programs for disadvantaged students interested in careers in mathematics and science; the maryland governor's academy, integrating technology into the classroom; stream sampling with the maryland biological stream survey (MBSS); the imaging system inspection software technology, the preparation and detection of nominal and faulted steel ingots; event-based science, the development of real-world science units; correlation between anxiety and past experiences; environmental education through summer nature camp; enhancing learning opportunities at the Salisbury zoo; plant growth experiment, a module for the middle school classroom; the effects of proxisome proliferators in Japanese medaka embryos; development of a chapter on birth control and contraceptive methodologies as part of an interactive computer-based education module on hiv and aids; excretion of gentamicin in toadfish and goldfish; the renaissance summer program; and Are field trips important to the regional math science center?

  19. Psychological interventions used to reduce sports injuries: a systematic review of real-world effectiveness.

    Science.gov (United States)

    Gledhill, Adam; Forsdyke, Dale; Murray, Eliot

    2018-02-20

    To systematically review studies examining the role of psychological interventions in injury prevention. The primary research question was: What is the real-world effectiveness of psychological intervention in preventing sports injuries? Mixed methods systematic review with best evidence synthesis. CINAHL, MEDLINE, PsycARTICLES, PsycINFO, SPORTDiscus, Science Direct and PubMed. Randomised controlled trials (RCT), non-RCTs that included a comparison group, before and after study designs and qualitative methods. Studies were required to outline specific unimodal or multimodal psychological interventions used in relation to injury prevention in the real-world setting. Studies were independently appraised with the Mixed Methods Appraisal Tool. Thirteen papers (incorporating 14 studies) met the eligibility criteria, of which 93% (13/14) reported a decrease in injury rates (effect size range=0.2-1.21). There was an overall moderate risk of bias in reporting (52%). There is a dominance of stress management-based interventions in literature due to the prominence of the model of stress and athletic injury within the area. Psychological interventions demonstrate small (0.2) to large (1.21) effects on sports injury rates. The research area demonstrates a cumulative moderate risk in reporting bias (52%). CRD42016035879. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Can We Model Driver Perceptions? An In-Situ Experiment in Real-World Conditions

    Directory of Open Access Journals (Sweden)

    Aly M. Tawfik, PhD

    2014-06-01

    Full Text Available It is clear that perceptions play a significant role in traveler decisions. Consequently, traveler perceptions are a corner stone in the feasibility of traveler information systems; for traveler information systems are only valuable if the drivers are incapable of accurately acquiring the provided information on their own, and if the provided information is relevant for the drivers' decision criteria. Accuracy of traveler perceptions has been repeatedly researched in public transportation, and has been found to vary according to different reasons. However, in spite of the clear significance of traveler perceptions, minimal effort has been put into modeling it. Almost all travel behavior models are based on traveler experiences, which are assumed to reflect traveler perceptions via the addition of some random error component. This works introduces an alternative approach: instead of adding an error component to represent driver perceptions, it proposes to model driver perceptions. This work is based on a real-world route choice experiment of a sample of 20 drivers who made more than 2,000 real-world route choices. Each of the drivers' experiences, perceptions, and choices were recorded, analyzed and cross examined. The paper demonstrates that: i driver experiences are different from driver perceptions, ii driver perceptions explain driver choices better than driver experiences, iii it is possible to model and predict driver perceptions of travel distance, time and speed.

  1. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting

    DEFF Research Database (Denmark)

    Zanichelli, Andrea; Longhurst, Hilary J; Maurer, Marcus

    2016-01-01

    . OBJECTIVE: To evaluate the history of misdiagnosis in patients participating in the Icatibant Outcome Survey (IOS). METHODS: The IOS is an observational study in which safety and effectiveness of icatibant have been evaluated since 2009. As part of the IOS, patients record any misdiagnoses received before...

  2. Double Relapsed and/or Refractory Multiple Myeloma: Clinical Outcomes and Real World Healthcare Costs.

    Directory of Open Access Journals (Sweden)

    Sarah Gooding

    Full Text Available Double relapsed and/or refractory multiple myeloma (DRMM, MM that is relapsed and/or refractory to bortezomib and lenalidomide, carries a poor prognosis. The healthcare costs of DRMM have not previously been reported. We analyzed detailed medical resource utilization (MRU costs, drug costs and outcomes for 39 UK patients receiving standard DRMM therapy. Median OS in this cohort was 5.6 months. The mean cost of DRMM treatment plus MRU until death was £23,472 [range: £1,411-£90,262], split between drug costs £11,191 and other resource use costs £12,281. The cost per assumed quality-adjusted life year (QALY during DRMM was £66,983. These data provide a standard of care comparison when evaluating the cost-effectiveness of new drugs in DRMM.

  3. Cost-effectiveness analysis of biodegradable polymer versus durable polymer drug-eluting stents incorporating real-world evidence.

    Science.gov (United States)

    Teng, Monica; Zhao, Ying Jiao; Khoo, Ai Leng; Ananthakrishna, Rajiv; Yeo, Tiong Cheng; Lim, Boon Peng; Chan, Mark Y; Loh, Joshua P

    2018-06-05

    Compared with second-generation durable polymer drug-eluting stents (DP-DES), the cost-effectiveness of biodegradable polymer drug-eluting stents (BP-DES) remains unclear in the real-world setting. We assessed the cost-effectiveness of BP-DES in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). We developed a decision-analytic model to compare the cost-effectiveness of BP-DES to DP-DES over one year and five years from healthcare payer perspective. Relative treatment effects during the first year post-PCI were obtained from a real-world population analysis while clinical event risks in the subsequent four years were derived from a meta-analysis of published studies. At one year, based on the clinical data analysis of 497 propensity-score matched pairs of patients, BP-DES were associated with an incremental cost-effectiveness ratio (ICER) of USD20,503 per quality-adjusted life-year (QALY) gained. At five years, BP-DES yielded an ICER of USD4,062 per QALY gained. At the willingness-to-pay threshold of USD50,400 (one gross domestic product per capita in Singapore in 2015), BP-DES were cost-effective. Sensitivity analysis showed that the cost of stents had a significant impact on the cost-effectiveness of BP-DES. Threshold analysis demonstrated that if the cost difference between BP-DES and DP-DES exceeded USD493, BP-DES would not be cost-effective in patients with one-year of follow-up. BP-DES were cost-effective compared with DP-DES in patients with coronary artery disease at one year and five years after PCI. It is worth noting that the cost of stents had a significant impact on the findings. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  4. 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.

  5. Real-world emissions of in-use off-road vehicles in Mexico.

    Science.gov (United States)

    Zavala, Miguel; Huertas, Jose Ignacio; Prato, Daniel; Jazcilevich, Aron; Aguilar, Andrés; Balam, Marco; Misra, Chandan; Molina, Luisa T

    2017-09-01

    Off-road vehicles used in construction and agricultural activities can contribute substantially to emissions of gaseous pollutants and can be a major source of submicrometer carbonaceous particles in many parts of the world. However, there have been relatively few efforts in quantifying the emission factors (EFs) and for estimating the potential emission reduction benefits using emission control technologies for these vehicles. This study characterized the black carbon (BC) component of particulate matter and NOx, CO, and CO 2 EFs of selected diesel-powered off-road mobile sources in Mexico under real-world operating conditions using on-board portable emissions measurements systems (PEMS). The vehicles sampled included two backhoes, one tractor, a crane, an excavator, two front loaders, two bulldozers, an air compressor, and a power generator used in the construction and agricultural activities. For a selected number of these vehicles the emissions were further characterized with wall-flow diesel particle filters (DPFs) and partial-flow DPFs (p-DPFs) installed. Fuel-based EFs presented less variability than time-based emission rates, particularly for the BC. Average baseline EFs in working conditions for BC, NOx, and CO ranged from 0.04 to 5.7, from 12.6 to 81.8, and from 7.9 to 285.7 g/kg-fuel, respectively, and a high dependency by operation mode and by vehicle type was observed. Measurement-base frequency distributions of EFs by operation mode are proposed as an alternative method for characterizing the variability of off-road vehicles emissions under real-world conditions. Mass-based reductions for black carbon EFs were substantially large (above 99%) when DPFs were installed and the vehicles were idling, and the reductions were moderate (in the 20-60% range) for p-DPFs in working operating conditions. The observed high variability in measured EFs also indicates the need for detailed vehicle operation data for accurately estimating emissions from off

  6. Real-World Rib Fracture Patterns in Frontal Crashes in Different Restraint Conditions.

    Science.gov (United States)

    Lee, Ellen L; Craig, Matthew; Scarboro, Mark

    2015-01-01

    The purpose of this study was to use the detailed medical injury information in the Crash Injury Research and Engineering Network (CIREN) to evaluate patterns of rib fractures in real-world crash occupants in both belted and unbelted restraint conditions. Fracture patterns binned into rib regional levels were examined to determine normative trends associated with belt use and other possible contributing factors. Front row adult occupants with Abbreviated Injury Scale (AIS) 3+ rib fractures, in frontal crashes with a deployed frontal airbag, were selected from the CIREN database. The circumferential location of each rib fracture (with respect to the sternum) was documented using a previously published method (Ritchie et al. 2006) and digital computed tomography scans. Fracture patterns for different crash and occupant parameters (restraint use, involved physical component, occupant kinematics, crash principal direction of force, and occupant age) were compared qualitatively and quantitatively. There were 158 belted and 44 unbelted occupants included in this study. For belted occupants, fractures were mainly located near the path of the shoulder belt, with the majority of fractures occurring on the inboard (with respect to the vehicle) side of the thorax. For unbelted occupants, fractures were approximately symmetric and distributed across both sides of the thorax. There were negligible differences in fracture patterns between occupants with frontal (0°) and near side (330° to 350° for drivers; 10° to 30° for passengers) crash principal directions of force but substantial differences between groups when occupant kinematics (and contacts within the vehicle) were considered. Age also affected fracture pattern, with fractures tending to occur more anteriorly in older occupants and more laterally in younger occupants (both belted and unbelted). Results of this study confirmed with real-world data that rib fracture patterns in unbelted occupants were more distributed

  7. Effectiveness of a Web 2.0 Intervention to Increase Physical Activity in Real-World Settings: Randomized Ecological Trial.

    Science.gov (United States)

    Vandelanotte, Corneel; Kolt, Gregory S; Caperchione, Cristina M; Savage, Trevor N; Rosenkranz, Richard R; Maeder, Anthony J; Van Itallie, Anetta; Tague, Rhys; Oldmeadow, Christopher; Mummery, W Kerry; Duncan, Mitch J

    2017-11-13

    was more effective in improving physical activity in real-world conditions. While the Web 2.0 website was visited significantly more, both groups nevertheless displayed high nonusage attrition and low intervention engagement. More research is needed to examine the external validity and generalizability of Web-based physical activity interventions. Australian New Zealand Clinical Trials Registry: ACTRN12611000253909; https://anzctr.org.au /Trial/Registration/TrialReview.aspx?id=336588&isReview=true (Archived by WebCite at http://www.webcitation.org/6ufzw 2HxD). ©Corneel Vandelanotte, Gregory S Kolt, Cristina M Caperchione, Trevor N Savage, Richard R Rosenkranz, Anthony J Maeder, Anetta Van Itallie, Rhys Tague, Christopher Oldmeadow, W Kerry Mummery, Mitch J Duncan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.11.2017.

  8. 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

  9. Trans-jugular intrahepatic porto-systemic shunt placement for refractory ascites: a 'real-world' UK health economic evaluation.

    Science.gov (United States)

    Parker, Matthew J; Guha, Neil; Stedman, Brian; Hacking, Nigel; Wright, Mark

    2013-07-01

    To assess the benefit of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement for refractory ascites. A retrospective observational study of all patients undergoing TIPS for refractory ascites in our hospital between 2003 and 2012. Secondary care. Cirrhotic patients with refractory ascites. We examined direct real-world (National Health Service) health related costs in the year before and after the TIPS procedure took place. Data were collected relating to the need for reintervention and hepatic encephalopathy. Data were available for 24 patients who underwent TIPS for refractory ascites (86% of eligible patients). TIPS was technically successful in all cases. Mean number of bed days in the year prior to TIPS was 30.3 and 14.3 in the year following (p=0.005). No patient had ascites at the end of the year after the TIPS with less requirement for paracentesis over the course of the year (p<0.001). Mean reduction in cost was £2759 per patient. TIPS was especially cost-effective in patients requiring between 6 and 12 drains per year with a mean saving of £9204 per patient. TIPS is both a clinically effective and economically advantageous therapeutic option for selected patients with refractory ascites.

  10. Hot utilitarianism and cold deontology: Insights from a response patterns approach to sacrificial and real world dilemmas.

    Science.gov (United States)

    Rosas, Alejandro; Viciana, Hugo; Caviedes, Esteban; Arciniegas, Alejandra

    2018-04-18

    Research on moral judgment with moral dilemmas suggests that "utilitarian" responses (UR) to sacrificial high-conflict dilemmas are due to decreased harm aversion, not only in individuals with clinical conditions, but also in healthy participants with high scores in antisocial personality traits. We investigated the patterns of responses to different dilemma types in healthy participants and present evidence that some URs to sacrificial dilemmas are morally motivated, as indicated by their empathic concern (EC) or primary psychopathy (PP) scores. In study 1 (N = 230) we tested students with four categories of sacrificial dilemmas featuring innocent victims. In study 2 (N = 590) we tested students with two categories of sacrificial dilemmas and two "real-world" moral dilemmas, where the agent can improve the lot of strangers by making a personal sacrifice. Results in both studies showed no decreased harm aversion in a pattern where the only UR is to the sacrificial dilemma where the number of saved people is very high, and significantly lower harm aversion only in the pattern of all-deontological respondents in Study 2. The analysis by response patterns allowed a better discrimination of the moral motivations of participants and showed that at least some of them express moral concerns in their URs.

  11. 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.

  12. Noise-robust cortical tracking of attended speech in real-world acoustic scenes

    DEFF Research Database (Denmark)

    Fuglsang, Søren; Dau, Torsten; Hjortkjær, Jens

    2017-01-01

    Selectively attending to one speaker in a multi-speaker scenario is thought to synchronize low-frequency cortical activity to the attended speech signal. In recent studies, reconstruction of speech from single-trial electroencephalogram (EEG) data has been used to decode which talker a listener...... is attending to in a two-talker situation. It is currently unclear how this generalizes to more complex sound environments. Behaviorally, speech perception is robust to the acoustic distortions that listeners typically encounter in everyday life, but it is unknown whether this is mirrored by a noise......-robust neural tracking of attended speech. Here we used advanced acoustic simulations to recreate real-world acoustic scenes in the laboratory. In virtual acoustic realities with varying amounts of reverberation and number of interfering talkers, listeners selectively attended to the speech stream...

  13. The Geometric Construction Abilities Of Gifted Students In Solving Real - World Problems: A Case From Turkey

    Directory of Open Access Journals (Sweden)

    Avni YILDIZ

    2016-10-01

    Full Text Available Geometric constructions have already been of interest to mathematicians. However, studies on geometric construction are not adequate in the relevant literature. Moreover, these studies generally focus on how secondary school gifted students solve non-routine mathematical problems. The present study aims to examine the geometric construction abilities of ninth-grade (15 years old gifted students in solving real-world geometry problems; thus a case study was conducted. Six gifted students participated in the study. The data consisted of voice records, solutions, and models made by the students on the GeoGebra screen. Results indicate that gifted students use their previous knowledge effectively during the process of geometric construction. They modeled the situations available in the problems through using mathematical concepts and the software in coordination. Therefore, it is evident that gifted students think more creatively while solving problems using GeoGebra.

  14. Cascade Probability Control to Mitigate Bufferbloat under Multiple Real-World TCP Stacks

    Directory of Open Access Journals (Sweden)

    Hoang-Linh To

    2015-01-01

    Full Text Available Persistently full buffer problem, commonly known as bufferbloat, causes unnecessary additional latency and throughput degradation whenever congestion happens in Internet. Several proposed queue management schemes, with the debloat mission, are almost based on the modification of one-loop feedback control where the instability and bad transient behavior are still big challenges. In this paper, we present a cascade probability control scheme using margin optimal method to address such challenges under different kinds of real-world TCP stacks. Simulation results guarantee the measured round trip time tracking to a low value of delay (e.g., ≈180 ms under TCP Reno, and ≈130 ms under TCP Cubic and ≈50% delay reduction in comparison to current deployed queue management schemes in network devices.

  15. Recognition and attention guidance during contextual cueing in real-world scenes: evidence from eye movements.

    Science.gov (United States)

    Brockmole, James R; Henderson, John M

    2006-07-01

    When confronted with a previously encountered scene, what information is used to guide search to a known target? We contrasted the role of a scene's basic-level category membership with its specific arrangement of visual properties. Observers were repeatedly shown photographs of scenes that contained consistently but arbitrarily located targets, allowing target positions to be associated with scene content. Learned scenes were then unexpectedly mirror reversed, spatially translating visual features as well as the target across the display while preserving the scene's identity and concept. Mirror reversals produced a cost as the eyes initially moved toward the position in the display in which the target had previously appeared. The cost was not complete, however; when initial search failed, the eyes were quickly directed to the target's new position. These results suggest that in real-world scenes, shifts of attention are initially based on scene identity, and subsequent shifts are guided by more detailed information regarding scene and object layout.

  16. Is Ki67 prognostic for aggressive prostate cancer? A multicenter real-world study.

    Science.gov (United States)

    Fantony, Joseph J; Howard, Lauren E; Csizmadi, Ilona; Armstrong, Andrew J; Lark, Amy L; Galet, Colette; Aronson, William J; Freedland, Stephen J

    2018-06-15

    To test if Ki67 expression is prognostic for biochemical recurrence (BCR) after radical prostatectomy (RP). Ki67 immunohistochemistry was performed on tissue microarrays constructed from specimens obtained from 464 men undergoing RP at the Durham and West LA Veterans Affairs Hospitals. Hazard ratios (HR) for Ki67 expression and time to BCR were estimated using Cox regression. Ki67 was associated with more recent surgery year (p < 0.001), positive margins (p = 0.001) and extracapsular extension (p < 0.001). In center-stratified analyses, the adjusted HR for Ki67 expression and BCR approached statistical significance for west LA (HR: 1.54; p = 0.06), but not Durham (HR: 1.10; p = 0.74). This multi-institutional 'real-world' study provides limited evidence for the prognostic role of Ki67 in predicting outcome after RP.

  17. On the Impact of using Mixed Integer Programming Techniques on Real-world Offshore Wind Parks

    DEFF Research Database (Denmark)

    Fischetti, Martina; Pisinger, David

    2017-01-01

    Wind power is a leading technology in the transition to sustainable energy. Being a new and still more competitive field, it is of major interest to investigate new techniques to solve the design challenges involved. In this paper, we consider optimization of the inter-array cable routing...... optimization problem considers two objectives: minimizing immediate costs (CAPEX) and minimizing costs due to power losses. This makes it possible to perform various what-if analyses to evaluate the impact of different preferences to CAPEX versus reduction of power losses. Thanks to the close collaboration...... with a leading energy company, we have been able to report results on a set of real-world instances, based on six existing wind parks, studying the economical impact of considering power losses in the cable routing design phase....

  18. Replication protocol analysis: a method for the study of real-world design thinking

    DEFF Research Database (Denmark)

    Galle, Per; Kovacs, L. B.

    1996-01-01

    ’ is refined into a method called ‘replication protocol analysis’ (RPA), and discussed from a methodological perspective of design research. It is argued that for the study of real-world design thinking this method offers distinct advantages over traditional ‘design protocol analysis’, which seeks to capture......Given the brief of an architectural competition on site planning, and the design awarded the first prize, the first author (trained as an architect but not a participant in the competition) produced a line of reasoning that might have led from brief to design. In the paper, such ‘design replication...... the designer’s authentic line of reasoning. To illustrate how RPA can be used, the site planning case is briefly presented, and part of the replicated line of reasoning analysed. One result of the analysis is a glimpse of a ‘logic of design’; another is an insight which sheds new light on Darke’s classical...

  19. 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)

  20. Accuracy and speed of material categorization in real-world images

    Science.gov (United States)

    Sharan, Lavanya; Rosenholtz, Ruth; Adelson, Edward H.

    2014-01-01

    It is easy to visually distinguish a ceramic knife from one made of steel, a leather jacket from one made of denim, and a plush toy from one made of plastic. Most studies of material appearance have focused on the estimation of specific material properties such as albedo or surface gloss, and as a consequence, almost nothing is known about how we recognize material categories like leather or plastic. We have studied judgments of high-level material categories with a diverse set of real-world photographs, and we have shown (Sharan, 2009) that observers can categorize materials reliably and quickly. Performance on our tasks cannot be explained by simple differences in color, surface shape, or texture. Nor can the results be explained by observers merely performing shape-based object recognition. Rather, we argue that fast and accurate material categorization is a distinct, basic ability of the visual system. PMID:25122216

  1. Local self-similarity descriptor for point-of-interest reconstruction of real-world scenes

    International Nuclear Information System (INIS)

    Gao, Xianglu; Wan, Weibing; Zhao, Qunfei; Zhang, Xianmin

    2015-01-01

    Scene reconstruction is utilized commonly in close-range photogrammetry, with diverse applications in fields such as industry, biology, and aerospace industries. Presented surfaces or wireframe three-dimensional (3D) model reconstruction applications are either too complex or too inflexible to accommodate various types of real-world scenes, however. This paper proposes an algorithm for acquiring point-of-interest (referred to throughout the study as POI) coordinates in 3D space, based on multi-view geometry and a local self-similarity descriptor. After reconstructing several POIs specified by a user, a concise and flexible target object measurement method, which obtains the distance between POIs, is described in detail. The proposed technique is able to measure targets with high accuracy even in the presence of obstacles and non-Lambertian surfaces. The method is so flexible that target objects can be measured with a handheld digital camera. Experimental results further demonstrate the effectiveness of the algorithm. (paper)

  2. From the ideal to the real world: a phenomenological inquiry into student sojourners' reentry adaptation.

    Science.gov (United States)

    Hsiao, Feilin

    2011-01-01

    This phenomenological study examines the thematic structure of reentry transition for international music therapy graduates who have returned home after studying in the United States. Emphasis is placed upon career development. Standardized open-ended interviews were used to obtain rich and in-depth descriptions of the participants' experiences. Ten music therapists from six countries participated in the study. The themes that emerged from the data include moving from the ideal to the real world, shifting from the role of student to professional, confronting reality and working through challenges, and achieving personal growth and self-transformation. The dynamics of cross-cultural comparison, confronting the home culture, and redefining music therapy and professional identities within the local cultural context are illustrated via quotations from the participants. Implications and recommendations for music therapy education and career preparation for international graduates are discussed.

  3. Experiences from Real-World Deployment of Context-Aware Technologies in a Hospital Environment

    DEFF Research Database (Denmark)

    Bardram, Jakob Eyvind; Hansen, Thomas Riisgaard; Mogensen, Martin

    2006-01-01

    and discuss our experiences from an ongoing deployment of a suite of context-aware technologies and applications in a hospital environment, including a context-awareness infrastructure, a location tracking system, and two context-aware applications running on interactive wall displays and mobile phones. Based......Context-aware computing is a central concept in ubiquitous computing and many suggestions for context-aware technologies and applications have been proposed. There is, however, little evidence on how these concepts and technologies play out in a real-world setting. In this paper we describe...... on an analysis of the use of these systems, we observe that many of the ideas behind context-aware computing are valid, and that the context-aware applications are useful for clinicians in their work. By reflecting on the nature of the designed context-aware technologies, we present a model which states...

  4. 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.

  5. Real-World Outcomes and Critical Thinking: Differential Analysis by Academic Major and Gender

    Directory of Open Access Journals (Sweden)

    Amanda Franco

    2015-08-01

    Full Text Available The Real-World Outcomes is an inventory that measures everyday problematic behaviors that represent decisions where critical thinking is presumably absent; assessing the negative outcomes of poor daily decisions helps to infer the degree of critical thinking that mediates everyday reasoning. In the present paper, we describe the process of translation and cultural adaptation of this inventory to Portuguese. We present evidence of its administration to 259 college students concerning reliability, and differences based on academic major and gender. No statistically significant differences were found, either due to academic major or gender. Results suggest the value of this instrument to assessing daily decision making and life outcomes, and also, to estimate the quality of critical thinking in everyday life.

  6. Synthetic graph generation for data-intensive HPC benchmarking: Scalability, analysis and real-world application

    Energy Technology Data Exchange (ETDEWEB)

    Powers, Sarah S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Lothian, Joshua [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2014-12-01

    The benchmarking effort within the Extreme Scale Systems Center at Oak Ridge National Laboratory seeks to provide High Performance Computing benchmarks and test suites of interest to the DoD sponsor. The work described in this report is a part of the effort focusing on graph generation. A previously developed benchmark, SystemBurn, allows the emulation of a broad spectrum of application behavior profiles within a single framework. To complement this effort, similar capabilities are desired for graph-centric problems. This report described the in-depth analysis of the generated synthetic graphs' properties at a variety of scales using different generator implementations and examines their applicability to replicating real world datasets.

  7. Effective pollutant emission heights for atmospheric transport modelling based on real-world information.

    Science.gov (United States)

    Pregger, Thomas; Friedrich, Rainer

    2009-02-01

    Emission data needed as input for the operation of atmospheric models should not only be spatially and temporally resolved. Another important feature is the effective emission height which significantly influences modelled concentration values. Unfortunately this information, which is especially relevant for large point sources, is usually not available and simple assumptions are often used in atmospheric models. As a contribution to improve knowledge on emission heights this paper provides typical default values for the driving parameters stack height and flue gas temperature, velocity and flow rate for different industrial sources. The results were derived from an analysis of the probably most comprehensive database of real-world stack information existing in Europe based on German industrial data. A bottom-up calculation of effective emission heights applying equations used for Gaussian dispersion models shows significant differences depending on source and air pollutant and compared to approaches currently used for atmospheric transport modelling.

  8. 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.

  9. 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.

  10. Accuracy and speed of material categorization in real-world images.

    Science.gov (United States)

    Sharan, Lavanya; Rosenholtz, Ruth; Adelson, Edward H

    2014-08-13

    It is easy to visually distinguish a ceramic knife from one made of steel, a leather jacket from one made of denim, and a plush toy from one made of plastic. Most studies of material appearance have focused on the estimation of specific material properties such as albedo or surface gloss, and as a consequence, almost nothing is known about how we recognize material categories like leather or plastic. We have studied judgments of high-level material categories with a diverse set of real-world photographs, and we have shown (Sharan, 2009) that observers can categorize materials reliably and quickly. Performance on our tasks cannot be explained by simple differences in color, surface shape, or texture. Nor can the results be explained by observers merely performing shape-based object recognition. Rather, we argue that fast and accurate material categorization is a distinct, basic ability of the visual system. © 2014 ARVO.

  11. Real World Learning: toward a differentiated framework for outdoor learning for sustainability

    Directory of Open Access Journals (Sweden)

    Lewis Winks

    2015-12-01

    Full Text Available The Real World Learning network (RWLn set out in 2011 to explore elements which contribute to a ‘deep and meaningful’ outdoor education experience. Following three years of work, the RWLn developed the ‘Hand Model’, a learning model designed to support educators in the development of Outdoor Learning for Sustainability (OLfS. Since its launch in early 2014, the model has been used for planning, delivering and reflecting upon OLfS experiences. Making use of the comments made in Činčera’s (2015 Real World Learning: a critical analysis which highlights inconsistencies existent within the model’s internal logic, this paper considers the perceived contradiction between emancipatory and instrumental approaches to learning. Beginning with a comprehensive introduction to the Hand model, this paper goes on to discuss the theoretical divide which the model spans between a goal-led, knowledge based approach promoted by the model’s focus upon understanding and values, and a pluralistic and exploratory approach typified by aspects of educational empowerment and experience. In response to this and augmented by examples, a differentiated conceptual framework is presented to facilitate a pragmatic application of the model from a practice perspective, making use of what has been termed a ‘blended approach’, whilst acknowledging degrees of inconsistency and dissonance from a theoretical perspective. Additionally, the model is viewed from a context perspective where questions are asked regarding the appropriateness of particular approaches depending upon the setting in which learning takes place. It is hoped that by moving beyond theoretically entrenched positions a mediated middle ground for the model’s application may be established.

  12. 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.

  13. 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.

  14. Brain-to-Brain Synchrony Tracks Real-World Dynamic Group Interactions in the Classroom.

    Science.gov (United States)

    Dikker, Suzanne; Wan, Lu; Davidesco, Ido; Kaggen, Lisa; Oostrik, Matthias; McClintock, James; Rowland, Jess; Michalareas, Georgios; Van Bavel, Jay J; Ding, Mingzhou; Poeppel, David

    2017-05-08

    The human brain has evolved for group living [1]. Yet we know so little about how it supports dynamic group interactions that the study of real-world social exchanges has been dubbed the "dark matter of social neuroscience" [2]. Recently, various studies have begun to approach this question by comparing brain responses of multiple individuals during a variety of (semi-naturalistic) tasks [3-15]. These experiments reveal how stimulus properties [13], individual differences [14], and contextual factors [15] may underpin similarities and differences in neural activity across people. However, most studies to date suffer from various limitations: they often lack direct face-to-face interaction between participants, are typically limited to dyads, do not investigate social dynamics across time, and, crucially, they rarely study social behavior under naturalistic circumstances. Here we extend such experimentation drastically, beyond dyads and beyond laboratory walls, to identify neural markers of group engagement during dynamic real-world group interactions. We used portable electroencephalogram (EEG) to simultaneously record brain activity from a class of 12 high school students over the course of a semester (11 classes) during regular classroom activities (Figures 1A-1C; Supplemental Experimental Procedures, section S1). A novel analysis technique to assess group-based neural coherence demonstrates that the extent to which brain activity is synchronized across students predicts both student class engagement and social dynamics. This suggests that brain-to-brain synchrony is a possible neural marker for dynamic social interactions, likely driven by shared attention mechanisms. This study validates a promising new method to investigate the neuroscience of group interactions in ecologically natural settings. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Real world efficiency of retrofit partial-flow diesel particulate filters for trucks

    International Nuclear Information System (INIS)

    Van Asch, R.; Verbeek, R.; Ligterink, N.; Kadijk, G.

    2009-11-01

    In 2006 the Dutch Ministry of Housing, Spatial Planning and the Environment (VROM) introduced an incentive scheme for retrofitting diesel particulate filters on Euro II and Euro III trucks. This scheme involves both partial flow and full flow diesel particulate filters (also called semi-open or open respectively wall-flow or closed filters). In the period 2007 till January 2009 about 15,000 partial flow filters and 8,000 full flow diesel particulate filters were installed. The minimum filtration efficiency requirement for the partial flow diesel particulate filters is 50% during the type approval test. In 2008 an engine dynamometer test programme was conducted to measure the filtration efficiency of retrofit open particulates filters of heavy trucks. This led to somewhat disappointing results with average filtration efficiencies in the range of 5-20% during city and national motorway driving conditions up to 20-40% during long distance motorway driving. This result leads to two main questions: (1) Is this result also representative for medium heavy trucks used for delivery, and (2) do similar efficiencies show up also in tests on entire vehicles, tested under conditions as close as possible to their real world usage profile. To this end, an additional measurement programme was defined, which is reported here. The objective of the study reported here is to determine the real world filtration efficiency of retrofit partial flow particulate filters for a number of trucks under different driving conditions such as city and motorway driving. The emphasis should be on medium heavy trucks typically used for national delivery.

  16. 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

  17. A Comprehensive Review of Low-Speed Rear Impact Volunteer Studies and a Comparison to Real-World Outcomes.

    Science.gov (United States)

    Cormier, Joseph; Gwin, Lisa; Reinhart, Lars; Wood, Rawson; Bain, Charles

    2018-02-27

    This study combined all prior research involving human volunteers in low-speed rear-end impacts and performed a comparative analysis of real-world crashes using the National Automotive Sampling System - Crashworthiness Data System. The aim of this study was to assess the rates of neck pain between volunteer and real-world collisions as well as the likelihood of an injury beyond symptoms as a function of impact severity and occupant characteristics in real-world collisions. A total of 51 human volunteer studies were identified that produced a dataset of 1984 volunteer impacts along with a separate dataset of 515,601 weighted occupants in real-world rear impacts. Operating-characteristic curves were created to assess the utility of the volunteer dataset in making predictions regarding the overall population. Change in speed or delta-V was used to model the likelihood of reporting symptoms in both real-world and volunteer exposures and more severe injuries using real-world data. Logistic regression models were created for the volunteer data and survey techniques were used to analyze the weighted sampling scheme with the National Automotive Sampling System database. Symptom reporting rates were not different between males and females and were nearly identical between laboratory and real-world exposures. The minimal risk of injury predicted by real-world exposure is consistent with the statistical power of the large number of volunteer studies without any injury beyond the reporting of neck pain. This study shows that volunteer studies do not under-report symptoms and are sufficient in number to conclude that the risk of injury beyond neck strain under similar conditions is essentially zero. The real-world injury analyses demonstrate that rear impacts do not produce meaningful risks of cervical injury at impacts of similar and greater severity to those of the volunteer research. Future work concerning the mechanism of whiplash-related trauma should focus on impacts of

  18. Study of emissions and fuel economy for parallel hybrid versus conventional vehicles on real world and standard driving cycles

    Directory of Open Access Journals (Sweden)

    Ahmed Al-Samari

    2017-12-01

    Full Text Available Parallel hybrid electric vehicles (PHEVs increasing rapidly in the automobile markets. However, the benefits out of using this kind of vehicles are still concerned a lot of costumers. This work investigated the expected benefits (such as decreasing emissions and increasing fuel economy from using the parallel HEV in comparison to the conventional vehicle model of the real-world and standard driving cycles. The software Autonomie used in this study to simulate the parallel HEV and conventional models on these driving cycles.The results show that the fuel economy (FE can be improved significantly up to 68% on real-world driving cycle, which is represented mostly city activities. However, the FE improvement was limited (10% on the highway driving cycle, and this is expected since the using of brake system was infrequent. Moreover, the emissions from parallel HEV decreased about 40% on the real-world driving cycle, and decreased 11% on the highway driving cycle. Finally, the engine efficiency, improved about 12% on the real-world driving cycle, and about 7% on highway driving cycle. Keywords: Emissions, Hybrid electric vehicles, Fuel economy, Real-world driving cycle

  19. 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.

  20. Estimating the real world daily usage and cost for exenatide twice daily and liraglutide in Germany, the Netherlands, and the UK based on volumes dispensed by pharmacies

    Directory of Open Access Journals (Sweden)

    McDonell AL

    2015-01-01

    Full Text Available Amanda L McDonell,1 Urpo Kiiskinen,2 Danielle C Zammit,3 Robert W Kotchie,1 Per-Olof Thuresson,3 Claudia Nicolay,4 Thomas Haslam,1 Michiel Bruinsma,5 Anne-Jeanine Janszen-Van Oosterhout,6 Thorsten Otto41IMS Health, London, UK; 2Eli Lilly and Company, Helsinki, Finland; 3IMS Health, Basel, Switzerland; 4Eli Lilly and Company, Bad Homburg, Germany; 5IMS Health, Rotterdam, the Netherlands; 6Eli Lilly Nederland, Houten, the NetherlandsBackground: Glucagon-like peptide-1 (GLP-1 receptor agonists are indicated for improvement of glycemic control in adults with type 2 diabetes. Cost is one aspect of treatment to be considered, in addition to clinical benefits, when selecting optimal therapy for a patient. The objective of this study was to estimate the average dose usage and real world daily cost of the GLP-1 receptor agonists, exenatide twice daily and liraglutide once daily, in Germany, the Netherlands, and the UK.Methods: Administrative databases were used to source the data from longitudinal records of dispensed prescriptions. Data were extracted from the IMS Longitudinal Prescription database which captures details of prescriptions dispensed in pharmacies. Information on the dispensed quantity of each product was used to estimate average daily usage per patient. Daily dose usage was multiplied by the public price per unit to estimate daily cost.Results: The dispensed volume in Germany corresponded to a mean dispensed daily dose of 16.81 µg for exenatide twice daily and 1.37 mg for liraglutide (mean daily cost €4.02 and €4.54, respectively. In the Netherlands, average dispensed daily doses of 17.07 µg and 1.49 mg were observed for exenatide twice daily and liraglutide (mean daily cost €3.05 and €3.97, respectively. In the UK, the mean dispensed volume corresponded to a daily usage of 20.49 µg for exenatide twice daily and 1.50 mg for liraglutide (mean daily cost £2.53 and £3.28, respectively.Conclusion: Estimates of average daily

  1. 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...

  2. Simulated Real-World Energy Impacts of a Thermally Sensitive Powertrain Considering Viscous Losses and Enrichment: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Wood, E.; Gonder, J.; Lopp, S.; Jehlik, F.

    2015-02-01

    It is widely understood that cold ambient temperatures increase vehicle fuel consumption due to heat transfer losses, increased friction (increased viscosity lubricants), and enrichment strategies (accelerated catalyst heating). However, relatively little effort has been dedicated to thoroughly quantifying these impacts across a large set of real world drive cycle data and ambient conditions. This work leverages experimental dynamometer vehicle data collected under various drive cycles and ambient conditions to develop a simplified modeling framework for quantifying thermal effects on vehicle energy consumption. These models are applied over a wide array of real-world usage profiles and typical meteorological data to develop estimates of in-use fuel economy. The paper concludes with a discussion of how this integrated testing/modeling approach may be applied to quantify real-world, off-cycle fuel economy benefits of various technologies.

  3. Association Between NCAP Ratings and Real-World Rear Seat Occupant Risk of Injury.

    Science.gov (United States)

    Metzger, Kristina B; Gruschow, Siobhan; Durbin, Dennis R; Curry, Allison E

    2015-01-01

    Several studies have evaluated the correlation between U.S. or Euro New Car Assessment Program (NCAP) ratings and injury risk to front seat occupants, in particular driver injuries. Conversely, little is known about whether NCAP 5-star ratings predict real-world risk of injury to restrained rear seat occupants. The NHTSA has identified rear seat occupant protection as a specific area under consideration for improvements to its NCAP. In order to inform NHTSA's efforts, we examined how NCAP's current 5-star rating system predicts risk of moderate or greater injury among restrained rear seat occupants in real-world crashes. We identified crash-involved vehicles, model year 2004-2013, in NASS-CDS (2003-2012) with known make and model and nonmissing occupant information. We manually matched these vehicles to their NCAP star ratings using data on make, model, model year, body type, and other identifying information. The resultant linked NASS-CDS and NCAP database was analyzed to examine associations between vehicle ratings and rear seat occupant injury risk; risk to front seat occupants was also estimated for comparison. Data were limited to restrained occupants and occupant injuries were defined as any injury with a maximum Abbreviated Injury Scale (AIS) score of 2 or greater. We linked 95% of vehicles in NASS-CDS to a specific vehicle in NCAP. The 18,218 vehicles represented an estimated 6 million vehicles with over 9 million occupants. Rear seat passengers accounted for 12.4% of restrained occupants. The risk of injury in all crashes for restrained rear seat occupants was lower in vehicles with a 5-star driver rating in frontal impact tests (1.4%) than with 4 or fewer stars (2.6%, P =.015); results were similar for the frontal impact passenger rating (1.3% vs. 2.4%, P =.024). Conversely, side impact driver and passenger crash tests were not associated with rear seat occupant injury risk (driver test: 1.7% for 5-star vs. 1.8% for 1-4 stars; passenger test: 1.6% for 5

  4. Eye Movement Patterns during Locomotion in Real-World and Simulated Environments

    Directory of Open Access Journals (Sweden)

    Ming Zhao

    2012-05-01

    Full Text Available Eye movements in a search-and-count walking task were compared between a simulated (SE and real-world environment (RE. Eye movements were recorded using the mobile WearCam in either RE or the StroMoHab locomotion simulator, a treadmill-based system for gait mobility rehabilitation. For Experiment 1, a RE was prepared with objects (coloured balls and occluding barriers placed along a 38 m long corridor. A video was captured from a walker's viewpoint at 1.3 km/hr. Fifteen subjects per environment reported the total object count after completing a walk while viewing the video in the SE (at 0, 1.3, or 2.5 km/h and RE (at 1.3 km/h. Examining the number of eye transitions (TotET between objects in relation to walking speed in SE, revealed significant increases between 0 and 2.5 km/h (F3, 56 =20.62, p = .02 and 1.3 and 2.5 km/h (F3, 56 =20.62, p = .039, despite no change in video speed; no significant difference was found between 0 and 1.3 km/h. In Experiment 2, 15 subjects viewed a static checkered screen and were instructed to ‘view the screen’ while walking. TotET decreased significantly, between 1.3 km/h and 5.2 km/h (F2, 27 =3.437, p = .014; no significant differences were observed between 2.6 km/h and either 1.3 km/h or 5.2 km/h. In real-world conditions, walking faster increases the difficulty of search tasks, with a likely correlated increase in eye movements. Apparently, the expectation of increased difficulty carries over to SE, even if the visual task is not more difficult. The findings point to physiological and perceptual correlations between locomotion and eye movements.

  5. Efficacy and safety of tenofovir in chronic hepatitis B: Australian real world experience.

    Science.gov (United States)

    Lovett, Grace C; Nguyen, Tin; Iser, David M; Holmes, Jacinta A; Chen, Robert; Demediuk, Barbara; Shaw, Gideon; Bell, Sally J; Desmond, Paul V; Thompson, Alexander J

    2017-01-08

    To evaluate the long-term treatment outcomes of tenofovir therapy in patients in a real world Australian tertiary care setting. We performed a retrospective analysis of treatment outcomes among treatment-naïve and treatment-experienced patients receiving a minimum 3 mo tenofovir therapy through St Vincent's Hospital Melbourne, Australia. We included patients receiving tenofovir [tenofovir disoproxil fumarate (TDF)] monotherapy, as well as patients treated with TDF in combination with a second antiviral agent. Patients were excluded if they demonstrated human immune-deficiency virus/hepatitis C virus/hepatitis delta virus coinfection or were less than 18 years of age. We considered virological and biochemical response, as well as safety outcomes. Virological response was determined by measurement of hepatitis B virus (HBV) DNA using sensitive assays; biochemical response was determined via serum liver function tests; histological response was determined from liver biopsy and fibroscan; safety analysis focused on glomerular renal function and bone mineral density. The primary efficacy endpoint was complete virological suppression over time, defined by HBV DNA < 20 IU/mL. Secondary efficacy endpoints included rates of biochemical response, and HB e antigen (HBeAg)/HB surface antigen loss and seroconversion over time. Ninety-two patients were identified who fulfilled the enrolment criteria. Median follow-up was 26 mo (range 3-114). Mean age was 46 (24-78) years, 64 (70%) were male and 77 (84%) were of Asian origin. 55 (60%) patients were treatment-naïve and 62 patients (67%) were HBeAg-negative. Complete virological suppression was achieved by 45/65 (71%) patients at 12 mo, 37/46 (80%) at 24 mo and 25/28 (89%) at 36 mo. Partial virological response (HBV DNA 20-2000 IU/mL) was achieved by 89/92 (96.7%) of patients. Multivariate analysis showed a significant relationship between virological suppression at end of follow-up and baseline HBV DNA level (OR = 0.897, 95%CI

  6. [Real-world data on novel oral anticoagulants: the added value of registries and observational studies. Focus on apixaban].

    Science.gov (United States)

    Pelliccia, Francesco; Tanzilli, Gaetano; Schiariti, Michele; Viceconte, Nicola; Greco, Cesare; Gaudio, Carlo

    2016-12-01

    Anticoagulant therapy has been used with great effect for decades for the prevention of stroke among patients with atrial fibrillation. In recent years, the therapeutic armamentarium has been strengthened considerably, with the addition of anticoagulants acting through novel pathways. The currently available novel agents are apixaban, rivaroxaban and dabigatran. These novel oral anticoagulants (NOACs) were approved for use on the basis of major clinical trials clearly demonstrating improved risk reductions compared to warfarin for stroke and/or major bleeding events. In these studies, apixaban and dabigatran 150 mg each significantly reduced the risk of stroke, while apixaban and dabigatran 110 mg reduced the risk of major bleeding compared to warfarin. Extrapolating the results of the randomized clinical trials on NOACs to all patients is not possible, as the strict design of clinical trials yields information that is directly applicable to a relatively narrow spectrum of patients. To control for confounding variables, randomized studies restrict enrolment to a prespecified set of criteria that do not necessarily reflect the profiles of all those who could potentially benefit from these agents. Research continues using the trial databases, in an attempt to better identify patient subgroups who do or do not benefit from each of the agents. At the European Society of Cardiology (ESC) annual meetings in London in 2015 and in Rome in 2016, there were several presentations and posters providing this type of evidence. Perhaps more important, as real-world experience with these agents grows, we are beginning to obtain meaningful new information about the NOACs in everyday use. This has involved the study of large databases including patients receiving these medications in clinical situations less stringently defined than in the randomized clinical trials. These include purpose-built registries, observational studies, and analyses of healthcare administrative databases

  7. Probabilistic Elastic Part Model: A Pose-Invariant Representation for Real-World Face Verification.

    Science.gov (United States)

    Li, Haoxiang; Hua, Gang

    2018-04-01

    Pose variation remains to be a major challenge for real-world face recognition. We approach this problem through a probabilistic elastic part model. We extract local descriptors (e.g., LBP or SIFT) from densely sampled multi-scale image patches. By augmenting each descriptor with its location, a Gaussian mixture model (GMM) is trained to capture the spatial-appearance distribution of the face parts of all face images in the training corpus, namely the probabilistic elastic part (PEP) model. Each mixture component of the GMM is confined to be a spherical Gaussian to balance the influence of the appearance and the location terms, which naturally defines a part. Given one or multiple face images of the same subject, the PEP-model builds its PEP representation by sequentially concatenating descriptors identified by each Gaussian component in a maximum likelihood sense. We further propose a joint Bayesian adaptation algorithm to adapt the universally trained GMM to better model the pose variations between the target pair of faces/face tracks, which consistently improves face verification accuracy. Our experiments show that we achieve state-of-the-art face verification accuracy with the proposed representations on the Labeled Face in the Wild (LFW) dataset, the YouTube video face database, and the CMU MultiPIE dataset.

  8. The Pale Blue Dot: Utilizing Real World Globes in High School and Undergraduate Oceanography Classrooms

    Science.gov (United States)

    Rogers, D. B.

    2017-12-01

    Geoscience classrooms have benefitted greatly from the use of interactive, dry-erasable globes to supplement instruction on topics that require three-dimensional visualization, such as seismic wave propagation and the large-scale movements of tectonic plates. Indeed, research by Bamford (2013) demonstrates that using three-dimensional visualization to illustrate complex processes enhances student comprehension. While some geoscience courses tend to bake-in lessons on visualization, other disciplines of earth science that require three-dimensional visualization, such as oceanography, tend to rely on students' prior spatial abilities. In addition to spatial intelligence, education on the three-dimensional structure of the ocean requires knowledge of the external processes govern the behavior of the ocean, as well as the vertical and lateral distribution of water properties around the globe. Presented here are two oceanographic activities that utilize RealWorldGlobes' dry-erase globes to supplement traditional oceanography lessons on thermohaline and surface ocean circulation. While simultaneously promoting basic plotting techniques, mathematical calculations, and unit conversions, these activities touch on the processes that govern global ocean circulation, the principles of radiocarbon dating, and the various patterns exhibited by surface ocean currents. These activities challenge students to recognize inherent patterns within their data and synthesize explanations for their occurrence. Spatial visualization and critical thinking are integral to any geoscience education, and the combination of these abilities with engaging hands-on activities has the potential to greatly enhance oceanography education in both secondary and postsecondary settings

  9. Stress responses of Calluna vulgaris to reduced and oxidised N applied under 'real world conditions'

    International Nuclear Information System (INIS)

    Sheppard, Lucy J.; Leith, Ian D.; Crossley, A.; Van Dijk, N.; Fowler, D.; Sutton, M.A.; Woods, C.

    2008-01-01

    Effects and implications of reduced and oxidised N, applied under 'real world' conditions, since May 2002, are reported for Calluna growing on an ombrotrophic bog. Ammonia has been released from a 10 m line source generating monthly concentrations of 180-6 μg m -3 , while ammonium chloride and sodium nitrate are applied in rainwater at nitrate and ammonium concentrations below 4 mM and providing up to 56 kg N ha -1 year -1 above a background deposition of 10 kg N ha -1 year -1 . Ammonia concentrations, >8 μg m -3 have significantly enhanced foliar N concentrations, increased sensitivity to drought, frost and winter desiccation, spring frost damage and increased the incidence of pathogen outbreaks. The mature Calluna bushes nearest the NH 3 source have turned bleached and moribund. By comparison the Calluna receiving reduced and oxidised N in rain has shown no significant visible or stress related effects with no significant increase in N status. - Exposure to NH 3 reduces stress resistance and increases visible damage in mature Calluna

  10. Neural signal during immediate reward anticipation in schizophrenia: Relationship to real-world motivation and function

    Science.gov (United States)

    Subramaniam, Karuna; Hooker, Christine I.; Biagianti, Bruno; Fisher, Melissa; Nagarajan, Srikantan; Vinogradov, Sophia

    2015-01-01

    Amotivation in schizophrenia is a central predictor of poor functioning, and is thought to occur due to deficits in anticipating future rewards, suggesting that impairments in anticipating pleasure can contribute to functional disability in schizophrenia. In healthy comparison (HC) participants, reward anticipation is associated with activity in frontal–striatal networks. By contrast, schizophrenia (SZ) participants show hypoactivation within these frontal–striatal networks during this motivated anticipatory brain state. Here, we examined neural activation in SZ and HC participants during the anticipatory phase of stimuli that predicted immediate upcoming reward and punishment, and during the feedback/outcome phase, in relation to trait measures of hedonic pleasure and real-world functional capacity. SZ patients showed hypoactivation in ventral striatum during reward anticipation. Additionally, we found distinct differences between HC and SZ groups in their association between reward-related immediate anticipatory neural activity and their reported experience of pleasure. HC participants recruited reward-related regions in striatum that significantly correlated with subjective consummatory pleasure, while SZ patients revealed activation in attention-related regions, such as the IPL, which correlated with consummatory pleasure and functional capacity. These findings may suggest that SZ patients activate compensatory attention processes during anticipation of immediate upcoming rewards, which likely contribute to their functional capacity in daily life. PMID:26413478

  11. External Prior Guided Internal Prior Learning for Real-World Noisy Image Denoising

    Science.gov (United States)

    Xu, Jun; Zhang, Lei; Zhang, David

    2018-06-01

    Most of existing image denoising methods learn image priors from either external data or the noisy image itself to remove noise. However, priors learned from external data may not be adaptive to the image to be denoised, while priors learned from the given noisy image may not be accurate due to the interference of corrupted noise. Meanwhile, the noise in real-world noisy images is very complex, which is hard to be described by simple distributions such as Gaussian distribution, making real noisy image denoising a very challenging problem. We propose to exploit the information in both external data and the given noisy image, and develop an external prior guided internal prior learning method for real noisy image denoising. We first learn external priors from an independent set of clean natural images. With the aid of learned external priors, we then learn internal priors from the given noisy image to refine the prior model. The external and internal priors are formulated as a set of orthogonal dictionaries to efficiently reconstruct the desired image. Extensive experiments are performed on several real noisy image datasets. The proposed method demonstrates highly competitive denoising performance, outperforming state-of-the-art denoising methods including those designed for real noisy images.

  12. Microinverter Thermal Performance in the Real-World: Measurements and Modeling

    Science.gov (United States)

    Hossain, Mohammad Akram; Xu, Yifan; Peshek, Timothy J.; Ji, Liang; Abramson, Alexis R.; French, Roger H.

    2015-01-01

    Real-world performance, durability and reliability of microinverters are critical concerns for microinverter-equipped photovoltaic systems. We conducted a data-driven study of the thermal performance of 24 new microinverters (Enphase M215) connected to 8 different brands of PV modules on dual-axis trackers at the Solar Durability and Lifetime Extension (SDLE) SunFarm at Case Western Reserve University, based on minute by minute power and thermal data from the microinverters and PV modules along with insolation and environmental data from July through October 2013. The analysis shows the strengths of the associations of microinverter temperature with ambient temperature, PV module temperature, irradiance and AC power of the PV systems. The importance of the covariates are rank ordered. A multiple regression model was developed and tested based on stable solar noon-time data, which gives both an overall function that predicts the temperature of microinverters under typical local conditions, and coefficients adjustments reecting refined prediction of the microinverter temperature connected to the 8 brands of PV modules in the study. The model allows for prediction of internal temperature for the Enphase M215 given similar climatic condition and can be expanded to predict microinverter temperature in fixed-rack and roof-top PV systems. This study is foundational in that similar models built on later stage data in the life of a device could reveal potential influencing factors in performance degradation. PMID:26147339

  13. Comparisons of MOVES Light-duty Gasoline NOx Emission Rates with Real-world Measurements

    Science.gov (United States)

    Choi, D.; Sonntag, D.; Warila, J.

    2017-12-01

    Recent studies have shown differences between air quality model estimates and monitored values for nitrogen oxides. Several studies have suggested that the discrepancy between monitored and modeled values is due to an overestimation of NOx from mobile sources in EPA's emission inventory, particularly for light-duty gasoline vehicles. EPA's MOtor Vehicle Emission Simulator (MOVES) is an emission modeling system that estimates emissions for cars, trucks and other mobile sources at the national, county, and project level for criteria pollutants, greenhouse gases, and air toxics. Studies that directly measure vehicle emissions provide useful data for evaluating MOVES when the measurement conditions are properly accounted for in modeling. In this presentation, we show comparisons of MOVES2014 to thousands of real-world NOx emissions measurements from individual light-duty gasoline vehicles. The comparison studies include in-use vehicle emissions tests conducted on chassis dynamometer tests in support of Denver, Colorado's Vehicle Inspection & Maintenance Program and remote sensing data collected using road-side instruments in multiple locations and calendar years in the United States. In addition, we conduct comparisons of MOVES predictions to fleet-wide emissions measured from tunnels. We also present details on the methodology used to conduct the MOVES model runs in comparing to the independent data.

  14. Parameterizing unresolved obstacles with source terms in wave modeling: A real-world application

    Science.gov (United States)

    Mentaschi, Lorenzo; Kakoulaki, Georgia; Vousdoukas, Michalis; Voukouvalas, Evangelos; Feyen, Luc; Besio, Giovanni

    2018-06-01

    Parameterizing the dissipative effects of small, unresolved coastal features, is fundamental to improve the skills of wave models. The established technique to deal with this problem consists in reducing the amount of energy advected within the propagation scheme, and is currently available only for regular grids. To find a more general approach, Mentaschi et al., 2015b formulated a technique based on source terms, and validated it on synthetic case studies. This technique separates the parameterization of the unresolved features from the energy advection, and can therefore be applied to any numerical scheme and to any type of mesh. Here we developed an open-source library for the estimation of the transparency coefficients needed by this approach, from bathymetric data and for any type of mesh. The spectral wave model WAVEWATCH III was used to show that in a real-world domain, such as the Caribbean Sea, the proposed approach has skills comparable and sometimes better than the established propagation-based technique.

  15. The real-world outcomes of treating Polycythemia Vera: Physician adherence to treatment guidelines.

    Science.gov (United States)

    Jackson Chornenki, Nicholas L; Chai-Adisaksopha, Chatree; Leong, Darryl P; Siegal, Deborah M; Hillis, Christopher M

    2018-06-04

    Therapy in Polycythemia Vera (PV), a myeloproliferative neoplasm, focuses on reducing cardiovascular (CV) risk without increasing bleeding or hematological progression. However, the real-world practice of treating PV in North America is understudied. We performed a retrospective cohort study of newly diagnosed PV (JAK2V617F mutation positive) patients in Hamilton, Canada to fill this knowledge gap. Out of 108 patients included, (n = 45, 41.7%) patients did not receive therapy consistent with contemporary treatment guidelines. Multivariable analysis showed increased white blood cell count at diagnosis (HR, 1.09; 95% CI, 1.04-1.14; p < 0.001), older age (HR, 1.15; 95% CI, 1.07-1.23; p < 0.001) and diabetic history (HR, 3.71; 95% CI, 1.27-10.78; p = 0.012) associated with greater mortality. Not receiving pharmacological treatment according to guidelines was also independently associated with increased mortality (HR, 3.12; 95% CI, 1.13-8.65; p = 0.029). Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. Real world vehicle fleet emission factors: Seasonal and diurnal variations in traffic related air pollutants

    Science.gov (United States)

    Wang, Jonathan M.; Jeong, Cheol-Heon; Zimmerman, Naomi; Healy, Robert M.; Evans, Greg J.

    2018-07-01

    Temporal variations of vehicle emissions are affected by various compounding factors in the real world. The focus of this study is to determine the effects of ambient conditions and post-tailpipe changes on traffic emissions measured in the near-road region. Emission factors allowed for the isolation of the traffic signal and accounted for effects of local meteorology and dilution. Five month-long measurement campaigns were conducted at an urban near-road site that exhibited a broad range of ambient conditions with temperatures ranging between -18 and +30 °C. Particle number emission factors were 2.0× higher in the winter relative to the summer, which was attributed to changes in particles post-tailpipe. Conversely, toluene emissions were 2.5× higher in the summer relative to the winter, attributed to changes in fuel composition. Diurnal trends of emission factors showed substantial increases in emissions during the morning rush hour for black carbon (1.9×), particle number (2.4×), and particle-bound polycyclic aromatic hydrocarbons (3.0×), affected by fleet make-up. In contrast, particle number emission factors were highest midday with mean values 3.7× higher than at night. This midday increase was attributed to particle formation or growth from local traffic emissions and showed different wind direction dependence than regional events.

  17. Neural signal during immediate reward anticipation in schizophrenia: Relationship to real-world motivation and function

    Directory of Open Access Journals (Sweden)

    Karuna Subramaniam

    2015-01-01

    Full Text Available Amotivation in schizophrenia is a central predictor of poor functioning, and is thought to occur due to deficits in anticipating future rewards, suggesting that impairments in anticipating pleasure can contribute to functional disability in schizophrenia. In healthy comparison (HC participants, reward anticipation is associated with activity in frontal–striatal networks. By contrast, schizophrenia (SZ participants show hypoactivation within these frontal–striatal networks during this motivated anticipatory brain state. Here, we examined neural activation in SZ and HC participants during the anticipatory phase of stimuli that predicted immediate upcoming reward and punishment, and during the feedback/outcome phase, in relation to trait measures of hedonic pleasure and real-world functional capacity. SZ patients showed hypoactivation in ventral striatum during reward anticipation. Additionally, we found distinct differences between HC and SZ groups in their association between reward-related immediate anticipatory neural activity and their reported experience of pleasure. HC participants recruited reward-related regions in striatum that significantly correlated with subjective consummatory pleasure, while SZ patients revealed activation in attention-related regions, such as the IPL, which correlated with consummatory pleasure and functional capacity. These findings may suggest that SZ patients activate compensatory attention processes during anticipation of immediate upcoming rewards, which likely contribute to their functional capacity in daily life.

  18. Buses retrofitting with diesel particle filters: Real-world fuel economy and roadworthiness test considerations.

    Science.gov (United States)

    Fleischman, Rafael; Amiel, Ran; Czerwinski, Jan; Mayer, Andreas; Tartakovsky, Leonid

    2018-05-01

    Retrofitting older vehicles with diesel particulate filter (DPF) is a cost-effective measure to quickly and efficiently reduce particulate matter emissions. This study experimentally analyzes real-world performance of buses retrofitted with CRT DPFs. 18 in-use Euro III technology urban and intercity buses were investigated for a period of 12months. The influence of the DPF and of the vehicle natural aging on buses fuel economy are analyzed and discussed. While the effect of natural deterioration is about 1.2%-1.3%, DPF contribution to fuel economy penalty is found to be 0.6% to 1.8%, depending on the bus type. DPF filtration efficiency is analyzed throughout the study and found to be in average 96% in the size range of 23-560nm. Four different load and non-load engine operating modes are investigated on their appropriateness for roadworthiness tests. High idle is found to be the most suitable regime for PN diagnostics considering particle number filtration efficiency. Copyright © 2017. Published by Elsevier B.V.

  19. Real-World Data: Policy Issues Regarding their Access and Use.

    Science.gov (United States)

    Basu, Anirban; Axelsen, Kirsten; Grabowski, David C; Meltzer, David O; Polsky, Daniel; Ridley, David B; Wiederkehr, Daniel; Philipson, Tomas J

    2016-12-01

    As real-world data (RWD) in health care begin to cross over to the Big Data realms, a panel of health economists was gathered to establish how well the current US policy environment further the goals of RWD and, if not, what can be done to improve matters. This report summarizes these discussions spanning the current US landscape of RWD availability and usefulness, private versus public development of RWD assets, the current inherent bias in terms of access to RWD, and guiding principles in providing quality assessments of new RWD studies. Three main conclusions emerge: (1) a business case is often required to incentivize investments in RWD assets. However, access restrictions for public data assets have failed to generate a proper market for these data and hence may have led to an underinvestment of public RWDs; (2) Very weak empirical evidence exist on for-profit entities misusing public RWD data entities to further their own agendas, which is the basis for supporting access restrictions of public RWD data; and (3) perhaps developing standardized metrics that could flag misuse of RWDs in an efficient way could help quell some of the fear of sharing public RWD assets with for-profit entities. It is hoped that these discussions and conclusions would pave the way for more rigorous and timely debates on the greater availability and accessibility of RWD assets.

  20. Sequencing of real-world samples using a microfabricated hybrid device having unconstrained straight separation channels.

    Science.gov (United States)

    Liu, Shaorong; Elkin, Christopher; Kapur, Hitesh

    2003-11-01

    We describe a microfabricated hybrid device that consists of a microfabricated chip containing multiple twin-T injectors attached to an array of capillaries that serve as the separation channels. A new fabrication process was employed to create two differently sized round channels in a chip. Twin-T injectors were formed by the smaller round channels that match the bore of the separation capillaries and separation capillaries were incorporated to the injectors through the larger round channels that match the outer diameter of the capillaries. This allows for a minimum dead volume and provides a robust chip/capillary interface. This hybrid design takes full advantage, such as sample stacking and purification and uniform signal intensity profile, of the unique chip injection scheme for DNA sequencing while employing long straight capillaries for the separations. In essence, the separation channel length is optimized for both speed and resolution since it is unconstrained by chip size. To demonstrate the reliability and practicality of this hybrid device, we sequenced over 1000 real-world samples from Human Chromosome 5 and Ciona intestinalis, prepared at Joint Genome Institute. We achieved average Phred20 read of 675 bases in about 70 min with a success rate of 91%. For the similar type of samples on MegaBACE 1000, the average Phred20 read is about 550-600 bases in 120 min separation time with a success rate of about 80-90%.

  1. 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...

  2. Differences in Energy Consumption in Electric Vehicles: An Exploratory Real-World Study in Beijing

    Directory of Open Access Journals (Sweden)

    Kezhen Hu

    2017-01-01

    Full Text Available Electric vehicles (EVs are widely regarded as a promising solution to reduce air pollution in cities and key to a low carbon mobility future. However, their environmental benefits depend on the temporal and spatial context of actual usage (journey energy efficiency and the rolling out of EVs is complicated by issues such as limited range. This paper explores how the energy efficiency of EVs is affected and shaped by driving behavior, personal driving styles, traffic conditions, and infrastructure design in the real world. Tests have been conducted with a Nissan LEAF under a typical driving cycle on the Beijing road network in order to improve understanding of variations in energy efficiency among drivers under different urban traffic conditions. Energy consumption and operation parameters were recorded in both peak and off-peak hours for a total of 13 drivers. The analysis reported in this paper shows that there are clear patterns in energy consumption along a route that are in part related to differences in infrastructure design, traffic conditions, and personal driving styles. The proposed method for analyzing time series data about energy consumption along routes can be used for research with larger fleets of EVs in the future.

  3. [Real world instantaneous emission simulation for light-duty diesel vehicle].

    Science.gov (United States)

    Huang, Cheng; Chen, Chang-Hong; Dai, Pu; Li, Li; Huang, Hai-Ying; Cheng, Zhen; Jia, Ji-Hong

    2008-10-01

    Core architecture and input parameters of CMEM model were introduced to simulation the second by second vehicle emission rate on real world by taking a light-duty diesel car as a case. On-board test data by a portable emission measurement system were then used to validate the simulation results. Test emission factors of CO, THC, NO(x) and CO2 were respectively 0.81, 0.61, 2.09, and 193 g x km(-1), while calculated emission factors were 0.75, 0.47, 2.47, and 212 g x km(-1). The correlation coefficients reached 0.69, 0.69, 0.75, and 0.72. Simulated instantaneous emissions of the light duty diesel vehicle by CMEM model were strongly coherent with the transient driving cycle. By analysis, CO, THC, NO(x), and CO2 emissions would be reduced by 50%, 47%, 45%, and 44% after improving the traffic situation at the intersection. The result indicated that it is necessary and feasible to simulate the instantaneous emissions of mixed vehicle fleet in some typical traffic areas by the micro-scale vehicle emission model.

  4. Energy Consumption Prediction for Electric Vehicles Based on Real-World Data

    Directory of Open Access Journals (Sweden)

    Cedric De Cauwer

    2015-08-01

    Full Text Available Electric vehicle (EV energy consumption is variable and dependent on a number of external factors such as road topology, traffic, driving style, ambient temperature, etc. The goal of this paper is to detect and quantify correlations between the kinematic parameters of the vehicle and its energy consumption. Real-world data of EV energy consumption are used to construct the energy consumption calculation models. Based on the vehicle dynamics equation as underlying physical model, multiple linear regression is used to construct three models. Each model uses a different level of aggregation of the input parameters, allowing predictions using different types of available input parameters. One model uses aggregated values of the kinematic parameters of trips. This model allows prediction with basic, easily available input parameters such as travel distance, travel time, and temperature. The second model extends this by including detailed acceleration data. The third model uses the raw data of the kinematic parameters as input parameters to predict the energy consumption. Using detailed values of kinematic parameters for the prediction in theory increases the link between the statistical model and its underlying physical principles, but requires these parameters to be available as input in order to make predictions. The first two models show similar results. The third model shows a worse fit than the first two, but has a similar accuracy. This model has great potential for future improvement.

  5. Real-World Characteristics and Treatment Patterns in Patients with Urticaria Initiating Omalizumab in the United States.

    Science.gov (United States)

    Ke, Xuehua; Kavati, Abhishek; Wertz, Debra; Huang, Qing; Wang, Liya; Willey, Vincent J; Stephenson, Judith J; Ortiz, Benjamin; Paknis, Brandee; Bernstein, Jonathan A; Beck, Lisa A

    2017-12-19

    Omalizumab is indicated for the management of chronic idiopathic urticaria (CIU) in patients aged 12 years or older with persistent hives that are not adequately controlled by H1 antihistamines. While its safety and efficacy in CIU patients have been evaluated in multiple clinical trials, real-world use of omalizaumab in CIU has not been well characterized. To assess demographics, clinical characteristics, and treatment patterns of CIU patients who initiated omalizumab to better understand the usage of this agent in CIU management in the real world. This retrospective cohort study used medical and pharmacy claims data in the United States from the HealthCore Integrated Database to identify patients with CIU newly treated with omalizumab (≥ 4 omalizumab claims within 6 months of the initial claim) between March 21, 2014, and October 31, 2015 (study intake period). The index date was defined as the date of the first claim for omalizumab during the study intake period. Demographic and clinical characteristics were described for patients treated with omalizumab, as were treatment patterns associated with omalizumab and concomitant medications associated with CIU treatment. Descriptive and inferential statistics were reported. The Kaplan-Meier method was used to examine omalizumab treatment patterns. This study included 298 omalizumab-treated patients (mean [SD] age of 43.5 [13.64] years; 70.8% female); approximately 84% were seen by an allergist/immunologist. All patients had ≥ 12 months of continuous enrolment and a subset of 138 patients had ≥ 18 months of follow-up. For patients with ≥ 12 months of post-index follow-up, 12.1% (n = 36), 28.5% (n = 85), and 32.9% (n = 98) discontinued omalizumab within the 6-month, 12-month, and the entire post-index periods (mean 530 days), respectively; the mean number of days patients were continuously treated with omalizumab was 443.1 (95% CI = 425.0-461.3); the probabilities of continuous treatment (95% CI) were 0.879 (0

  6. Interferon-free treatments in patients with hepatitis C genotype 1-4 infections in a real-world setting

    Science.gov (United States)

    Ramos, Huascar; Linares, Pedro; Badia, Ester; Martín, Isabel; Gómez, Judith; Almohalla, Carolina; Jorquera, Francisco; Calvo, Sara; García, Isidro; Conde, Pilar; Álvarez, Begoña; Karpman, Guillermo; Lorenzo, Sara; Gozalo, Visitación; Vásquez, Mónica; Joao, Diana; de Benito, Marina; Ruiz, Lourdes; Jiménez, Felipe; Sáez-Royuela, Federico; Asociación Castellano y Leonesa de Hepatología (ACyLHE)

    2017-01-01

    AIM To investigated the real-world effectiveness and safety of various regimens of interferon-free treatments in patients infected with hepatitis C virus (HCV). METHODS We performed an observational study to analyze different antiviral treatments administered to 462 HCV-infected patients, of which 56.7% had liver cirrhosis. HCV RNA after 4 wk of treatment and at 12 wk after treatment sustained virologic response (SVR) as well as serious adverse events (SAEs) was analyzed first for the whole cohort and then separately in patients who met or did not meet the inclusion criteria of a clinical trial (CT-met and CT-unmet, respectively). RESULTS The most frequently prescribed treatment was simeprevir/sofosbuvir (36.4%), followed by sofosbuvir/ledipasvir (24.9%) and ombitasvir/paritaprevir/ritonavir (r)/dasabuvir (19.9%). Ribavirin (RBV) was administered in 198 patients (42.9%). SVRs occurred in 437/462 patients (94.6%). The SVRs ranged between 93.3% and 100% for genotypes 1-4. SVRs were achieved in 96.2% patients in the CT-met group vs 91.9% patients in the CT-unmet group (P = 0.049). Undetectable HCV RNA at week 4 occurred in 72.9% of the patients. In the univariate analysis, the factors associated with SVRs were lower liver stiffness, absence of cirrhosis, higher platelet count, higher albumin levels, no RBV dose reduction, undetectable HCV RNA at week 4 and CT-met group. In the multivariate analysis, only albumin was an independent predictor of treatment failure (P = 0.04). Eleven patients (2.4%) developed SAEs; 5.2% and 0.7% of the patients in the CT-unmet and CT-met groups, respectively (P = 0.003). CONCLUSION A high proportion of patients with HCV infection achieved SVRs. For patients who did not meet the CT criteria, treatment regimens must be optimized. PMID:28533924

  7. Evaluation of a Pharmacokinetic-Pharmacodynamic Model for Hypouricemic Effects of Febuxostat Using Datasets Obtained from Real-world Patients.

    Science.gov (United States)

    Hirai, Toshinori; Itoh, Toshimasa; Kimura, Toshimi; Echizen, Hirotoshi

    2018-06-06

    Febuxostat is an active xanthine oxidase (XO) inhibitor that is widely used in the hyperuricemia treatment. We aimed to evaluate the predictive performance of a pharmacokinetic-pharmacodynamic (PK-PD) model for hypouricemic effects of febuxostat. Previously, we have formulated a PK--PD model for predicting hypouricemic effects of febuxostat as a function of baseline serum urate levels, body weight, renal function, and drug dose using datasets reported in preapproval studies (Hirai T et al., Biol Pharm Bull 2016; 39: 1013-21). Using an updated model with sensitivity analysis, we examined the predictive performance of the PK-PD model using datasets obtained from the medical records of patients who received febuxostat from March 2011 to December 2015 at Tokyo Women's Medical University Hospital. Multivariate regression analysis was performed to explore clinical variables to improve the predictive performance of the model. A total of 1,199 serum urate data were retrieved from 168 patients (age: 60.5 ±17.7 years, 71.4% males) who received febuxostat as hyperuricemia treatment. There was a significant correlation (r=0.68, p<0.01) between serum urate levels observed and those predicted by the modified PK-PD model. A multivariate regression analysis revealed that the predictive performance of the model may be improved further by considering comorbidities, such as diabetes mellitus, estimated glomerular filtration rate (eGFR), and co-administration of loop diuretics (r = 0.77, p<0.01). The PK-PD model may be useful for predicting individualized maintenance doses of febuxostat in real-world patients. This article is protected by copyright. All rights reserved.

  8. Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism.

    Science.gov (United States)

    Santos, Sónia Martins; Cunha, Susana; Baptista, Rui; Monteiro, Sílvia; Monteiro, Pedro; Gonçalves, Francisco; Pêgo, Mariano

    2017-11-01

    Intermediate-high risk pulmonary embolism (IHR-PE) has a poor prognosis, but is under-represented in trials of direct oral anticoagulants (DOACs) in venous thromboembolic disease (VTE). We aimed to assess whether the administration of DOACs was equivalent to the conventional (CONV) treatment of low-molecular weight heparin bridged with warfarin for treating IHR-PE. We conducted a retrospective cohort study including 59 consecutive patients admitted with IHR-PE and followed for up to three months after discharge. Two groups were created based on the anticoagulant strategy: CONV (n=35) and DOAC (n=24). The efficacy endpoints were death, recurrent PE, estimated pulmonary artery systolic pressure (PASP), right ventricular systolic function (RVSF) at discharge, and length of stay; the safety endpoint was major bleeding. The two groups were similar regarding demographics, PE etiology and markers of clinical severity. There were four in-hospital deaths in the CONV group and none in the DOAC group. No recurrent PE or major bleeding event was recorded in either group. At discharge, neither PASP nor RVSF was different between the groups. Patients in the DOAC group were discharged 1.7 days earlier on average than patients in the CONV group (4.7±2.4 vs. 3.0±1.5 days, p=0.002). The adoption of a DOAC treatment strategy in this real-world cohort of IHR-PE patients was associated with similar efficacy and safety to the CONV approach. The fact that monitoring of anticoagulation effect was unnecessary probably led to the significant reduction in length of stay. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Prospects for research in haemophilia with real-world data-An analysis of German registry and secondary data.

    Science.gov (United States)

    Schopohl, D; Bidlingmaier, C; Herzig, D; Klamroth, R; Kurnik, K; Rublee, D; Schramm, W; Schwarzkopf, L; Berger, K

    2018-02-28

    Open questions in haemophilia, such as effectiveness of innovative therapies, clinical and patient-reported outcomes (PROs), epidemiology and cost, await answers. The aim was to identify data attributes required and investigate the availability, appropriateness and accessibility of real-world data (RWD) from German registries and secondary databases to answer the aforementioned questions. Systematic searches were conducted in BIOSIS, EMBASE and MEDLINE to identify non-commercial secondary healthcare databases and registries of patients with haemophilia (PWH). Inclusion of German patients, type of patients, data elements-stratified by use in epidemiology, safety, outcomes and health economics research-and accessibility were investigated by desk research. Screening of 676 hits, identification of four registries [national PWH (DHR), national/international paediatric (GEPARD, PEDNET), international safety monitoring (EUHASS)] and seven national secondary databases. Access was limited to participants in three registries and to employees in one secondary database. One registry asks for PROs. Limitations of secondary databases originate from the ICD-coding system (missing: severity of haemophilia, presence of inhibitory antibodies), data protection laws and need to monitor reliability. Rigorous observational analysis of German haemophilia RWD shows that there is potential to supplement current knowledge and begin to address selected policy goals. To improve the value of existing RWD, the following efforts are proposed: ethical, legal and methodological discussions on data linkage across different sources, formulation of transparent governance rules for data access, redefinition of the ICD-coding, standardized collection of outcome data and implementation of incentives for treatment centres to improve data collection. © 2018 John Wiley & Sons Ltd.

  10. Number of Patients Eligible for PCSK9 Inhibitors Based on Real-world Data From 2.5 Million Patients.

    Science.gov (United States)

    Zamora, Alberto; Masana, Luís; Comas-Cufi, Marc; Plana, Núria; Vila, Àlex; García-Gil, Maria; Alves-Cabratosa, Lia; Elosua, Roberto; Marrugat, Jaume; Ramos, Rafel

    2018-03-29

    PCSK9 inhibitors (PCSK9i) are safe and effective lipid-lowering drugs. Their main limitation is their high cost. The aim of this study was to estimate the number of patients eligible for treatment with PCSK9i according to distinct published criteria. Data were obtained from the Information System for the Development of Research in Primary Care. Included patients were equal to or older than 18 years and had at least 1 low-density lipoprotein cholesterol measurement recorded between 2006 and 2014 (n = 2 500 907). An indication for treatment with PCSK9i was assigned according to the following guidelines: National Health System, Spanish Society of Arteriosclerosis, Spanish Society of Cardiology, National Institute for Health and Care Excellence, and the European Society of Cardiology/European Atherosclerosis Society Task Force. Lipid-lowering treatment was defined as optimized if it reduced low-density lipoprotein levels by ≥ 50% and adherence was > 80%. Among the Spanish population aged 18 years or older, the number of possible candidates to receive PCSK9i in an optimal lipid-lowering treatment scenario ranged from 0.1% to 1.7%, depending on the guideline considered. The subgroup of patients with the highest proportion of potential candidates consisted of patients with familial hypercholesterolemia, and the subgroup with the highest absolute number consisted of patients in secondary cardiovascular prevention. The number of candidates to receive PCSK9i in conditions of real-world clinical practice is high and varies widely depending on the recommendations of distinct scientific societies. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  11. 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…

  12. 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

  13. How Adolescents with Autism Spectrum Disorder (ASD) Spontaneously Attend to Real-World Scenes: Use of a Change Blindness Paradigm

    Science.gov (United States)

    Hochhauser, Michal; Aran, Adi; Grynszpan, Ouriel

    2018-01-01

    Visual attention of adolescents with autism spectrum disorder (ASD) was assessed using a change blindness paradigm. Twenty-five adolescents with ASD aged 12-18 years and 25 matched typically developing (TD) adolescents viewed 36 pairs of digitized real-world images. Each pair of images was displayed in a "flicker paradigm" whereby a…

  14. Effects of an Augmented Reality-Based Educational Game on Students' Learning Achievements and Attitudes in Real-World Observations

    Science.gov (United States)

    Hwang, Gwo-Jen; Wu, Po-Han; Chen, Chi-Chang; Tu, Nien-Ting

    2016-01-01

    Augmented reality (AR) has been recognized as a potential technology to help students link what they are observing in the real world to their prior knowledge. One of the most challenging issues of AR-based learning is the provision of effective strategy to help students focus on what they need to observe in the field. In this study, a competitive…

  15. On the early detection of threats in the real world based on open-source information on the internet

    NARCIS (Netherlands)

    Bouma, H.; Rajadell Rojas, O.; Worm, D.T.H.; Versloot, C.A.; Wedemeijer, H.

    2012-01-01

    Many threats in the real world can be related to activities of persons on the internet. Internet surveillance aims to detect threats in an early stage and to assist in finding suspects based on information from the web. However, the amount of data on the internet rapidly increases and it is time

  16. Comparison and Extension of Existing 3D Propagation Models with Real-World Effects Based on Ray-tracing

    DEFF Research Database (Denmark)

    Kifle, Dereje W.; Gimenez, Lucas Chavarria; Wegmann, Bernhard

    2014-01-01

    antenna beam orientation like antenna tilting or when users are distributed in the third dimension (height) in multi-floor scenarios. Ray tracing based generated propagation maps that show the realistic propagation effect are used as 3D real world reference for investigation and model approval....

  17. What Is Real-World Data (RWD)? : A Review of Definitions Based on Literature and Stakeholder Interviews

    NARCIS (Netherlands)

    Makady, Amr; de Boer, Anthonius; Hillege, Hans; Klungel, Olaf; Goettsch, Wim

    Background: Despite increasing recognition of the value of real-world data (RWD), consensus on the definition of RWD is lacking. Objectives: To review definitions publicly available for RWD to shed light on similarities and differences between them. Methods: A literature review and stakeholder

  18. 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…

  19. The Design of an Instructional Model Based on Connectivism and Constructivism to Create Innovation in Real World Experience

    Science.gov (United States)

    Jirasatjanukul, Kanokrat; Jeerungsuwan, Namon

    2018-01-01

    The objectives of the research were to (1) design an instructional model based on Connectivism and Constructivism to create innovation in real world experience, (2) assess the model designed--the designed instructional model. The research involved 2 stages: (1) the instructional model design and (2) the instructional model rating. The sample…

  20. Assessing the real-world cost-effectiveness of adjuvant trastuzumab in HER-2/neu positive breast cancer.

    LENUS (Irish Health Repository)

    Hedden, Lindsay

    2012-01-01

    Among women with surgically removed, high-risk HER-2\\/neu-positive breast cancer, trastuzumab has demonstrated significant improvements in disease-free and overall survival. The objective of this study is to evaluate the cost-effectiveness of the currently recommended 12-month adjuvant protocol of trastuzumab using a Markov modeling approach and real-world cost data.

  1. Georgetown University Round Table on Languages and Linguistics 2001. Linguistics, Language, and the Real World: Discourse and Beyond.

    Science.gov (United States)

    Tannen, Deborah, Ed.; Alatis, James E., Ed.

    This book contains papers from the 2001 Georgetown University Round Table on Languages and Linguistics, "Linguistics, Language, and the Real World: Discourse and Beyond." Papers include: "Introduction" (Deborah Tannen); "A Brief History of the Georgetown University Round Table on Languages and Linguistics" (James E.…

  2. 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

  3. Working memory is not fixed-capacity: More active storage capacity for real-world objects than for simple stimuli.

    Science.gov (United States)

    Brady, Timothy F; Störmer, Viola S; Alvarez, George A

    2016-07-05

    Visual working memory is the cognitive system that holds visual information active to make it resistant to interference from new perceptual input. Information about simple stimuli-colors and orientations-is encoded into working memory rapidly: In under 100 ms, working memory ‟fills up," revealing a stark capacity limit. However, for real-world objects, the same behavioral limits do not hold: With increasing encoding time, people store more real-world objects and do so with more detail. This boost in performance for real-world objects is generally assumed to reflect the use of a separate episodic long-term memory system, rather than working memory. Here we show that this behavioral increase in capacity with real-world objects is not solely due to the use of separate episodic long-term memory systems. In particular, we show that this increase is a result of active storage in working memory, as shown by directly measuring neural activity during the delay period of a working memory task using EEG. These data challenge fixed-capacity working memory models and demonstrate that working memory and its capacity limitations are dependent upon our existing knowledge.

  4. Size-resolved particle number emission patterns under real-world driving conditions using positive matrix factorization.

    Science.gov (United States)

    Domínguez-Sáez, Aida; Viana, Mar; Barrios, Carmen C; Rubio, Jose R; Amato, Fulvio; Pujadas, Manuel; Querol, Xavier

    2012-10-16

    A novel on-board system was tested to characterize size-resolved particle number emission patterns under real-world driving conditions, running in a EURO4 diesel vehicle and in a typical urban circuit in Madrid (Spain). Emission profiles were determined as a function of driving conditions. Source apportionment by Positive Matrix Factorization (PMF) was carried out to interpret the real-world driving conditions. Three emission patterns were identified: (F1) cruise conditions, with medium-high speeds, contributing in this circuit with 60% of total particle number and a particle size distribution dominated by particles >52 nm and around 60 nm; (F2) transient conditions, stop-and-go conditions at medium-high speed, contributing with 25% of the particle number and mainly emitting particles in the nucleation mode; and (F3) creep-idle conditions, representing traffic congestion and frequent idling periods, contributing with 14% to the total particle number and with particles in the nucleation mode (emissions depending on particle size and driving conditions. Differences between real-world emission patterns and regulatory cycles (NEDC) are also presented, which evidence that detecting particle number emissions real-world driving conditions.

  5. Size-resolved particle number emission patterns under real-world driving conditions using positive matrix factorization

    NARCIS (Netherlands)

    Domínguez-Sáez, A.; Viana, M.; Barrios, C.C.; Rubio, J.R.; Amato, F.; Pujadas, M.; Querol, X.

    2012-01-01

    A novel on-board system was tested to characterize size-resolved particle number emission patterns under real-world driving conditions, running in a EURO4 diesel vehicle and in a typical urban circuit in Madrid (Spain). Emission profiles were determined as a function of driving conditions. Source

  6. 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…

  7. Using Real-Worldness and Cultural Difference to Enhance Student Learning in a Foundation Phase Life Skills Module

    Science.gov (United States)

    Koen, Mariette; Ebrahim, Hasina Banu

    2013-01-01

    Our aim was to explore how real-world experience, inclusive of engagement with cultural differences, influences the quality of students' learning in a Life Skills module in pre-service Foundation Phase teacher education. The study was conducted with 147 students in their final year of the Bachelor of Education (Foundation Phase specialisation), at…

  8. [Construction and realization of real world integrated data warehouse from HIS on re-evaluation of post-maketing traditional Chinese medicine].

    Science.gov (United States)

    Zhuang, Yan; Xie, Bangtie; Weng, Shengxin; Xie, Yanming

    2011-10-01

    To construct real world integrated data warehouse on re-evaluation of post-marketing traditional Chinese medicine for the research on key techniques of clinic re-evaluation which mainly includes indication of traditional Chinese medicine, dosage usage, course of treatment, unit medication, combined disease and adverse reaction, which provides data for reviewed research on its safety,availability and economy,and provides foundation for perspective research. The integrated data warehouse extracts and integrate data from HIS by information collection system and data warehouse technique and forms standard structure and data. The further research is on process based on the data. A data warehouse and several sub data warehouses were built, which focused on patients' main records, doctor orders, diseases diagnoses, laboratory results and economic indications in hospital. These data warehouses can provide research data for re-evaluation of post-marketing traditional Chinese medicine, and it has clinical value. Besides, it points out the direction for further research.

  9. 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.

  10. Driver trust in five driver assistance technologies following real-world use in four production vehicles.

    Science.gov (United States)

    Kidd, David G; Cicchino, Jessica B; Reagan, Ian J; Kerfoot, Laura B

    2017-05-29

    Information about drivers' experiences with driver assistance technologies in real driving conditions is sparse. This study characterized driver interactions with forward collision warning, adaptive cruise control, active lane keeping, side-view assist, and lane departure warning systems following real-world use. Fifty-four Insurance Institute for Highway Safety employees participated and drove a 2016 Toyota Prius, 2016 Honda Civic, 2017 Audi Q7, or 2016 Infiniti QX60 for up to several weeks. Participants reported mileage and warnings from the technologies in an online daily-use survey. Participants reported their level of agreement with five statements regarding trust in an online post-use survey. Responses were averaged to create a composite measure of trust ranging from -2 (strongly disagree) to +2 (strongly agree) for each technology. Mixed-effect regression models were constructed to compare trust among technologies and separately among the study vehicles. Participants' free-response answers about what they liked least about each system were coded and examined. Participants reported driving 33,584 miles during 4 months of data collection. At least one forward collision warning was reported in 26% of the 354 daily reports. The proportion of daily reports indicating a forward collision warning was much larger for the Honda (70%) than for the Audi (18%), Infiniti (15%), and Toyota (10%). Trust was highest for side-view assist (0.98) and lowest for active lane keeping (0.20). Trust in side-view assist was significantly higher than trust in active lane keeping and lane departure warning (0.53). Trust in active lane keeping was significantly lower than trust in adaptive cruise control (0.67) and forward collision warning (0.71). Trust in adaptive cruise control was higher for the Audi (0.72) and Toyota (0.75) compared with the Honda (0.30), and significantly higher for the Infiniti (0.93). Trust in Infiniti's side-view assist (0.58) was significantly lower than

  11. Electrochemistry Experiments to Develop Novel Sensors for Real-World Applications

    Directory of Open Access Journals (Sweden)

    Suzanne Lunsford

    2013-08-01

    Full Text Available These novel STEM (Science Technology Engineering and Mathematics Electrochemistry experiments have been designed to increase the integrated science content, pedagogical, and technological knowledge for real-world applications. This study has focused on (1 the fundamental understanding on the relationship of metal oxide films and polymers to electrochemical sensors, and (2 the development of new materials which have great application of electrode materials. Following the inquiry based learning strategy the research students learn to develop and study the electrode surfaces to meet the needs of stability and low detection limits. Recently, new advances in environmental health are revealing the anthropogenic or naturally occurring harmful organic chemicals in sources of water supply expose a great health threat to human and aquatic life. Due to their well-known carcinogenic and lethal properties, the presence of human produced toxic chemicals such as phenol and its derivatives poses a critical threat to human health and aquatic life in such water resources. In order to achieve effective assessment and monitoring of these toxic chemicals there is a need to develop in-situ (electrochemical sensors methods to detect rapidly. Electrochemical sensors have attracted more attention to analytical chemist and electrochemistry engineers due to its simplicity, rapidness and high sensitivity. However, there will be real challenges of achieving successful analysis of chemicals (phenol in the presence of common interferences in water resources, which will be discussed regarding the students challenging learning experiences in developing an electrochemical sensor. The electrochemical sensor developed (TiO2 , ZrO2 or sol-gel mixture TiO2/ZrO2 will be illustrated and the successes will be shown by cyclic voltammetry data in detection of 1,2-dihydroxybenzenes (catechol, dopamine and phenol.

  12. 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.

  13. Hard and Soft Selection Revisited: How Evolution by Natural Selection Works in the Real World.

    Science.gov (United States)

    Reznick, David

    2016-01-01

    The modern synthesis of evolutionary biology unified Darwin's natural selection with Mendelian genetics, but at the same time it created the dilemma of genetic load. Lewontin and Hubby's (1966) and Harris's (1966) characterization of genetic variation in natural populations increased the apparent burden of this load. Neutrality or near neutrality of genetic variation was one mechanism proposed for the revealed excessive genetic variation. Bruce Wallace coined the term "soft selection" to describe an alternative way for natural selection to operate that was consistent with observed variation. He envisioned nature as presenting ecological vacancies that could be filled by diverse genotypes. Survival and successful reproduction was a combined function of population density, genotype, and genotype frequencies, rather than a fixed value of the relative fitness of each genotype. My goal in this review is to explore the importance of soft selection in the real world. My motive and that of my colleagues as described here is not to explain what maintains genetic variation in natural populations, but rather to understand the factors that shape how organisms adapt to natural environments. We characterize how feedbacks between ecology and evolution shape both evolution and ecology. These feedbacks are mediated by density- and frequency-dependent selection, the mechanisms that underlie soft selection. Here, I report on our progress in characterizing these types of selection with a combination of a consideration of the published literature and the results from my collaborators' and my research on natural populations of guppies. © The American Genetic Association. 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Real-World Treatment Patterns for Golimumab and Concomitant Medications in Japanese Rheumatoid Arthritis Patients.

    Science.gov (United States)

    Okazaki, Masateru; Kobayashi, Hisanori; Ishii, Yutaka; Kanbori, Masayoshi; Yajima, Tsutomu

    2018-06-01

    The aim of this study was to investigate real-world treatment patterns for use of golimumab and concomitant medications in Japanese patients with rheumatoid arthritis. This study was a post hoc retrospective analysis from post-marketing surveillance data on 2350 Japanese patients with moderate/severe rheumatoid arthritis who received golimumab for 24 weeks. The study population was divided based on initiation treatment or dose adjustment patterns with golimumab, methotrexate, or oral glucocorticoids. Logistic regression analysis revealed that the baseline factors associated with administration of golimumab (100 mg) were higher body weight, failure of prior biological therapy (bio-failure), no previous methotrexate use, and respiratory disease, while previous methotrexate use and absence of renal impairment or respiratory disease were associated with concomitant methotrexate therapy, and previous glucocorticoid use was associated with concomitant glucocorticoid therapy. The following associations were identified with regard to dose adjustment during treatment: bio-failure, no previous methotrexate use, previous csDMARDs use, presence of respiratory disease, allergy history, and higher CRP for golimumab dose escalation; shorter disease duration, previous GC, and no previous methotrexate use for methotrexate dose escalation; no prior biological therapy and renal impairment for methotrexate dose reduction; no previous GC use for glucocorticoid dose escalation; and absence of Steinbrocker's stage II/III/IV, absence of Steinbrocker's class II, no bio-failure, and no previous csDMARDs use for glucocorticoid dose reduction. This study revealed that various baseline factors were associated with initiation of treatment and dose adjustment of golimumab, methotrexate, or oral glucocorticoids, reflecting both the treatment strategies of physicians for improving RA symptoms and/or reducing adverse events. Janssen Pharmaceutical K.K. and Mitsubishi Tanabe Pharma Corporation.

  15. Real-world treatment patterns and outcomes among metastatic cutaneous melanoma patients treated with ipilimumab.

    Science.gov (United States)

    Mohr, P; Ascierto, P; Arance, A; McArthur, G; Hernaez, A; Kaskel, P; Shinde, R; Stevinson, K

    2018-06-01

    There is a scarcity of real-world data on treatment patterns and outcomes among advanced melanoma patients treated with immunotherapies including ipilimumab, an anti-CTLA-4 antibody approved since 2011. To evaluate ipilimumab and postipilimumab treatment patterns and outcomes among patients with advanced melanoma in Australia, Germany, Italy and Spain, following regulatory approval. Retrospective multicentre, multinational, observational chart review study. Data were extracted from the start of ipilimumab therapy until the end of at least 40 weeks of follow-up, or death. Data from 371 patients (Australia, 103; Germany, 152; Italy, 76; Spain, 40) were analysed. Mean age was 65 years; 62% were male. Eastern Cooperative Oncology Group performance status (ECOG PS) was 0 or 1 for 94%. In 67%, ipilimumab was initially received as second-line or later therapy. Patients received on average 3.4 ipilimumab doses. The ipilimumab-refractory cohort comprised of 226 patients. Of these, 17% in Australia, 47% in Germany, 29% in Italy and 14% in Spain received another antimelanoma treatment after ipilimumab including chemotherapy in 26% and BRAF/other kinase inhibitors in 11%. Ipilimumab-refractory patients who received postipilimumab treatment showed a 40% reduced hazard of dying than those not receiving treatment after ipilimumab (HR 0.60; 95% CI 0.43-0.83), after adjustment for potential confounders. During the time observed, ipilimumab was mainly used as second-line or later therapy. A significant proportion of patients received postipilimumab therapy, most of which was chemotherapy. Nevertheless, overall survival following progression on ipilimumab treatment remained poor, highlighting the need for research to develop more effective end-of-life treatment options. © 2017 European Academy of Dermatology and Venereology.

  16. What Is Real-World Data? A Review of Definitions Based on Literature and Stakeholder Interviews.

    Science.gov (United States)

    Makady, Amr; de Boer, Anthonius; Hillege, Hans; Klungel, Olaf; Goettsch, Wim

    Despite increasing recognition of the value of real-world data (RWD), consensus on the definition of RWD is lacking. To review definitions publicly available for RWD to shed light on similarities and differences between them. A literature review and stakeholder interviews were used to compile data from eight groups of stakeholders. Data from documents and interviews were subjected to coding analysis. Definitions identified were classified into four categories: 1) data collected in a non-randomized controlled trial setting, 2) data collected in a non-interventional/non-controlled setting, 3) data collected in a non-experimental setting, and 4) others (i.e., data that do not fit into the other three categories). The frequency of definitions identified per category was recorded. Fifty-three documents and 20 interviews were assessed. Thirty-eight definitions were identified: 20 out of 38 definitions (53%) were category 1 definitions, 9 (24%) were category 2 definitions, 5 (13%) were category 3 definitions, and 4 (11%) were category 4 definitions. Differences were identified between, and within, definition categories. For example, opinions differed on the aspects of intervention with which non-interventional/non-controlled settings should abide. No definitions were provided in two interviews or identified in 33 documents. Most of the definitions defined RWD as data collected in a non-randomized controlled trial setting. A considerable number of definitions, however, diverged from this concept. Moreover, a significant number of authors and stakeholders did not have an official, institutional definition for RWD. Persisting variability in stakeholder definitions of RWD may lead to disparities among different stakeholders when discussing RWD use in decision making. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. Bringing Real World Underwater Science, Engineering and Technology in Tomorrow's Classroom

    Science.gov (United States)

    Livingston, C.

    2012-04-01

    What do Remotely Operated Vehicles (ROVs), Ocean Science, Engineering and Technology have in common with science education in today's classroom? They all meet the growing demand for science, technology, engineering, and mathematics (STEM) professionals in tomorrow's U.S. workforce. Engaging students in real world science experiences will help them develop skills such as critical thinking, problem solving, collaboration, communication, innovation, and creativity. These skills are crucial to building a strong, competitive workforce in an integrated global economy. Fifth grade students from St. Andrew's School of Math and Science in Charleston, SC, USA science classes were introduced to engineering and robotics by using a combination of two underwater ROVs programs from the Office of Naval Research (SeaPerch) and Marine Advanced Technology Education (MATE). Students were grouped in teams as "real scientists" to design and construct a ROV. Students selected their role from a list of engineering positions, and researched how to construct the best ROV. Students created blueprints and models of their ROV design. Scientists/engineers from various local agencies were scheduled to come and share their expertise with the students. On World Ocean Day, a presentation was planned for fifth grade students to work closely with kindergarten through fourth grade students. The purpose of the day was two-fold; it provided students the opportunity to peer teach and the opportunity to present their experiences to a wide audience. All students presented their designs and demonstrated their ROV's movement capabilities in child size pools. They also modeled how submersible pilots communicate with scientists and other researchers while operating their newly designed ROV. As a culminating event, students visited a local marine science high school class with similar ROVs and evaluated their engineering designs in a fresh water pond.

  18. Recognition of "real-world" musical excerpts by cochlear implant recipients and normal-hearing adults.

    Science.gov (United States)

    Gfeller, Kate; Olszewski, Carol; Rychener, Marly; Sena, Kimberly; Knutson, John F; Witt, Shelley; Macpherson, Beth

    2005-06-01

    The purposes of this study were (a) to compare recognition of "real-world" music excerpts by postlingually deafened adults using cochlear implants and normal-hearing adults; (b) to compare the performance of cochlear implant recipients using different devices and processing strategies; and (c) to examine the variability among implant recipients in recognition of musical selections in relation to performance on speech perception tests, performance on cognitive tests, and demographic variables. Seventy-nine cochlear implant users and 30 normal-hearing adults were tested on open-set recognition of systematically selected excerpts from musical recordings heard in real life. The recognition accuracy of the two groups was compared for three musical genre: classical, country, and pop. Recognition accuracy was correlated with speech recognition scores, cognitive measures, and demographic measures, including musical background. Cochlear implant recipients were significantly less accurate in recognition of previously familiar (known before hearing loss) musical excerpts than normal-hearing adults (p genre. Implant recipients were most accurate in the recognition of country items and least accurate in the recognition of classical items. There were no significant differences among implant recipients due to implant type (Nucleus, Clarion, or Ineraid), or programming strategy (SPEAK, CIS, or ACE). For cochlear implant recipients, correlations between melody recognition and other measures were moderate to weak in strength; those with statistically significant correlations included age at time of testing (negatively correlated), performance on selected speech perception tests, and the amount of focused music listening following implantation. Current-day cochlear implants are not effective in transmitting several key structural features (i.e., pitch, harmony, timbral blends) of music essential to open-set recognition of well-known musical selections. Consequently, implant

  19. Evaluating climate field reconstruction techniques using improved emulations of real-world conditions

    Science.gov (United States)

    Wang, J.; Emile-Geay, J.; Guillot, D.; Smerdon, J. E.; Rajaratnam, B.

    2014-01-01

    Pseudoproxy experiments (PPEs) have become an important framework for evaluating paleoclimate reconstruction methods. Most existing PPE studies assume constant proxy availability through time and uniform proxy quality across the pseudoproxy network. Real multiproxy networks are, however, marked by pronounced disparities in proxy quality, and a steep decline in proxy availability back in time, either of which may have large effects on reconstruction skill. A suite of PPEs constructed from a millennium-length general circulation model (GCM) simulation is thus designed to mimic these various real-world characteristics. The new pseudoproxy network is used to evaluate four climate field reconstruction (CFR) techniques: truncated total least squares embedded within the regularized EM (expectation-maximization) algorithm (RegEM-TTLS), the Mann et al. (2009) implementation of RegEM-TTLS (M09), canonical correlation analysis (CCA), and Gaussian graphical models embedded within RegEM (GraphEM). Each method's risk properties are also assessed via a 100-member noise ensemble. Contrary to expectation, it is found that reconstruction skill does not vary monotonically with proxy availability, but also is a function of the type and amplitude of climate variability (forced events vs. internal variability). The use of realistic spatiotemporal pseudoproxy characteristics also exposes large inter-method differences. Despite the comparable fidelity in reconstructing the global mean temperature, spatial skill varies considerably between CFR techniques. Both GraphEM and CCA efficiently exploit teleconnections, and produce consistent reconstructions across the ensemble. RegEM-TTLS and M09 appear advantageous for reconstructions on highly noisy data, but are subject to larger stochastic variations across different realizations of pseudoproxy noise. Results collectively highlight the importance of designing realistic pseudoproxy networks and implementing multiple noise realizations of PPEs

  20. Why do people donate to conservation? Insights from a 'real world' campaign.

    Science.gov (United States)

    Veríssimo, Diogo; Campbell, Hamish A; Tollington, Simon; MacMillan, Douglas C; Smith, Robert J

    2018-01-01

    Non-governmental organisations (NGOs) play a key role in biodiversity conservation. The majority of these organisations rely on public donations to fund their activities, and therefore fundraising success is a determinant of conservation outcomes. In spite of this integral relationship, the key principals for fundraising success in conservation are still guided by expert opinion and anecdotal evidence, with very few quantitative studies in the literature. Here we assessed the behaviour of monetary donors across twenty-five different species-focused conservation campaigns organised by an NGO conservation and environmental society. The Australian Geographic Society (AGS) carried out fundraising campaigns over a five and half year period using an identical methodology in thirty-four of its country-wide network of outlet shops. AGS owns and operates these shops that sell toys and games related to science and nature. We tested how the following factors influenced monetary donations from members of the public:1) campaign duration, 2) appeal and familiarity of species, 3) species geographic distribution relative to the fundraising location, 4) level of income and education of potential donors, 5) age and gender profile of potential donors. Contrary to past research, we found most of these factors did not significantly influence the amount of donations made to each campaign by members of the public. Larger animals did elicit a significantly higher amount donated per transaction than smaller animals, as did shops located in poorer neighbourhoods. Our study findings contrast with past research that has focused largely on hypothetical donations data collected via surveys, and demonstrates the complexity and case-specific nature of relationships between donor characteristics and spending patterns. The study highlights the value of assessing real-world fundraising campaigns, and illustrates how collaboration between academia and NGOs could be used to better tailor fundraising

  1. Spiromax, a New Dry Powder Inhaler: Dose Consistency under Simulated Real-World Conditions.

    Science.gov (United States)

    Canonica, Giorgio Walter; Arp, Jan; Keegstra, Johan René; Chrystyn, Henry

    2015-10-01

    Spiromax(®) is a novel dry powder inhaler for patients with asthma or chronic obstructive pulmonary disease (COPD). The studies presented here provide further data on attributes (in vitro dosing consistency with budesonide-formoterol (DuoResp) Spiromax; flow rates through empty versions of the Spiromax and Turbuhaler inhaler) of importance to patients with asthma or COPD. Dose-delivery studies were performed using low-, middle-, and high-strength DuoResp Spiromax. Dose consistency was assessed over inhaler life. Total emitted doses (TEDs) were measured at various flow rates, after exposure to high and low temperature or humidity, at different inhaler orientations, and after dropping the inhaler. The criterion for evaluating dose uniformity was whether mean TEDs were within the product specification limits. In separate studies, flow rates were measured after training, using the patient information leaflets, and again after enhanced training as part of a randomized, open-label, cross-over study. Mean values for both budesonide and formoterol were within 85%-115% of the label claim for each strength of DuoResp Spiromax for initial dose uniformity and for the other investigated conditions (temperature, humidity, orientation, dropping, knocking), with the exception of approximately an 80% increase in first dose after dropping the inhaler (subsequent doses not affected). In the flow rate patient study, two patients' inhalations with Spiromax and six with Turbuhaler were 60 L/min. DuoResp Spiromax consistently meets dose uniformity criteria, under controlled laboratory conditions and with variations intended to mimic real-world use. Following enhanced training, all patients in the flow study were able to achieve the minimal inspiratory flow rate of >30 L/min, which is required for effective treatment.

  2. Physical Analytics: An emerging field with real-world applications and impact

    Science.gov (United States)

    Hamann, Hendrik

    2015-03-01

    In the past most information on the internet has been originated by humans or computers. However with the emergence of cyber-physical systems, vast amount of data is now being created by sensors from devices, machines etc digitizing the physical world. While cyber-physical systems are subject to active research around the world, the vast amount of actual data generated from the physical world has attracted so far little attention from the engineering and physics community. In this presentation we use examples to highlight the opportunities in this new subject of ``Physical Analytics'' for highly inter-disciplinary research (including physics, engineering and computer science), which aims understanding real-world physical systems by leveraging cyber-physical technologies. More specifically, the convergence of the physical world with the digital domain allows applying physical principles to everyday problems in a much more effective and informed way than what was possible in the past. Very much like traditional applied physics and engineering has made enormous advances and changed our lives by making detailed measurements to understand the physics of an engineered device, we can now apply the same rigor and principles to understand large-scale physical systems. In the talk we first present a set of ``configurable'' enabling technologies for Physical Analytics including ultralow power sensing and communication technologies, physical big data management technologies, numerical modeling for physical systems, machine learning based physical model blending, and physical analytics based automation and control. Then we discuss in detail several concrete applications of Physical Analytics ranging from energy management in buildings and data centers, environmental sensing and controls, precision agriculture to renewable energy forecasting and management.

  3. Medium Truck Duty Cycle Data from Real-World Driving Environments: Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Lascurain, Mary Beth [ORNL; Franzese, Oscar [ORNL; Capps, Gary J [ORNL; Siekmann, Adam [ORNL; Thomas, Neil [ORNL; LaClair, Tim J [ORNL; Barker, Alan M [ORNL; Knee, Helmut E [ORNL

    2012-11-01

    Since the early part of the 20th century, the US trucking industry has provided a safe and economical means of moving commodities across the country. At present, nearly 80% of US domestic freight movement involves the use of trucks. The US Department of Energy (DOE) is spearheading a number of research efforts to improve heavy vehicle fuel efficiencies. This includes research in engine technologies (including hybrid and fuel cell technologies), lightweight materials, advanced fuels, and parasitic loss reductions. In addition, DOE is developing advanced tools and models to support heavy vehicle research and is leading the 21st Century Truck Partnership and the SuperTruck development effort. Both of these efforts have the common goal of decreasing the fuel consumption of heavy vehicles. In the case of SuperTruck, a goal of improving the overall freight efficiency of a combination tractor-trailer has been established. This Medium Truck Duty Cycle (MTDC) project is a critical element in DOE s vision for improved heavy vehicle energy efficiency; it is unique in that there is no other existing national database of characteristic duty cycles for medium trucks based on collecting data from Class 6 and 7 vehicles. It involves the collection of real-world data on medium trucks for various situational characteristics (e.g., rural/urban, freeway/arterial, congested/free-flowing, good/bad weather) and looks at the unique nature of medium trucks drive cycles (stop-and-go delivery, power takeoff, idle time, short-radius trips). This research provides a rich source of data that can contribute to the development of new tools for FE and modeling, provide DOE a sound basis upon which to make technology investment decisions, and provide a national archive of real-world-based medium-truck operational data to support energy efficiency research. The MTDC project involved a two-part field operational test (FOT). For the Part-1 FOT, three vehicles each from two vocations (urban transit and

  4. 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.

  5. A retrospective multicentric observational study of trastuzumab emtansine in HER2 positive metastatic breast cancer: a real-world experience

    Science.gov (United States)

    Vici, Patrizia; Pizzuti, Laura; Michelotti, Andrea; Sperduti, Isabella; Natoli, Clara; Mentuccia, Lucia; Lauro, Luigi Di; Sergi, Domenico; Marchetti, Paolo; Santini, Daniele; Magnolfi, Emanuela; Iezzi, Laura; Moscetti, Luca; Fabbri, Agnese; Cassano, Alessandra; Grassadonia, Antonino; Omarini, Claudia; Piacentini, Federico; Botticelli, Andrea; Bertolini, Ilaria; Scinto, Angelo Fedele; Zampa, Germano; Mauri, Maria; D’Onofrio, Loretta; Sini, Valentina; Barba, Maddalena; Maugeri-Saccà, Marcello; Rossi, Ernesto; Landucci, Elisabetta; Tomao, Silverio; Alberti, Antonio Maria; Giotta, Francesco; Ficorella, Corrado; Adamo, Vincenzo; Russo, Antonio; Lorusso, Vito; Cannita, Katia; Barni, Sandro; Laudadio, Lucio; Greco, Filippo; Garrone, Ornella; Giulia, Marina Della; Marolla, Paolo; Sanguineti, Giuseppe; Cocco, Barbara Di; Ciliberto, Gennaro; Maria, Ruggero De; Gamucci, Teresa

    2017-01-01

    We addressed trastuzumab emtansine (T-DM1) efficacy in HER2+ metastatic breast cancer patients treated in real-world practice, and its activity in pertuzumab-pretreated patients. We conducted a retrospective, observational study involving 23 cancer centres, and 250 patients. Survival data were analyzed by Kaplan Meier curves and log rank test. Factors testing significant in univariate analysis were tested in multivariate models. Median follow-up was 15 months and median T-DM1 treatment-length 4 months. Response rate was 41.6%, clinical benefit 60.9%. Median progression-free and median overall survival were 6 and 20 months, respectively. Overall, no differences emerged by pertuzumab pretreatment, with median progression-free and median overall survival of 4 and 17 months in pertuzumab-pretreated (p=0.13), and 6 and 22 months in pertuzumab-naïve patients (p=0.27). Patients who received second-line T-DM1 had median progression-free and median overall survival of 3 and 12 months (p=0.0001) if pertuzumab-pretreated, and 8 and 26 months if pertuzumab-naïve (p=0.06). In contrast, in third-line and beyond, median progression-free and median overall survival were 16 and 18 months in pertuzumab-pretreated (p=0.05) and 6 and 17 months in pertuzumab-naïve patients (p=0.30). In multivariate analysis, lower ECOG performance status was associated with progression-free survival benefit (p<0.0001), while overall survival was positively affected by lower ECOG PS (p<0.0001), absence of brain metastases (p 0.05), and clinical benefit (p<0.0001). Our results are comparable with those from randomized trials. Further studies are warranted to confirm and interpret our data on apparently lower T-DM1 efficacy when given as second-line treatment after pertuzumab, and on the optimal sequence order. PMID:28915642

  6. [Designs and thoughts of real world integrated data warehouse from HIS on re-evaluation of post-maketing traditional Chinese medicine].

    Science.gov (United States)

    Zhuang, Yan; Xie, Bangtie; Weng, Shengxin; Xie, Yanming

    2011-10-01

    To discuss the feasibility and necessity of using HIS data integration to build large data warehouse system which is extensively used on re-evaluation of post-marketing traditional Chinese medicine, and to provide the thought and method of the overall design for it. With domestic and overseas' analysis and comparison on clinical experiments' design based on real world using electronic information system, and with characteristics of HIS in China, a general framework was designed and discussed which refers to design thought, design characteristics, existing problems and solutions and so on. A design scheme of HIS data warehouse on re-evaluation of post-marketing traditional Chinese medicine was presented. The design scheme was proved to be high coherence and low coupling, safe, Universal, efficient and easy to maintain, which can effectively solve the problems many hospitals have faced during the process of HIS data integration.

  7. An Unobtrusive System to Measure, Assess, and Predict Cognitive Workload in Real-World Environments

    Science.gov (United States)

    Bracken, Bethany K.; Palmon, Noa; Elkin-Frankston, Seth; Irvin, Scott; Jenkins, Michael; Farry, Mike

    2017-01-01

    , designed to operate in real-world environments to be worn comfortably (e.g., positioned into a baseball cap or a surgeons cap) to measure changes in brain blood oxygenation without adding burden to the individual being assessed.

  8. Preparing laboratory and real-world EEG data for large-scale analysis: A containerized approach

    Directory of Open Access Journals (Sweden)

    Nima eBigdely-Shamlo

    2016-03-01

    Full Text Available Large-scale analysis of EEG and other physiological measures promises new insights into brain processes and more accurate and robust brain-computer interface (BCI models.. However, the absence of standard-ized vocabularies for annotating events in a machine understandable manner, the welter of collection-specific data organizations, the diffi-culty in moving data across processing platforms, and the unavailability of agreed-upon standards for preprocessing have prevented large-scale analyses of EEG. Here we describe a containerized approach and freely available tools we have developed to facilitate the process of an-notating, packaging, and preprocessing EEG data collections to enable data sharing, archiving, large-scale machine learning/data mining and (meta-analysis. The EEG Study Schema (ESS comprises three data Levels, each with its own XML-document schema and file/folder convention, plus a standardized (PREP pipeline to move raw (Data Level 1 data to a basic preprocessed state (Data Level 2 suitable for application of a large class of EEG analysis methods. Researchers can ship a study as a single unit and operate on its data using a standardized interface. ESS does not require a central database and provides all the metadata data necessary to execute a wide variety of EEG processing pipelines. The primary focus of ESS is automated in-depth analysis and meta-analysis EEG studies. However, ESS can also encapsulate meta-information for the other modalities such as eye tracking, that are in-creasingly used in both laboratory and real-world neuroimaging. ESS schema and tools are freely available at eegstudy.org, and a central cata-log of over 850 GB of existing data in ESS format is available at study-catalog.org. These tools and resources are part of a larger effort to ena-ble data sharing at sufficient scale for researchers to engage in truly large-scale EEG analysis and data mining (BigEEG.org.

  9. Incidental memory of younger and older adults for objects encountered in a real world context.

    Directory of Open Access Journals (Sweden)

    Xiaoyan Qin

    Full Text Available Effects of context on the perception of, and incidental memory for, real-world objects have predominantly been investigated in younger individuals, under conditions involving a single static viewpoint. We examined the effects of prior object context and object familiarity on both older and younger adults' incidental memory for real objects encountered while they traversed a conference room. Recognition memory for context-typical and context-atypical objects was compared with a third group of unfamiliar objects that were not readily named and that had no strongly associated context. Both older and younger adults demonstrated a typicality effect, showing significantly lower 2-alternative-forced-choice recognition of context-typical than context-atypical objects; for these objects, the recognition of older adults either significantly exceeded, or numerically surpassed, that of younger adults. Testing-awareness elevated recognition but did not interact with age or with object type. Older adults showed significantly higher recognition for context-atypical objects than for unfamiliar objects that had no prior strongly associated context. The observation of a typicality effect in both age groups is consistent with preserved semantic schemata processing in aging. The incidental recognition advantage of older over younger adults for the context-typical and context-atypical objects may reflect aging-related differences in goal-related processing, with older adults under comparatively more novel circumstances being more likely to direct their attention to the external environment, or age-related differences in top-down effortful distraction regulation, with older individuals' attention more readily captured by salient objects in the environment. Older adults' reduced recognition of unfamiliar objects compared to context-atypical objects may reflect possible age differences in contextually driven expectancy violations. The latter finding underscores the

  10. Real-world comparison of health care utilization between duloxetine and pregabalin initiators with fibromyalgia

    Directory of Open Access Journals (Sweden)

    Peng X

    2014-01-01

    Full Text Available X Peng,1 P Sun,2 D Novick,1 J Andrews,1 S Sun2 1Eli Lilly and Company, Indianapolis, IN, USA; 2Kailo Research Group, Indianapolis, IN, USA Objectives: To compare health care utilization of duloxetine initiators and pregabalin initiators among fibromyalgia patients in a real-world setting. Methods: A retrospective cohort study was conducted based on a US national commercial health claims database (2006–2009. Fibromyalgia patients who initiated duloxetine or pregabalin in 2008, aged 18–64 years, and who maintained continuous health insurance coverage 1 year before and 1 year after initiation were assigned to duloxetine or pregabalin cohorts on the basis of their initiated agent. Patients who had pill coverage of the agents over the course of 90 days preceding the initiation were excluded. The two comparative cohorts were constructed using propensity score greedy match methods. Descriptive analysis and paired t-test were performed to compare health care utilization rates in the postinitiation year and the changes of these rates from the preinitiation year to the postinitiation year. Results: Both matched cohorts (n=1,265 pairs had a similar mean initiation age (49–50 years, percentage of women (87%–88%, and prevalence of baseline comorbid conditions (neuropathic pain other than diabetic peripheral neuropathic pain, low back pain, cardiovascular disease, hypertension, headache or migraine, and osteoarthritis. In the preinitiation year, both cohorts had similar inpatient, outpatient, and medication utilization rates (inpatient, 15.7%–16.1%; outpatient, 100.0%; medication, 97.9%–98.7%. The utilization rates diverged in the postinitiation year, with the pregabalin cohort using more fibromyalgia-related inpatient care (3.2% versus 2.2%; P<0.05, any inpatient care (19.3% versus 16.8%; P<0.05, and fibromyalgia-related outpatient care (62.1% versus 51.8%; P<0.05. From the preinitiation period to the postinitiation period, the duloxetine cohort

  11. 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.

  12. Real-world efficacy and safety of ritonavir-boosted paritaprevir, ombitasvir, dasabuvir ± ribavirin for hepatitis C genotype 1 - final results of the REV1TAL study.

    Science.gov (United States)

    Lubel, John; Strasser, Simone; Stuart, Katherine A; Dore, Gregory; Thompson, Alexander; Pianko, Stephen; Bollipo, Steven; Mitchell, Joanne L; Fragomeli, Vincenzo; Jones, Tracey; Chivers, Sarah; Gow, Paul; Iser, David; Levy, Miriam; Tse, Edmund; Gazzola, Alessia; Cheng, Wendy; Nazareth, Saroj; Galhenage, Sam; Wade, Amanda; Weltman, Martin; Wigg, Alan; MacQuillan, Gerry; Sasadeusz, Joe; George, Jacob; Zekry, Amany; Roberts, Stuart K

    2017-01-01

    Limited data exist on the outcomes of ritonavir-boosted paritaprevir with ombitasvir and dasabuvir (PrOD) ± ribavirin in a real-world setting. The aim of this study was to compare the efficacy and safety of PrOD-based therapy in hepatitis C genotype 1 patients with and without cirrhosis, and to explore pre-treatment factors predictive of sustained viral response (SVR) and serious adverse events (SAEs) on treatment. 451 patients with hepatitis C genotype 1 treated in 20 centres across Australia were included. Baseline demographic, clinical and laboratory information, on-treatment biochemical, virological and haematological indices and details on serious adverse events were collected locally. Cirrhosis was present in 340 patients (75.4%). Overall SVR was 95.1% with no differences in SVR between the cirrhosis and non-cirrhosis groups (94.7% versus 96.4%). SVR in subgenotypes 1a and 1b was 93.1% and 99.2%, respectively. On multivariate analysis, baseline bilirubin level and early treatment cessation predicted SVR. SAEs occurred in 10.9% of patients including hepatic decompensation (2.7%) and hepatocellular carcinoma (1.8%). On multivariate analysis of factors predictive of SAEs in the overall group, Child-Turcotte-Pugh (CTP) B was the only significant factor, while in those with cirrhosis, baseline albumin and creatinine levels were significant. In this large real-world cohort of HCV genotype 1 subjects, treatment with PrOD was highly effective and similar to clinical trials. Important determinants of reduced SVR include early cessation of therapy and baseline bilirubin concentration. SAEs were not infrequent with CTP B patients being at greatest risk.

  13. Acute management of stroke patients taking non-vitamin K antagonist oral anticoagulants Addressing Real-world Anticoagulant Management Issues in Stroke (ARAMIS) Registry: Design and rationale.

    Science.gov (United States)

    Xian, Ying; Hernandez, Adrian F; Harding, Tina; Fonarow, Gregg C; Bhatt, Deepak L; Suter, Robert E; Khan, Yosef; Schwamm, Lee H; Peterson, Eric D

    2016-12-01

    Non-vitamin K antagonist oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) have been increasingly used as alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation. Yet there is substantial lack of information on how patients on NOACs are currently treated when they have an acute ischemic stroke and the best strategies for treating intracerebral hemorrhage for those on chronic anticoagulation with warfarin or a NOAC. These are critical unmet needs for real world clinical decision making in these emergent patients. The ARAMIS Registry is a multicenter cohort study of acute stroke patients who were taking chronic anticoagulation therapy prior to admission and are admitted with either an acute ischemic stroke or intracerebral hemorrhage. Built upon the existing infrastructure of American Heart Association/American Stroke Association Get With the Guidelines Stroke, the ARAMIS Registry will enroll a total of approximately 10,000 patients (5000 with acute ischemic stroke who are taking a NOAC and 5000 with anticoagulation-related intracerebral hemorrhage who are on warfarin or a NOAC). The primary goals of the ARAMIS Registry are to provide a comprehensive picture of current treatment patterns and outcomes of acute ischemic stroke patients on NOACs, as well as anticoagulation-related intracerebral hemorrhage in patients on either warfarin or NOACs. Beyond characterizing the index hospitalization, up to 2500 patients (1250 ischemic stroke and 1250 intracerebral hemorrhage) who survive to discharge will be enrolled in an optional follow-up sub-study and interviewed at 3 and 6 months after discharge to assess longitudinal medication use, downstream care, functional status, and patient-reported outcomes. The ARAMIS Registry will document the current state of management of NOAC treated patients with acute ischemic stroke as well as contemporary care and outcome of anticoagulation-related intracerebral hemorrhage. These

  14. 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).

  15. 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

  16. 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.

  17. A longitudinal examination of the moderating effects of symptoms on the relationship between functional competence and real world functional performance in Schizophrenia

    Directory of Open Access Journals (Sweden)

    Michael W. Best

    2014-06-01

    Conclusions: Residual negative and depressive symptoms are distinct constructs that impede the use of functional skills in the real world. Depressive symptoms are often overlooked in schizophrenia but appear to be an important factor that limits the use of functional ability in real world environments.

  18. Real-World Executive Functions in Adults with Autism Spectrum Disorder: Profiles of Impairment and Associations with Adaptive Functioning and Co-Morbid Anxiety and Depression

    Science.gov (United States)

    Wallace, Gregory L.; Kenworthy, Lauren; Pugliese, Cara E.; Popal, Haroon S.; White, Emily I.; Brodsky, Emily; Martin, Alex

    2016-01-01

    Although executive functioning (EF) difficulties are well documented among children and adolescents with autism spectrum disorder (ASD), little is known about real-world measures of EF among adults with ASD. Therefore, this study examined parent-reported real-world EF problems among 35 adults with ASD without intellectual disability and their…

  19. Real world programs, real world strategies, real world successes

    Energy Technology Data Exchange (ETDEWEB)

    Hogan, K. [EPA, Washington, DC (United States)

    1997-12-31

    This paper presents a very brief overview of market opportunities for using energy efficient technology. A brief summary of greenhouse gas emissions and global climate change concludes that the threat of global warming must be taken seriously. It is stated that there are numerous technologies available which can reduce energy use by up to 50%, while offering attractive rates of return. Market analysis has identified a trillion dollar market for high efficiency products and services over the next decade. Three main areas of business opportunity for capitalizing on the growing market for energy efficiency are identified: (1) using efficient energy technology in-house, (2) marketing energy efficient products, and (3) international markets.

  20. Informing Architecture and Urban Modeling with Real-world Data on 3D Tangible Interfaces and Augmented Displays

    DEFF Research Database (Denmark)

    Banke, Tore; Salim, Flora; Jaworski, Przemyslaw

    2011-01-01

    The proliferation of online and digital data in our world yields unprecedented opportunities for connecting physical and digital parametric models with live data input and feedback. Tangible interfaces and augmented displays provide theatrical settings for designers to visualize real-world data a...... detection, and multi-touch techniques, multidimensional tangible interfaces and augmented displays presented in this paper demonstrate a powerful new approach for designing and interacting with physical models, materials, and environmental data....

  1. Disruption in neural phase synchrony is related to identification of inattentional deafness in real-world setting

    OpenAIRE

    Callan , Daniel E.; Gateau , Thibault; Durantin , Gautier; Gonthier , Nicolas; Dehais , Frédéric

    2018-01-01

    International audience; Individuals often have reduced ability to hear alarms in real world situations (e.g., anesthesia monitoring, flying airplanes) when attention is focused on another task, sometimes with devastating consequences. This phenomenon is called inattentional deafness and usually occurs under critical high workload conditions. It is difficult to simulate the critical nature of these tasks in the laboratory. In this study, dry electroencephalography is used to investigate inatte...

  2. An Empirical Overview of the No Free Lunch Theorem and Its Effect on Real-World Machine Learning Classification.

    Science.gov (United States)

    Gómez, David; Rojas, Alfonso

    2016-01-01

    A sizable amount of research has been done to improve the mechanisms for knowledge extraction such as machine learning classification or regression. Quite unintuitively, the no free lunch (NFL) theorem states that all optimization problem strategies perform equally well when averaged over all possible problems. This fact seems to clash with the effort put forth toward better algorithms. This letter explores empirically the effect of the NFL theorem on some popular machine learning classification techniques over real-world data sets.

  3. Real-world healthcare costs of ipilimumab in patients with advanced cutaneous melanoma in The Netherlands.

    Science.gov (United States)

    Franken, Margreet G; Leeneman, Brenda; Jochems, Anouk; 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; de Groot, Jan Willem B; van der Hoeven, Koos J M; Hospers, Geke A P; Kapiteijn, Ellen; Koornstra, Rutger; Kruit, Wim H J; Louwman, Marieke W J; Piersma, Djura; van Rijn, Rozemarijn S; Suijkerbuijk, Karijn P M; Ten Tije, Albert J; Vreugdenhil, Gerard; Wouters, Michel W J M; van Zeijl, Michiel; Haanen, John B A G; Uyl-de Groot, Carin A

    2018-07-01

    There is limited evidence on the costs associated with ipilimumab. We investigated healthcare costs of all Dutch patients with advanced cutaneous melanoma who were treated with ipilimumab. Data were retrieved from the nation-wide Dutch Melanoma Treatment Registry. Costs were determined by applying unit costs to individual patient resource use. A total of 807 patients who were diagnosed between July 2012 and July 2015 received ipilimumab in Dutch practice. The mean (median) episode duration was 6.27 (4.61) months (computed from the start of ipilimumab until the start of a next treatment, death, or the last date of follow-up). The average total healthcare costs amounted to &OV0556;81 484, but varied widely (range: &OV0556;18 131-&OV0556;160 002). Ipilimumab was by far the most important cost driver (&OV0556;73 739). Other costs were related to hospital admissions (&OV0556;3323), hospital visits (&OV0556;1791), diagnostics and imaging (&OV0556;1505), radiotherapy (&OV0556;828), and surgery (&OV0556;297). Monthly costs for resource use other than ipilimumab were &OV0556;1997 (SD: &OV0556;2629). Treatment-naive patients (n=344) had higher total costs compared with previously-treated patients (n=463; &OV0556;85 081 vs. &OV0556;78 811). Although patients with colitis (n=106) had higher costs for resource use other than ipilimumab (&OV0556;11 426) compared with patients with other types of immune-related adverse events (n=90; &OV0556;9850) and patients with no immune-related adverse event (n=611; &OV0556;6796), they had lower total costs (&OV0556;76 075 vs. &OV0556;87 882 and &OV0556;81 480, respectively). In conclusion, this nation-wide study provides valuable insights into the healthcare costs of advanced cutaneous melanoma patients who were treated with ipilimumab in clinical practice. Most of the costs were attributable to ipilimumab, but the costs and its distribution varied considerably across subgroups.

  4. Real-World Adherence and Persistence to Oral Disease-Modifying Therapies in Multiple Sclerosis Patients Over 1 Year.

    Science.gov (United States)

    Johnson, Kristen M; Zhou, Huanxue; Lin, Feng; Ko, John J; Herrera, Vivian

    2017-08-01

    Disease-modifying therapies (DMTs) are indicated to reduce relapse rates and slow disease progression for relapsing-remitting multiple sclerosis (MS) patients when taken as prescribed. Nonadherence or non-persistence in the real-world setting can lead to greater risk for negative clinical outcomes. Although previous research has demonstrated greater adherence and persistence to oral DMTs compared with injectable DMTs, comparisons among oral DMTs are lacking. To compare adherence, persistence, and time to discontinuation among MS patients newly prescribed the oral DMTs fingolimod, dimethyl fumarate, or teriflunomide. This retrospective study used MarketScan Commercial and Medicare Supplemental claims databases. MS patients with ≥ 1 claim for specified DMTs from April 1, 2013, to June 30, 2013, were identified. The index drug was defined as the first oral DMT within this period. To capture patients newly initiating index DMTs, patients could not have a claim for their index drugs in the previous 12 months. Baseline characteristics were described for patients in each treatment cohort. Adherence, as measured by medication possession ratio (MPR) and proportion of days covered (PDC); persistence (30-day gap allowed); and time to discontinuation over a 12-month follow-up period were compared across treatment cohorts. Adjusted logistic regression models were used to examine adherence, and Cox regression models estimated risk of discontinuation. 1,498 patients newly initiated oral DMTs and met study inclusion criteria: fingolimod (n = 185), dimethyl fumarate (n = 1,160), and teriflunomide (n = 143). Patients were similar across most baseline characteristics, including region, relapse history, and health care resource utilization. Statistically significant differences were observed across the treatment cohorts for age, gender, previous injectable/infused DMT use, and comorbidities. Adherence and time to discontinuation were adjusted for age, gender, region, previous oral

  5. Circular contour retrieval in real-world conditions by higher order statistics and an alternating-least squares algorithm

    Science.gov (United States)

    Jiang, Haiping; Marot, Julien; Fossati, Caroline; Bourennane, Salah

    2011-12-01

    In real-world conditions, contours are most often blurred in digital images because of acquisition conditions such as movement, light transmission environment, and defocus. Among image segmentation methods, Hough transform requires a computational load which increases with the number of noise pixels, level set methods also require a high computational load, and some other methods assume that the contours are one-pixel wide. For the first time, we retrieve the characteristics of multiple possibly concentric blurred circles. We face correlated noise environment, to get closer to real-world conditions. For this, we model a blurred circle by a few parameters--center coordinates, radius, and spread--which characterize its mean position and gray level variations. We derive the signal model which results from signal generation on circular antenna. Linear antennas provide the center coordinates. To retrieve the circle radii, we adapt the second-order statistics TLS-ESPRIT method for non-correlated noise environment, and propose a novel version of TLS-ESPRIT based on higher-order statistics for correlated noise environment. Then, we derive a least-squares criterion and propose an alternating least-squares algorithm to retrieve simultaneously all spread values of concentric circles. Experiments performed on hand-made and real-world images show that the proposed methods outperform the Hough transform and a level set method dedicated to blurred contours in terms of computational load. Moreover, the proposed model and optimization method provide the information of the contour grey level variations.

  6. Understanding Is Key: An Analysis of Factors Pertaining to Trust in a Real-World Automation System

    Science.gov (United States)

    Balfe, Nora; Sharples, Sarah; Wilson, John R.

    2018-01-01

    Objective: This paper aims to explore the role of factors pertaining to trust in real-world automation systems through the application of observational methods in a case study from the railway sector. Background: Trust in automation is widely acknowledged as an important mediator of automation use, but the majority of the research on automation trust is based on laboratory work. In contrast, this work explored trust in a real-world setting. Method: Experienced rail operators in four signaling centers were observed for 90 min, and their activities were coded into five mutually exclusive categories. Their observed activities were analyzed in relation to their reported trust levels, collected via a questionnaire. Results: The results showed clear differences in activity, even when circumstances on the workstations were very similar, and significant differences in some trust dimensions were found between groups exhibiting different levels of intervention and time not involved with signaling. Conclusion: Although the empirical, lab-based studies in the literature have consistently found that reliability and competence of the automation are the most important aspects of trust development, understanding of the automation emerged as the strongest dimension in this study. The implications are that development and maintenance of trust in real-world, safety-critical automation systems may be distinct from artificial laboratory automation. Application: The findings have important implications for emerging automation concepts in diverse industries including highly automated vehicles and Internet of things. PMID:29613815

  7. Real-world exhaust temperature profiles of on-road heavy-duty diesel vehicles equipped with selective catalytic reduction.

    Science.gov (United States)

    Boriboonsomsin, Kanok; Durbin, Thomas; Scora, George; Johnson, Kent; Sandez, Daniel; Vu, Alexander; Jiang, Yu; Burnette, Andrew; Yoon, Seungju; Collins, John; Dai, Zhen; Fulper, Carl; Kishan, Sandeep; Sabisch, Michael; Jackson, Doug

    2018-09-01

    On-road heavy-duty diesel vehicles are a major contributor of oxides of nitrogen (NO x ) emissions. In the US, many heavy-duty diesel vehicles employ selective catalytic reduction (SCR) technology to meet the 2010 emission standard for NO x . Typically, SCR needs to be at least 200°C before a significant level of NO x reduction is achieved. However, this SCR temperature requirement may not be met under some real-world operating conditions, such as during cold starts, long idling, or low speed/low engine load driving activities. The frequency of vehicle operation with low SCR temperature varies partly by the vehicle's vocational use. In this study, detailed vehicle and engine activity data were collected from 90 heavy-duty vehicles involved in a range of vocations, including line haul, drayage, construction, agricultural, food distribution, beverage distribution, refuse, public work, and utility repair. The data were used to create real-world SCR temperature and engine load profiles and identify the fraction of vehicle operating time that SCR may not be as effective for NO x control. It is found that the vehicles participated in this study operate with SCR temperature lower than 200°C for 11-70% of the time depending on their vocation type. This implies that real-world NO x control efficiency could deviate from the control efficiency observed during engine certification. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Understanding Is Key: An Analysis of Factors Pertaining to Trust in a Real-World Automation System.

    Science.gov (United States)

    Balfe, Nora; Sharples, Sarah; Wilson, John R

    2018-06-01

    This paper aims to explore the role of factors pertaining to trust in real-world automation systems through the application of observational methods in a case study from the railway sector. Trust in automation is widely acknowledged as an important mediator of automation use, but the majority of the research on automation trust is based on laboratory work. In contrast, this work explored trust in a real-world setting. Experienced rail operators in four signaling centers were observed for 90 min, and their activities were coded into five mutually exclusive categories. Their observed activities were analyzed in relation to their reported trust levels, collected via a questionnaire. The results showed clear differences in activity, even when circumstances on the workstations were very similar, and significant differences in some trust dimensions were found between groups exhibiting different levels of intervention and time not involved with signaling. Although the empirical, lab-based studies in the literature have consistently found that reliability and competence of the automation are the most important aspects of trust development, understanding of the automation emerged as the strongest dimension in this study. The implications are that development and maintenance of trust in real-world, safety-critical automation systems may be distinct from artificial laboratory automation. The findings have important implications for emerging automation concepts in diverse industries including highly automated vehicles and Internet of things.

  9. 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.

  10. Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study.

    Science.gov (United States)

    Greenhalgh, Trisha; Shaw, Sara; Wherton, Joseph; Vijayaraghavan, Shanti; Morris, Joanne; Bhattacharya, Satya; Hanson, Philippa; Campbell-Richards, Desirée; Ramoutar, Seendy; Collard, Anna; Hodkinson, Isabel

    2018-04-17

    There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in

  11. Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project.

    Science.gov (United States)

    Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Oude Rengerink, Katrien; Gee, Harry; Mol, Ben W J; Khan, Khalid S

    2009-09-10

    Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their

  12. From the Lab to the real world : sources of error in UF6 gas enrichment monitoring

    International Nuclear Information System (INIS)

    Lombardi, Marcie L.

    2012-01-01

    monitors have required empty pipe measurements to accurately determine the pipe attenuation (the pipe attenuation is typically much larger than the attenuation in the gas). This dissertation reports on a method for determining the thickness of a pipe in a GCEP when obtaining an empty pipe measurement may not be feasible. This dissertation studies each of the components that may add to the final error in the enrichment measurement, and the factors that were taken into account to mitigate these issues are also detailed and tested. The use of an x-ray generator as a transmission source and the attending stability issues are addressed. Both analytical calculations and experimental measurements have been used. For completeness, some real-world analysis results from the URENCO Capenhurst enrichment plant have been included, where the final enrichment error has remained well below 1% for approximately two months

  13. Mimewrighting: Preparing Students for the Real World of Science, Technology, Engineering, and Math

    Science.gov (United States)

    Shope, R. E.

    2013-12-01

    READING, WRITING, & ENACTING SCIENTIFIC & TECHNICAL LITERATURE: Mimewrighting applies the art of mime as an interpretive springboard to integrate conceptual understanding across all content areas. Mimewrighting guides students to read and express complex ideas in carefully crafted movement integrations, mediating experience, so that students obtain an intuitive grasp of difficult and abstract ideas. THE PROBLEM: Reading science writing presents obstacles for middle and high school students, to the point that many students are turned OFF to science altogether. A typical science abstract, written for colleagues, is as densely packed with concept-laden words as a black hole is densely packed with matter- and just as mysterious. What reads to a science colleague as a richly crafted paragraph, from which a myriad of elegantly interrelated concepts can unfold to point to the significance and context of the study at hand, reads as jabberwocky nonsense to the uninitiated student. So, how do we turn such kids (and teachers) back ON to the inquiry-driven desire to seek out challenging and educative experiences? How do we step up to the national challenge to prepare ALL students adequately for the REAL-WORLD demands of science, technology, engineering, math, (STEM) and communications? How do we help kids read, write, and understand scientific and technical literature? AN UNCONVENTIONAL ANSWER: Mimewrighting applies the classic art of mime to unpack the meaning of science writing. We help students view the text as sequences of action, scenarios that can be enacted theatrically for understanding. HOW DOES IT WORK? READ ALOUD, MIME ALONG: It's as simple as read aloud and mime along. And as complex, in that it requires taking the time to acknowledge each concept packed into the passage. Three opening sentences might involve twenty minutes of mimewrighting activity to ensure that students apprehend the patterns, perceive the relationships, and comprehend the dynamics of such a

  14. The real-world use of regorafenib for metastatic colorectal cancer: multicentre analysis of treatment pattern and outcomes in Hong Kong.

    Science.gov (United States)

    Lam, Ka-On; Lee, Kin-Chung; Chiu, Joanne; Lee, Victor Ho-Fun; Leung, Roland; Choy, T S; Yau, Thomas

    2017-07-01

    To evaluate the benefits and tolerability of regorafenib in the real-world setting, we performed a multicentre analysis in Hong Kong. Individual patient data were retrieved from three leading oncology centres in Hong Kong for analyses. All patients with metastatic colorectal cancer (mCRC) treated with regorafenib after failure of all standard systemic options were included. From July 2013 to December 2015, 45 consecutive patients treated with regorafenib for mCRC were analysed. The median age was 63. Twenty patients were started at 160 mg, while the other 25 patients were started at a lower dose. The median progression-free survival was 15.6 weeks (95% CI 13.1 to 18.1 weeks) and the median overall survival was 30.4 weeks (95% CI 16.6 to 44.3 weeks). Among the 31 evaluable patients, only 1 patient (3.2%) achieved partial response and another 10 patients (32.3%) had stable disease. The commonest grade 3 non-haematological adverse event (AE) was hand-foot skin reaction (26.7%) and the commonest grade 3 or 4 haematological AE was anaemia (8.9%). Notably, patients who were started on a lower dose of regorafenib had significantly lower risk of grade 3 treatment-emergent AEs. Overall, 78.3% of the patients had dose reduction during the first and second cycles. Patients older than 65 years were more likely to experience cycle suspension and require dose reduction. Our study confirmed the efficacy and tolerability of regorafenib in the real-world setting. It also suggested that individualised dosing of regorafenib in patients with mCRC might result in better clinical outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Getting Real: A General Chemistry Laboratory Program Focusing on "Real World" Substances

    Science.gov (United States)

    Kerber, Robert C.; Akhtar, Mohammad J.

    1996-11-01

    In order to confront the abstractness of the freshman chemistry syllabus and the consequent failure of students to relate what they learn to their everyday lives, we have designed a new freshman laboratory program. It is intended as an interface between the substances that surround the students in their ordinary lives and the abstract principles presented in chemistry classrooms (1). A laboratory should provide the organized experiences and observations that underlie the intellectual constructs of chemistry, and tying these experiences and observations to the real world can help to provide motivation for study of the principles. The freshman laboratory program constitutes the foundation for subsequent laboratory courses. However, the good habits we strive to develop there (careful observation, thorough record keeping, proper use of equipment, objective data analysis) are essential to all scientific work, and are intended to provide lasting educational value for all students, especially those who do not take later laboratory work. What We Do A list of the laboratory exercises carried out during 1994-1995 is presented in Table 1. The course incorporates the following features. 1. The exercises deal with recognizable, everyday substances, not just with "chemicals". That "baking soda" and "sodium bicarbonate" are the same is a chemical truism of which the students may be aware, but the visible presence of the Arm and Hammer box nevertheless helps them to make connections to the world outside the laboratory. Perceiving the connections, students may be inspired by curiosity to understand chemical phenomena better, not just to tolerate what they are being taught, as an irrelevant hurdle in the pursuit of a career. 2. Since many significant substances around students in the everyday world are organic, we work in the lab with organic as well as the usual inorganic materials. These include analgesics, vitamins, antifreeze, foodstuffs, dyestuffs, plastics, and fibers. In

  16. ePCR: an R-package for survival and time-to-event prediction in advanced prostate cancer, applied to real-world patient cohorts.

    Science.gov (United States)

    Laajala, Teemu D; Murtojärvi, Mika; Virkki, Arho; Aittokallio, Tero

    2018-06-15

    Prognostic models are widely used in clinical decision-making, such as risk stratification and tailoring treatment strategies, with the aim to improve patient outcomes while reducing overall healthcare costs. While prognostic models have been adopted into clinical use, benchmarking their performance has been difficult due to lack of open clinical datasets. The recent DREAM 9.5 Prostate Cancer Challenge carried out an extensive benchmarking of prognostic models for metastatic Castration-Resistant Prostate Cancer (mCRPC), based on multiple cohorts of open clinical trial data. We make available an open-source implementation of the top-performing model, ePCR, along with an extended toolbox for its further re-use and development, and demonstrate how to best apply the implemented model to real-world data cohorts of advanced prostate cancer patients. The open-source R-package ePCR and its reference documentation are available at the Central R Archive Network (CRAN): https://CRAN.R-project.org/package=ePCR. R-vignette provides step-by-step examples for the ePCR usage. Supplementary data are available at Bioinformatics online.

  17. Cultural Lessons for Clinical Mental Health Practice: The Puyallup Tribal Community.

    Science.gov (United States)

    Guilmet, George M.; Whited, David L.

    1987-01-01

    Discusses the integration of American Indian cultural perspectives within counseling and mental health services. Outlines several issues illustrating cultural lessons for clinical practices: family and social structure, ritual, cultural values and conflict, sense of time and self, communication styles, anger, and traditionalism. Contains 47…

  18. Connecting Educators with Inter-Disciplinary Inquiry-Based Science and Students with STEM Careers with Real-World Experiences

    Directory of Open Access Journals (Sweden)

    Suzanne Lunsford

    2016-10-01

    Full Text Available Our professional development workshops have provided participating teachers (inservice and pre-service with interdisciplinary experiences in earth and environmental science that have built their content into real-world problem based research initiatives (STEM, Science Technology, Engineering and Mathematics. One of our real-world issues has been the detection of phenol since it has been a concern in the real-world coal mining industry. Coal tars are a complex of variable mixtures of phenols. Phenol and phenol derivative compounds are widely used in the production of polymers, drugs, dyes, explosives, pesticides, stabilizers and antioxidants. These phenolic compounds are discharged into the environment and can represent a serious hazard, mainly by the contamination of superficial and underground waters. The toxic effect of phenol can cause comas, convulsions, cyanosis, liver damage, kidney damage, lung damage and death. The mining industry for coal is an alternative source of energy and used in thermoelectric power plants. However, the pollutant phenol that can be found in coal has high need to be detected and is an important aspect to keep an eye on due to these harmful chemicals such as phenol discharging into the environment. Our inquiry-based labs have engaged our inservice and pre-service students by visiting a mine and learning the positive and negative aspects of mining and the importance of water quality. Thus, this inquiry-based module will illustrate the use of an electrochemistry modified carbon nanotube poly-3-hexylthiophene electrode to detect such harmful chemicals as phenol by unique electrochemistry techniques such as Differential Pulse Voltammetry (DPV.

  19. Real-world fuel economy and CO{sub 2} emissions of plug-in hybrid electric vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Ploetz, Patrick; Funke, Simon Arpad; Jochem, Patrick [Fraunhofer-Institut fuer System- und Innovationsforschung (ISI), Karlsruhe (Germany). Competence Center Energiepolitik und Energiesysteme

    2015-07-01

    Plug-in hybrid electric vehicles (PHEV) combine electric propulsion with an internal combustion engine. Their potential to reduce transport related green-house gas emissions highly depends on their actual usage and electricity provision. Various studies underline their environmental and economic advantages, but are based on standardised driving cycles, simulations or small PHEV fleets. Here, we analyse real-world fuel economy of PHEV and the factors influencing it based on about 2,000 actual PHEV that have been observed over more than a year in the U.S. and Germany. We find that real-world fuel economy of PHEV differ widely among users. The main factors explaining this variation are the annual mileage, the regularity of daily driving, and the likelihood of long-distance trips. Current test cycle fuel economy ratings neglect these factors. Despite the broad range of PHEV fuel economies, the test cycle fuel economy ratings can be close to empiric PHEV fleet averages if the average annual mile-age is about 17,000 km. For the largest group of PHEV in our data, the Chevrolet Volt, we find the average fuel economy to be 1.45 litres/100 km at an average electric driving share of 78%. The resulting real-world tank-to-wheel CO{sub 2} emissions of these PHEV are 42 gCO{sub 2}/km and the annual CO{sub 2} savings in the U.S. amount to about 50 Mt. In conclusion, the variance of empirical PHEV fuel economy is considerably higher than of conventional vehicles. This should be taken into account by future test cycles and high electric driving shares should be incentivised.

  20. Prediction and Characterization of High-Activity Events in Social Media Triggered by Real-World News.

    Science.gov (United States)

    Kalyanam, Janani; Quezada, Mauricio; Poblete, Barbara; Lanckriet, Gert

    2016-01-01

    On-line social networks publish information on a high volume of real-world events almost instantly, becoming a primary source for breaking news. Some of these real-world events can end up having a very strong impact on on-line social networks. The effect of such events can be analyzed from several perspectives, one of them being the intensity and characteristics of the collective activity that it produces in the social platform. We research 5,234 real-world news events encompassing 43 million messages discussed on the Twitter microblogging service for approximately 1 year. We show empirically that exogenous news events naturally create collective patterns of bursty behavior in combination with long periods of inactivity in the network. This type of behavior agrees with other patterns previously observed in other types of natural collective phenomena, as well as in individual human communications. In addition, we propose a methodology to classify news events according to the different levels of intensity in activity that they produce. In particular, we analyze the most highly active events and observe a consistent and strikingly different collective reaction from users when they are exposed to such events. This reaction is independent of an event's reach and scope. We further observe that extremely high-activity events have characteristics that are quite distinguishable at the beginning stages of their outbreak. This allows us to predict with high precision, the top 8% of events that will have the most impact in the social network by just using the first 5% of the information of an event's lifetime evolution. This strongly implies that high-activity events are naturally prioritized collectively by the social network, engaging users early on, way before they are brought to the mainstream audience.

  1. Effect of biodiesel fuel on "real-world", nonroad heavy duty diesel engine particulate matter emissions, composition and cytotoxicity.

    Science.gov (United States)

    Martin, Nathan; Lombard, Melissa; Jensen, Kirk R; Kelley, Patrick; Pratt, Tara; Traviss, Nora

    2017-05-15

    Biodiesel is regarded by many as a "greener" alternative fuel to petroleum diesel with potentially lower health risk. However, recent studies examining biodiesel particulate matter (PM) characteristics and health effects are contradictive, and typically utilize PM generated by passenger car engines in laboratory settings. There is a critical need to analyze diesel and biodiesel PM generated in a "real-world" setting where heavy duty-diesel (HDD) engines and commercially purchased fuel are utilized. This study compares the mass concentrations, chemical composition and cytotoxicity of real-world PM from combustion of both petroleum diesel and a waste grease 20% biodiesel blend (B20) at a community recycling center operating HDD nonroad equipment. PM was analyzed for metals, elemental/organic carbon (EC/OC), polycyclic aromatic hydrocarbons (PAHs), and nitro-polycyclic aromatic hydrocarbons (N-PAHs). Cytotoxicity in a human lung epithelial cell line (BEAS-2B) following 24h exposure to the real-world particles was also evaluated. On average, higher concentrations for both EC and OC were measured in diesel PM. B20 PM contained significantly higher levels of Cu and Mo whereas diesel PM contained significantly higher concentrations of Pb. Principal component analysis determined Mo, Cu, and Ni were the metals with the greatest loading factor, suggesting a unique pattern related to the B20 fuel source. Total PAH concentration during diesel fuel use was 1.9 times higher than during B20 operations; however, total N-PAH concentration was 3.3 times higher during B20 use. Diesel PM cytotoxicity was 8.5 times higher than B20 PM (pengine sources of metals, PAH and N-PAH species, comparing tailpipe PM vs. PM collected inside the equipment cabin. Results suggest PM generated from burning petroleum diesel in nonroad engines may be more harmful to human health, but the links between exposure, composition and toxicity are not straightforward. Copyright © 2016 Elsevier B.V. All rights

  2. Microsoft SharePoint 2010 Administration Real World Skills for MCITP Certification and Beyond (Exam 70-668)

    CERN Document Server

    Carpenter, Tom

    2011-01-01

    Delivers the information that SharePoint 2010 administrators in the field need most This book shows you how to design, deploy, and implement a SharePoint 2010 environment, providing practical skills and real-world techniques and scenarios you'll be able to apply on the job. You'll not only thoroughly learn SharePoint 2010, but you'll also get up to speed on business continuity and solutions. In addition, those preparing for the MCITP: SharePoint 2010 Administration certification exam 70-668 will find thorough coverage of all exam objectives.Shows you how to design, deploy, administer, and main

  3. Hybrid-Electric Passenger Car Carbon Dioxide and Fuel Consumption Benefits Based on Real-World Driving.

    Science.gov (United States)

    Holmén, Britt A; Sentoff, Karen M

    2015-08-18

    Hybrid-electric vehicles (HEVs) have lower fuel consumption and carbon dioxide (CO2) emissions than conventional vehicles (CVs), on average, based on laboratory tests, but there is a paucity of real-world, on-road HEV emissions and performance data needed to assess energy use and emissions associated with real-world driving, including the effects of road grade. This need is especially great as the electrification of the passenger vehicle fleet (from HEVs to PHEVs to BEVs) increases in response to climate and energy concerns. We compared tailpipe CO2 emissions and fuel consumption of an HEV passenger car to a CV of the same make and model during real-world, on-the-road network driving to quantify the in-use benefit of one popular full HEV technology. Using vehicle specific power (VSP) assignments that account for measured road grade, the mean CV/HEV ratios of CO2 tailpipe emissions or fuel consumption defined the corresponding HEV "benefit" factor for each VSP class (1 kW/ton resolution). Averaging over all VSP classes for driving in all seasons, including temperatures from -13 to +35 °C in relatively steep (-13.2 to +11.5% grade), hilly terrain, mean (±SD) CO2 emission benefit factors were 4.5 ± 3.6, 2.5 ± 1.7, and 1.4 ± 0.5 for city, exurban/suburban arterial and highway driving, respectively. Benefit factor magnitude corresponded to the frequency of electric-drive-only (EDO) operation, which was modeled as a logarithmic function of VSP. A combined model explained 95% of the variance in HEV benefit for city, 75% for arterial and 57% for highway driving. Benefit factors consistently exceeded 2 for VSP classes with greater than 50% EDO (i.e., only city and arterial driving). The reported HEV benefits account for real-world road grade that is often neglected in regulatory emissions and fuel economy tests. Fuel use HEV benefit factors were 1.3 and 2 for the regulatory highway (HWFET) and city (FTP) cycles, respectively, 18% and 31% higher than the EPA adjusted

  4. Simulated Real-World Energy Impacts of a Thermally Sensitive Powertrain Considering Viscous Losses and Enrichment (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Wood, E.; Gonder, J.; Lopp, S.; Jehlik, F.

    2014-09-01

    It is widely understood that cold-temperature engine operation negatively impacts vehicle fuel use due to a combination of increased friction (high-viscosity engine oil) and temporary enrichment (accelerated catalyst heating). However, relatively little effort has been dedicated to thoroughly quantifying these impacts across a large number of driving cycles and ambient conditions. This work leverages high-quality dynamometer data collected at various ambient conditions to develop a modeling framework for quantifying engine cold-start fuel penalties over a wide array of real-world usage profiles. Additionally, mitigation strategies including energy retention and exhaust heat recovery are explored with benefits quantified for each approach.

  5. Journal Article: Using Scientists and Real-World Scenarios in Professional Development for Middle School Science Teachers

    Energy Technology Data Exchange (ETDEWEB)

    Morrison, Judith A.; Estes, Jeffrey C.

    2007-04-01

    Middle school science teachers were involved in a problem-solving experience presented and guided by research scientists. Data on the teachers’ perspectives about this professional development and any impact it may have had on their teaching practices were collected through interviews, surveys, and classroom observations. The findings show that the professional development experience was positive, although one concern expressed by teachers was their lack of understanding of the scientists’ vocabulary. Using scientists and real-world scenarios was shown to be an effective strategy for encouraging middle school teachers to teach science as a process and help them strengthen their science content understanding.

  6. [Cancer screening in clinical practice: the value of shared decision-making].

    Science.gov (United States)

    Cornuz, Jacques; Junod, Noëlle; Pasche, Olivier; Guessous, Idris

    2010-07-14

    Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making.

  7. Clinician user involvement in the real world: Designing an electronic tool to improve interprofessional communication and collaboration in a hospital setting.

    Science.gov (United States)

    Tang, Terence; Lim, Morgan E; Mansfield, Elizabeth; McLachlan, Alexander; Quan, Sherman D

    2018-02-01

    User involvement is vital to the success of health information technology implementation. However, involving clinician users effectively and meaningfully in complex healthcare organizations remains challenging. The objective of this paper is to share our real-world experience of applying a variety of user involvement methods in the design and implementation of a clinical communication and collaboration platform aimed at facilitating care of complex hospitalized patients by an interprofessional team of clinicians. We designed and implemented an electronic clinical communication and collaboration platform in a large community teaching hospital. The design team consisted of both technical and healthcare professionals. Agile software development methodology was used to facilitate rapid iterative design and user input. We involved clinician users at all stages of the development lifecycle using a variety of user-centered, user co-design, and participatory design methods. Thirty-six software releases were delivered over 24 months. User involvement has resulted in improvement in user interface design, identification of software defects, creation of new modules that facilitated workflow, and identification of necessary changes to the scope of the project early on. A variety of user involvement methods were complementary and benefited the design and implementation of a complex health IT solution. Combining these methods with agile software development methodology can turn designs into functioning clinical system to support iterative improvement. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Teaching trainers to incorporate evidence-based medicine (EBM teaching in clinical practice: the EU-EBM project

    Directory of Open Access Journals (Sweden)

    Kaleta Anna

    2009-09-01

    Full Text Available Abstract Background Evidence based medicine (EBM is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. Methods We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. Results The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. Conclusion This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical

  9. Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization.

    Science.gov (United States)

    Armstrong, April W; Foster, Shonda A; Comer, Brian S; Lin, Chen-Yen; Malatestinic, William; Burge, Russel; Goldblum, Orin

    2018-06-28

    utilization (increased visit frequency and complexity). When compared between treatment groups (n = 10,454), healthcare resource utilization was highest for phototherapy. Annual medication costs were higher for biologics ($21,977) than oral systemics ($3413). Real-world research using a widely implemented dermatology EHR provided valuable insights on patient perceived treatment effectiveness, patterns of medication usage, healthcare resource utilization, and medication costs for psoriasis patients in the US. This study and others utilizing EHRs for real-world research may assist clinical and payer decisions regarding the management of psoriasis.

  10. Primary Nonadherence to Oral Anticoagulants in Patients with Atrial Fibrillation: Real-World Data from a Population-Based Cohort.

    Science.gov (United States)

    Rodriguez-Bernal, Clara L; Peiró, Salvador; Hurtado, Isabel; García-Sempere, Aníbal; Sanfélix-Gimeno, Gabriel

    2018-05-01

    Primary nonadherence (not filling a first prescription) is an important yet unstudied aspect of adherence to oral anticoagulant (OAC) therapy. To estimate the rates of primary nonadherence to OACs and determine associated factors in real-world practice. This population-based retrospective cohort study set in the Valencia region of Spain (about 5 million inhabitants) included all patients with atrial fibrillation who were newly prescribed OACs during 2011-2014 (N = 18,715). Primary nonadherence was obtained by linking electronic prescription and dispensing data and assessed by type of OAC-vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs). Covariates were obtained from diverse databases, including electronic medical records. Multivariate logistic regression models were used to assess characteristics associated with primary nonadherence, adjusting for a propensity score to minimize confounding by indication. Primary nonadherence to OACs was 5.62% (VKA 4.29% vs. NOAC 10.81%; P 75 years); being a non-Spanish European (OR = 1.49, 95% CI = 1.12-1.99); and having dementia (OR = 1.72, 95% CI = 1.37-2.16) were positively associated with primary nonadherence. Electronic transmission of prescriptions (OR = 0.85, 95% CI = 0.74-0.96); liver disease (OR = 0.73, 95% CI = 0.54-0.99); and polypharmacy (OR = 0.59, 95% CI = 0.50-0.70) were inversely associated with primary nonadherence. Overall, primary nonadherence to OACs was relatively low (5%). However, important differences were found between VKAs and NOACs. After adjustment, patients prescribed NOACs nearly tripled the likelihood of nonadherence compared with patients prescribed VKAs, which could negatively affect their effectiveness in clinical practice. Identified correlates were similar to those shown in the limited evidence for other medications. This work was partially supported by the 2013 Collaboration Agreement between the Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO

  11. Ambulatory blood pressure monitoring in daily clinical practice - the Spanish ABPM Registry experience.

    Science.gov (United States)

    Gorostidi, Manuel; Banegas, José R; de la Sierra, Alejandro; Vinyoles, Ernest; Segura, Julián; Ruilope, Luis M

    2016-01-01

    Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  12. Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

    Directory of Open Access Journals (Sweden)

    Sissel Steihaug

    2016-07-01

    Full Text Available Introduction: This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles. Methods: The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work. Results: Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients. Conclusion: Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients.

  13. Pharmacogenetics and Metabolism from Science to Implementation in Clinical Practice: The Example of Dihydropyrimidine Dehydrogenase.

    Science.gov (United States)

    Del Re, Marzia; Restante, Giuliana; Di Paolo, Antonello; Crucitta, Stefania; Rofi, Eleonora; Danesi, Romano

    2017-01-01

    Fluoropyrimidines are widely used in the treatment of solid tumors and remain the backbone of many combination chemotherapy regimens. Despite their clinical benefit, they are associated with frequent gastrointestinal and hematological toxicities, which often lead to treatment discontinuation. Fluoropyrimidines undergo complex anabolic and catabolic biotransformation. Enzymes involved in this pathway include dihydropyrimidine dehydrogenase (DPD), which breaks down 5-FU and its prodrugs. Candidate gene approaches have demonstrated associations between 5-FU treatment outcomes and germline polymorphisms in DPD. The aim of this review is to report and discuss the latest results on fluoropyrimidine pharmacogenetics. Literature from PubMed databases and bibliography from retrieved publications have been analyzed according to terms such DPD, DPYD, fluoropyrimdines, polymorphisms, toxicity, pharmacogenetics. To date, many sequence variations have been identified within DPYD gene, although the majority of these have no functional consequences on enzymatic activity. Nowadays, there is a general agreement on the clinical significance of the importance of DPD deficiency in patients who suffer from severe, life-threatening drug toxicity although preemptive testing is not applied to all patients. Considering the published literature, clinicians are strongly encouraged to consider testing for DPD poor metabolizer variants as a rational pre-treatment screening for patients candidate to a fluoropyrimidine-based regimens, in order to prevent toxicities and personalise treatments. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  14. Subjective tinnitus assessment and treatment in clinical practice: the necessity of personalized medicine.

    Science.gov (United States)

    Van de Heyning, Paul; Gilles, Annick; Rabau, Sarah; Van Rompaey, Vincent

    2015-10-01

    Subjective tinnitus can be triggered by a variety of causes, and therefore tinnitus patients constitute a very heterogeneous population difficult to manage. In this article, we reviewed the current literature to present our conceptual model of the conscious auditory percept and tinnitus - based on experimental research - in order to explain the clinical approach to the individual tinnitus patient. Fundamental research has provided evidence to support the neurophysiological model of tinnitus developed by Jastreboff. By manipulating the limbic, autonomic and auditory systems, tinnitus retraining therapy (TRT) aims to reduce the response to the abnormal stimulus. Evidence has confirmed the effectiveness of TRT and cognitive behavioral therapy in reducing the negative impact of subjective tinnitus on the patients' quality of life. Every patient with subjective tinnitus has its unique 'tinnitus profile' which provides a guide to the necessary combination of therapeutic actions. Evidence suggests the multidisciplinary approach combining etiological therapy as well as TRT, and cognitive behavioral therapy in specialized clinics is not only effective in reducing the patient's quality of life but also cost-effective from a healthcare and societal point of view.

  15. Decision support systems in clinical practice: The case of venous thromboembolism prevention.

    Science.gov (United States)

    Nazarenko, G I; Kleymenova, E B; Payushik, S A; Otdelenov, V A; Sychev, D A; Yashina, L P

    2015-01-01

    Today medicine is facing a "knowledge crisis" in that explosively expanding medical knowledge encounters limited abilities to disseminate new practices [1]. Clinical practice guidelines (CPGs) are intended to promote high standards of care in specific areas of medicine by summarizing best clinical practice based on careful reviews of current research. However, doctors are often short of time to study these documents and check their updates, have little motivation for strict adherence to them. A systematic review of 11 studies reporting on 29 recommendations has found that median adherence to all recommendations was 34%, suggesting that potential benefits for patients from health research may be lost [2].Clinical decision support systems (CDSS) can serve as a knowledge translation tool, mediator between clinical guidelines and physicians by providing the right information to the right person at the right time. To evaluate the effectiveness of implementation of international and national CPGs for venous thromboembolism (VTE) prevention with the help of CDSS in a general hospital. A multifunctional CDSS based on national and international guidelines on the VTE prevention was developed and implemented in the Medical Center of the Bank of Russia (MC). The system has the following functionalities: 1) it supports the decision on the VTE prevention based on individual risk assessment of thrombosis (scales of Caprini, Rogers and Khorana, Padua Prediction Score, additional risk factors) and bleeding (IMPROVE scale for non-surgical patients, major bleeding scale for surgical patients and major orthopedic surgeries, hemorrhagic complications risk in cancer patients); 2) generates the summary containing the grade of recommendations and the level of evidence, personalized recommendations on regimen and duration of preventive antithrombotic therapy, dose correction according to creatinine clearance; 3) provides an audit form for and statistical analysis of VTE cases; 3

  16. Effect of hybrid system battery performance on determining CO2 emissions of hybrid electric vehicles in real-world conditions

    International Nuclear Information System (INIS)

    Alvarez, Robert; Schlienger, Peter; Weilenmann, Martin

    2010-01-01

    Hybrid electric vehicles (HEVs) can potentially reduce vehicle CO 2 emissions by using recuperated kinetic vehicle energy stored as electric energy in a hybrid system battery (HSB). HSB performance affects the individual net HEV CO 2 emissions for a given driving pattern, which is considered to be equivalent to unchanged net energy content in the HSB. The present study investigates the influence of HSB performance on the statutory correction procedure used to determine HEV CO 2 emissions in Europe based on chassis dynamometer measurements with three identical in-use examples of a full HEV model featuring different mileages. Statutory and real-world driving cycles and full electric vehicle operation modes have been considered. The main observation is that the selected HEVs can only use 67-80% of the charge provided to the HSB, which distorts the outcomes of the statutory correction procedure that does not consider such irreversibility. CO 2 emissions corrected according to this procedure underestimate the true net CO 2 emissions of one HEV by approximately 13% in real-world urban driving. The correct CO 2 emissions are only reproduced when considering the HSB performance in this driving pattern. The statutory procedure for correcting HEV CO 2 emissions should, therefore, be adapted.

  17. Differential Medial Temporal Lobe and Parietal Cortical Contributions to Real-world Autobiographical Episodic and Autobiographical Semantic Memory.

    Science.gov (United States)

    Brown, Thackery I; Rissman, Jesse; Chow, Tiffany E; Uncapher, Melina R; Wagner, Anthony D

    2018-04-18

    Autobiographical remembering can depend on two forms of memory: episodic (event) memory and autobiographical semantic memory (remembering personally relevant semantic knowledge, independent of recalling a specific experience). There is debate about the degree to which the neural signals that support episodic recollection relate to or build upon autobiographical semantic remembering. Pooling data from two fMRI studies of memory for real-world personal events, we investigated whether medial temporal lobe (MTL) and parietal subregions contribute to autobiographical episodic and semantic remembering. During scanning, participants made memory judgments about photograph sequences depicting past events from their life or from others' lives, and indicated whether memory was based on episodic or semantic knowledge. Results revealed several distinct functional patterns: activity in most MTL subregions was selectively associated with autobiographical episodic memory; the hippocampal tail, superior parietal lobule, and intraparietal sulcus were similarly engaged when memory was based on retrieval of an autobiographical episode or autobiographical semantic knowledge; and angular gyrus demonstrated a graded pattern, with activity declining from autobiographical recollection to autobiographical semantic remembering to correct rejections of novel events. Collectively, our data offer insights into MTL and parietal cortex functional organization, and elucidate circuitry that supports different forms of real-world autobiographical memory.

  18. How context information and target information guide the eyes from the first epoch of search in real-world scenes.

    Science.gov (United States)

    Spotorno, Sara; Malcolm, George L; Tatler, Benjamin W

    2014-02-11

    This study investigated how the visual system utilizes context and task information during the different phases of a visual search task. The specificity of the target template (the picture or the name of the target) and the plausibility of target position in real-world scenes were manipulated orthogonally. Our findings showed that both target template information and guidance of spatial context are utilized to guide eye movements from the beginning of scene inspection. In both search initiation and subsequent scene scanning, the availability of a specific visual template was particularly useful when the spatial context of the scene was misleading and the availability of a reliable scene context facilitated search mainly when the template was abstract. Target verification was affected principally by the level of detail of target template, and was quicker in the case of a picture cue. The results indicate that the visual system can utilize target template guidance and context guidance flexibly from the beginning of scene inspection, depending upon the amount and the quality of the available information supplied by either of these high-level sources. This allows for optimization of oculomotor behavior throughout the different phases of search within a real-world scene.

  19. 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.

  20. Top-down and bottom-up aspects of active search in a real-world environment.

    Science.gov (United States)

    Foulsham, Tom; Chapman, Craig; Nasiopoulos, Eleni; Kingstone, Alan

    2014-03-01

    Visual search has been studied intensively in the labouratory, but lab search often differs from search in the real world in many respects. Here, we used a mobile eye tracker to record the gaze of participants engaged in a realistic, active search task. Participants were asked to walk into a mailroom and locate a target mailbox among many similar mailboxes. This procedure allowed control of bottom-up cues (by making the target mailbox more salient; Experiment 1) and top-down instructions (by informing participants about the cue; Experiment 2). The bottom-up salience of the target had no effect on the overall time taken to search for the target, although the salient target was more likely to be fixated and found once it was within the central visual field. Top-down knowledge of target appearance had a larger effect, reducing the need for multiple head and body movements, and meaning that the target was fixated earlier and from further away. Although there remains much to be discovered in complex real-world search, this study demonstrates that principles from visual search in the labouratory influence gaze in natural behaviour, and provides a bridge between these labouratory studies and research examining vision in natural tasks.

  1. Eye guidance during real-world scene search: The role color plays in central and peripheral vision.

    Science.gov (United States)

    Nuthmann, Antje; Malcolm, George L

    2016-01-01

    The visual system utilizes environmental features to direct gaze efficiently when locating objects. While previous research has isolated various features' contributions to gaze guidance, these studies generally used sparse displays and did not investigate how features facilitated search as a function of their location on the visual field. The current study investigated how features across the visual field--particularly color--facilitate gaze guidance during real-world search. A gaze-contingent window followed participants' eye movements, restricting color information to specified regions. Scene images were presented in full color, with color in the periphery and gray in central vision or gray in the periphery and color in central vision, or in grayscale. Color conditions were crossed with a search cue manipulation, with the target cued either with a word label or an exact picture. Search times increased as color information in the scene decreased. A gaze-data based decomposition of search time revealed color-mediated effects on specific subprocesses of search. Color in peripheral vision facilitated target localization, whereas color in central vision facilitated target verification. Picture cues facilitated search, with the effects of cue specificity and scene color combining additively. When available, the visual system utilizes the environment's color information to facilitate different real-world visual search behaviors based on the location within the visual field.

  2. Detecting changes in real-world objects: The relationship between visual long-term memory and change blindness.

    Science.gov (United States)

    Brady, Timothy F; Konkle, Talia; Oliva, Aude; Alvarez, George A

    2009-01-01

    A large body of literature has shown that observers often fail to notice significant changes in visual scenes, even when these changes happen right in front of their eyes. For instance, people often fail to notice if their conversation partner is switched to another person, or if large background objects suddenly disappear.1,2 These 'change blindness' studies have led to the inference that the amount of information we remember about each item in a visual scene may be quite low.1 However, in recent work we have demonstrated that long-term memory is capable of storing a massive number of visual objects with significant detail about each item.3 In the present paper we attempt to reconcile these findings by demonstrating that observers do not experience 'change blindness' with the real world objects used in our previous experiment if they are given sufficient time to encode each item. The results reported here suggest that one of the major causes of change blindness for real-world objects is a lack of encoding time or attention to each object (see also refs. 4 and 5).

  3. Temporal and kinematic variables for real-world falls harvested from lumbar sensors in the elderly population.

    Science.gov (United States)

    Bourke, A K; Klenk, J; Schwickert, L; Aminian, K; Ihlen, E A F; Helbostad, J L; Chiari, L; Becker, C

    2015-01-01

    Automatic fall detection will reduce the consequences of falls in the elderly and promote independent living, ensuring people can confidently live safely at home. Inertial sensor technology can distinguish falls from normal activities. However, fall data recorded from elderly people in real life. The FARSEEING project has compiled a database of real life falls from elderly people, to gain new knowledge about fall events. We have extracted temporal and kinematic parameters to further improve the development of fall detection algorithms. A total of 100 real-world falls were analysed. Subjects with a known fall history were recruited, inertial sensors were attached to L5 and a fall report, following a fall, was used to extract the fall signal. This data-set was examined, and variables were extracted that include upper and lower impact peak values, posture angle change during the fall and time of occurrence. These extracted parameters, can be used to inform the design of fall-detection algorithms for real-world falls detection in the elderly.

  4. Real-world volatile organic compound emission rates from seated adults and children for use in indoor air studies.

    Science.gov (United States)

    Stönner, C; Edtbauer, A; Williams, J

    2018-01-01

    Human beings emit many volatile organic compounds (VOCs) of both endogenous (internally produced) and exogenous (external source) origin. Here we present real-world emission rates of volatile organic compounds from cinema audiences (50-230 people) as a function of time in multiple screenings of three films. The cinema location and film selection allowed high-frequency measurement of human-emitted VOCs within a room flushed at a known rate so that emissions rates could be calculated for both adults and children. Gas-phase emission rates are analyzed as a function of time of day, variability during the film, and age of viewer. The average emission rates of CO 2 , acetone, and isoprene were lower (by a factor of ~1.2-1.4) for children under twelve compared to adults while for acetaldehyde emission rates were equivalent. Molecules influenced by exogenous sources such as decamethylcyclopentasiloxanes and methanol tended to decrease over the course of day and then rise for late evening screenings. These results represent average emission rates of people under real-world conditions and can be used in indoor air quality assessments and building design. Averaging over a large number of people generates emission rates that are less susceptible to individual behaviors. © 2017 The Authors. Indoor Air published by John Wiley & Sons Ltd.

  5. A path model investigation of neurocognition, theory of mind, social competence, negative symptoms and real-world functioning in schizophrenia.

    Science.gov (United States)

    Couture, Shannon M; Granholm, Eric L; Fish, Scott C

    2011-02-01

    Problems in real-world functioning are pervasive in schizophrenia and much recent effort has been devoted to uncovering factors which contribute to poor functioning. The goal of this study was to examine the role of four such factors: social cognition (theory of mind), neurocognition, negative symptoms, and functional capacity (social competence). 178 individuals with schizophrenia or schizoaffective disorder completed measures of theory of mind, neurocognition, negative symptoms, social competence, and self-reported functioning. Path models sought to determine the relationships among these variables. Theory of mind as indexed by the Hinting Task partially mediated the relationship between neurocognition and social competence, and negative symptoms and social competence demonstrated significant direct paths with self-reported functioning. Study results suggest theory of mind serves as an important mediator in addition to previously investigated social cognitive domains of emotional and social perception. The current study also highlights the need to determine variables which mediate the relationship between functional capacity and real-world functioning. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Concentration measurement in a road tunnel as a method to assess "real-world" vehicles exhaust emissions

    Science.gov (United States)

    Zanini, G.; Berico, M.; Monforti, F.; Vitali, L.; Zambonelli, S.; Chiavarini, S.; Georgiadis, T.; Nardino, M.

    An experiment aimed at comparing particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) concentrations produced in a road tunnel by buses is described. The experiment took place in 2001 in Bologna when a couple of buses belonging to the public transport fleet where driven backwards and forwards in a road tunnel closed to all other vehicles. Buses run in the tunnel for 8 h a day for 4 experiment days, each day using a different fuel: biodiesel, diesel-water emulsion, diesel-water emulsion with low sulphur content and commercial diesel. Average daily concentrations of PM of different sizes and of 12 PHAs were measured and comparison between different fuels was attempted in order to assess "real-world" exhaust emissions of different fuels. Due to heterogeneity of experimental conditions in different days and the relatively large measurement uncertainties, the effort was only partially successful, and it was not possible to state any firm conclusion on fuels reliability even if some indications in agreement with literature were found. Nevertheless, the experiment and the data analysis method developed could be of interest as a methodological approach for future experiments aimed at evaluating "real-world" exhaust emissions of single vehicles.

  7. Leveraging Real-World Evidence in Disease-Management Decision-Making with a Total Cost of Care Estimator.

    Science.gov (United States)

    Nguyen, Thanh-Nghia; Trocio, Jeffrey; Kowal, Stacey; Ferrufino, Cheryl P; Munakata, Julie; South, Dell

    2016-12-01

    Health management is becoming increasingly complex, given a range of care options and the need to balance costs and quality. The ability to measure and understand drivers of costs is critical for healthcare organizations to effectively manage their patient populations. Healthcare decision makers can leverage real-world evidence to explore the value of disease-management interventions in shifting total cost trends. To develop a real-world, evidence-based estimator that examines the impact of disease-management interventions on the total cost of care (TCoC) for a patient population with nonvalvular atrial fibrillation (NVAF). Data were collected from a patient-level real-world evidence data set that uses the IMS PharMetrics Health Plan Claims Database. Pharmacy and medical claims for patients meeting the inclusion or exclusion criteria were combined in longitudinal cohorts with a 180-day preindex and 360-day follow-up period. Descriptive statistics, such as mean and median patient costs and event rates, were derived from a real-world evidence analysis and were used to populate the base-case estimates within the TCoC estimator, an exploratory economic model that was designed to estimate the potential impact of several disease-management activities on the TCoC for a patient population with NVAF. Using Microsoft Excel, the estimator is designed to compare current direct costs of medical care to projected costs by varying assumptions on the impact of disease-management activities and applying the associated changes in cost trends to the affected populations. Disease-management levers are derived from literature-based concepts affecting costs along the NVAF disease continuum. The use of the estimator supports analyses across 4 US geographic regions, age, cost types, and care settings during 1 year. All patients included in the study were continuously enrolled in their health plan (within the IMS PharMetrics Health Plan Claims Database) between July 1, 2010, and June 30

  8. High intensity interval training in a real world setting: a randomized controlled feasibility study in overweight inactive adults, measuring change in maximal oxygen uptake.

    Directory of Open Access Journals (Sweden)

    Helen Lunt

    Full Text Available BACKGROUND: In research clinic settings, overweight adults undertaking HIIT (high intensity interval training improve their fitness as effectively as those undertaking conventional walking programs but can do so within a shorter time spent exercising. We undertook a randomized controlled feasibility (pilot study aimed at extending HIIT into a real world setting by recruiting overweight/obese, inactive adults into a group based activity program, held in a community park. METHODS: Participants were allocated into one of three groups. The two interventions, aerobic interval training and maximal volitional interval training, were compared with an active control group undertaking walking based exercise. Supervised group sessions (36 per intervention were held outdoors. Cardiorespiratory fitness was measured using VO2max (maximal oxygen uptake, results expressed in ml/min/kg, before and after the 12 week interventions. RESULTS: On ITT (intention to treat analyses, baseline (N = 49 and exit (N = 39 [Formula: see text]O2 was 25.3±4.5 and 25.3±3.9, respectively. Participant allocation and baseline/exit VO2max by group was as follows: Aerobic interval training N =  16, 24.2±4.8/25.6±4.8; maximal volitional interval training N = 16, 25.0±2.8/25.2±3.4; walking N = 17, 26.5±5.3/25.2±3.6. The post intervention change in VO2max was +1.01 in the aerobic interval training, -0.06 in the maximal volitional interval training and -1.03 in the walking subgroups. The aerobic interval training subgroup increased VO2max compared to walking (p = 0.03. The actual (observed, rather than prescribed time spent exercising (minutes per week, ITT analysis was 74 for aerobic interval training, 45 for maximal volitional interval training and 116 for walking (p =  0.001. On descriptive analysis, the walking subgroup had the fewest adverse events. CONCLUSIONS: In contrast to earlier studies, the improvement in cardiorespiratory fitness in a

  9. Comparative effectiveness of early-line nab-paclitaxel vs. paclitaxel in patients with metastatic breast cancer: a US community-based real-world analysis

    Directory of Open Access Journals (Sweden)

    Mahtani RL

    2018-02-01

    Full Text Available Reshma L Mahtani,1 Monika Parisi,2 Stefan Glück,3 Quanhong Ni,2 Siyeon Park,4 Corey Pelletier,2 Claudio Faria,2 Fadi Braiteh5,6 1Division of Hematology/Oncology, University of Miami, Miami, FL, 2Health Economics and Outcomes Research, Celgene Corporation, Summit, NJ, 3Global Medical Affairs, Celgene Corporation, Summit, NJ, 4School of Pharmacy, The Ohio State University, Columbus, OH, 5Department of Hematology/Oncology, University of Nevada School of Medicine, Las Vegas, NV, 6Department of Hematology/Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA Background: Real-world analyses of treatments for patients with metastatic breast cancer are limited. We evaluated the comparative effectiveness of nab-paclitaxel vs. paclitaxel in patients with metastatic breast cancer using data from an electronic medical record database from community practices across the USA.Methods: We performed a retrospective cohort study using fully de-identified data from an independent US electronic medical record platform of patients with metastatic breast cancer initiating single-agent nab-paclitaxel or paclitaxel as a first- or second-line treatment from December 1, 2010 to October 6, 2014. The clinical efficacy objectives were time to treatment discontinuation (TTD and time to next treatment (TTNT. Subgroup analyses were performed in patients with 2 types of metastatic breast cancer as follows: 1 hormone receptor-positive and human epidermal growth factor receptor 2 negative, and 2 triple-negative disease. Results: This analysis included 925 patients. Patients receiving nab-paclitaxel vs. paclitaxel had significantly longer TTD (median 4.2 vs. 2.8 months, P<0.0001 and TTNT (median 6.0 vs. 4.2 months, P<0.0001; similar outcomes were observed for patients with hormone receptor-positive/human epidermal growth factor receptor 2 negative disease. Compared with paclitaxel, nab-paclitaxel was associated with significantly longer TTD in patients with triple

  10. Real-world healthcare utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir® HFA with and without integrated dose counters

    Directory of Open Access Journals (Sweden)

    Kerwin EM

    2017-05-01

    Full Text Available Edward M Kerwin,1 Thomas J Ferro,2 Rinat Ariely,3 Debra E Irwin,4 Ruchir Parikh3 1Clinical Trials Division, Clinical Research Institute of Southern Oregon, PC, Medford, OR, 2Global Medical Affairs, 3Global Health Economics and Outcome Research, Teva Pharmaceuticals, Frazer, PA, 4Outcomes Research, Truven Health Analytics, Durham, NC, USA Background: Accurate tracking of the administered dose of asthma rescue inhalers is critical for optimal disease management and is related to reductions in rates of unscheduled health care utilization in asthma patients. There are few published data on the real-world impact of rescue inhalers with integrated dose counters (IDCs on health care resource utilization (HRU for asthma patients. This study evaluates HRU among users of ProAir® hydrofluoroalkane (HFA (albuterol sulfate inhalation aerosol, with IDC versus without IDC, in asthma patients.Methods: This was a retrospective administrative claims study of asthma patients receiving a new prescription for albuterol inhalation aerosol without IDC during 2 years (January 2011–December 2012 or with IDC during the first full year after IDC implementation in the USA (July 2013–July 2014. Six months of continuous enrollment with medical and prescription drug benefits were required before and after the first prescription during the study period. Data on respiratory-related hospitalizations and emergency department (ED visits were collected during the follow-up period.Results: A total of 135,305 (32% patients used albuterol inhalation aerosol with IDC, and 287,243 (68% patients received albuterol inhalation aerosol without IDC. After adjusting for baseline confounding factors, the odds ratio (OR for experiencing a respiratory-related hospitalization (OR=0.92; 95% confidence interval [CI] 0.88–0.96 or ED visit (OR=0.92; 95% CI 0.90–0.94 was significantly lower among patients using albuterol inhalation aerosol with IDC versus without IDC.Conclusion: In a real-world

  11. Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study

    Directory of Open Access Journals (Sweden)

    Kiiskinen U

    2013-07-01

    Full Text Available Urpo Kiiskinen,1 Stephan Matthaei,2 Matthew Reaney,3 Chantal Mathieu,4 Claes-Göran Östenson,5 Thure Krarup,6 Michael Theodorakis,7,* Jacek Kiljanski,8 Carole Salaun-Martin,9 Hélène Sapin,9 Bruno Guerci10 1Eli Lilly, Helsinki, Finland; 2Quakenbrück Diabetes Center, Quakenbrück, Germany; 3Eli Lilly, Windlesham, Surrey, UK; 4Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium; 5Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 6Department of Endocrinology, Bispebjerg Hospital, Copenhagen, Denmark; 7Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; 8Eli Lilly, Warsaw, Poland; 9Eli Lilly, Neuilly Cedex, France; 10Department of Diabetes, Metabolic Diseases, and Nutrition, Hôpital Brabois, Vandoeuvre-Lès-Nancy, France *Michael Theodorakis was affiliated with the institution shown above at the time of the study, but has since left this institution Purpose: CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. Methods: CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. Results: A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both, but mean weight was reduced in the exenatide bid cohort (P < 0

  12. Estimating the real-world effects of expanding antiretroviral treatment eligibility: Evidence from a regression discontinuity analysis in Zambia.

    Directory of Open Access Journals (Sweden)

    Aaloke Mody

    2018-06-01

    Full Text Available Although randomized trials have established the clinical efficacy of treating all persons living with HIV (PLWHs, expanding treatment eligibility in the real world may have additional behavioral effects (e.g., changes in retention or lead to unintended consequences (e.g., crowding out sicker patients owing to increased patient volume. Using a regression discontinuity design, we sought to assess the effects of a previous change to Zambia's HIV treatment guidelines increasing the threshold for treatment eligibility from 350 to 500 cells/μL to anticipate effects of current global efforts to treat all PLWHs.We analyzed antiretroviral therapy (ART-naïve adults who newly enrolled in HIV care in a network of 64 clinics operated by the Zambian Ministry of Health and supported by the Centre for Infectious Disease Research in Zambia (CIDRZ. Patients were restricted to those enrolling in a narrow window around the April 1, 2014 change to Zambian HIV treatment guidelines that raised the CD4 threshold for treatment from 350 to 500 cells/μL (i.e., August 1, 2013, to November 1, 2014. Clinical and sociodemographic data were obtained from an electronic medical record system used in routine care. We used a regression discontinuity design to estimate the effects of this change in treatment eligibility on ART initiation within 3 months of enrollment, retention in care at 6 months (defined as clinic attendance between 3 and 9 months after enrollment, and a composite of both ART initiation by 3 months and retention in care at 6 months in all new enrollees. We also performed an instrumental variable (IV analysis to quantify the effect of actually initiating ART because of this guideline change on retention. Overall, 34,857 ART-naïve patients (39.1% male, median age 34 years [IQR 28-41], median CD4 268 cells/μL [IQR 134-430] newly enrolled in HIV care during this period; 23,036 were analyzed after excluding patients around the threshold to allow for clinic-to-clinic

  13. Effectiveness of the VOICES/VOCES sexually transmitted disease/human immunodeficiency virus prevention intervention when administered by health department staff: does it work in the "real world"?

    Science.gov (United States)

    Neumann, Mary Spink; O'Donnell, Lydia; Doval, Alexi San; Schillinger, Julia; Blank, Susan; Ortiz-Rios, Elizabeth; Garcia, Trinidad; O'Donnell, Carl R

    2011-02-01

    Prevention providers wonder whether benefits achieved in the original, researcher-led, efficacy trials of interventions are replicated when the intervention is delivered in real-world settings by their agency's staff. A replication study was conducted at 2 public sexually transmitted disease (STD) clinics (New York City and San Juan, PR). Using a controlled trial design, intervention (VOICES/VOCES) and comparison conditions (regular clinic services) were assigned in alternating 4-week blocks. Trained agency staff delivered the intervention. Effectiveness was assessed for incident STDs, redemption of coupons for condoms at neighborhood location after the visit, and improved knowledge and attitudes about STDs and condoms. A total of 3365 patients were recruited, completed the protocol, and followed through STD surveillance systems for an average of 17 months. Of 397 with an incident infection, 226 (13.4%) were among those enrolled during comparison blocks; 171 were among those in the intervention condition (10.2%). Controlling for site and gender, participants enrolled during intervention blocks were significantly less likely to have an incident STD reported to the surveillance system (hazard ratio, 0.78; 95% confidence interval, 0.64-0.96). Intervention block participants scored higher on scales of STD knowledge (4.89 vs. 3.87, P VOCES redeemed condoms (P < 0.05). Positive effects were more consistent in New York, which may be related to fidelity of implementation. A packaged human immunodeficiency virus prevention intervention can be delivered by agencies, with benefits similar to those achieved in the research setting.

  14. How can primary care providers manage pediatric obesity in the real world?

    Science.gov (United States)

    Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

    2011-06-01

    To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  15. Trial efficacy vs real world effectiveness in first line treatment of multiple myeloma

    NARCIS (Netherlands)

    Liwing, J.; Heeg, B.M.; Karstorp, S.; Postma, M.; Silvennoinen, R.; Putkonen, M.; Anttila, P.; Remes, K.; Abildgaard, N.; Waage, A.; Nahi, H.

    2015-01-01

    Background: Large randomized clinical trials (RCT) are the foundation of the registration of newly developed drugs. A potential problem with RCTs is that the inclusion/exclusion criteria will make the population different from the actual population treated in real life. Hence, it is important to

  16. Impact of managed care on healthcare delivery practices: the perception of healthcare administrators and clinical practitioners.

    Science.gov (United States)

    Tietze, Mari F

    2003-01-01

    Managed care has introduced changes, such as cost effectiveness, access to care, and quality of care, to many components of the U.S. healthcare delivery system. These changes have affected how healthcare administrators and clinical practitioners perceive the impact of managed care on healthcare delivery practices. A survey was initiated to explore whether the perceptions of administrators differed from those of practitioners and to discover which organizational variables could explain the difference. A descriptive, cross-sectional survey design was used for the target population of administrators and practitioners in high, moderate, and low managed-care-penetration markets. Two investigator-developed instruments--the Managed Care Perceptions Inventory (MCPI) and the MCPI-Demographic--and an intact centralization of decision-making assessment subscale were used for data collection. Administrators had a statistically significant, more positive perception of the impact of managed care on healthcare delivery than did practitioners. When the distinction between administrator and practitioner was not used as a grouping factor, managed care market penetration, nonprofit status, and years in current employment position were factors that had statistically significant associations with a more positive perception of managed care. Based on these findings, both administrators and practitioners have a role in maintaining awareness regarding their perceptions and should work collaboratively to address issues of concern. Similarly, promoting trust and commitment at the organizational level is important. Recommendations for further research are also provided.

  17. Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment.

    Science.gov (United States)

    Stanga, Z; Brunner, A; Leuenberger, M; Grimble, R F; Shenkin, A; Allison, S P; Lobo, D N

    2008-06-01

    The refeeding syndrome is a potentially lethal complication of refeeding in patients who are severely malnourished from whatever cause. Too rapid refeeding, particularly with carbohydrate may precipitate a number of metabolic and pathophysiological complications, which may adversely affect the cardiac, respiratory, haematological, hepatic and neuromuscular systems leading to clinical complications and even death. We aimed to review the development of the refeeding syndrome in a variety of situations and, from this and the literature, devise guidelines to prevent and treat the condition. We report seven cases illustrating different aspects of the refeeding syndrome and the measures used to treat it. The specific complications encountered, their physiological mechanisms, identification of patients at risk, and prevention and treatment are discussed. Each case developed one or more of the features of the refeeding syndrome including deficiencies and low plasma levels of potassium, phosphate, magnesium and thiamine combined with salt and water retention. These responded to specific interventions. In most cases, these abnormalities could have been anticipated and prevented. The main features of the refeeding syndrome are described with a protocol to anticipate, prevent and treat the condition in adults.

  18. Caries preventive measures in orthodontic practice: the development of a clinical practice guideline.

    Science.gov (United States)

    Oosterkamp, B C M; van der Sanden, W J M; Frencken, J E F M; Kuijpers-Jagtman, A M

    2016-02-01

    White spot lesions (WSLs) are a side effect of orthodontic treatment, causing esthetic problems and a risk of deeper enamel and dentine lesions. Many strategies have been developed for preventing WSLs, but great variability exists in preventive measures between orthodontists. This study developed statements on which a clinical practice guideline (CPG) can be developed in order to help orthodontists select preventive measures based on the best available evidence. A nominal group technique (RAND-e modified Delphi procedure) was used. A multidisciplinary expert panel rated 264 practice- and evidence-based statements related to the management of WSLs. To provide panel members with the same knowledge, a total of six articles obtained from a systematic review of the literature were read by the panel in preparation of three consensus rounds. According to the technique, a threshold of 75% of all ratings within any 3-point section of the 9-point scale regarding a specific statement was accepted as consensus. After the first and second consensus rounds, consensus was reached on 37.5 and 31.1% of statements, respectively. For the remaining 31.4% of statements, consensus was reached during a 4-h consensus meeting. Statements on the management of WSLs derived from a systematic literature review combined with expert opinion were formally integrated toward consensus through a nominal group technique. These statements formed the basis for developing a CPG on the management of WSLs before and during orthodontic treatment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study.

    Science.gov (United States)

    Elder, William G; Munk, Niki; Love, Margaret M; Bruckner, Geza G; Stewart, Kathryn E; Pearce, Kevin

    2017-07-01

    While efficacy of massage and other nonpharmacological treatments for chronic low back pain is established, stakeholders have called for pragmatic studies of effectiveness in "real-world" primary health care. The Kentucky Pain Research and Outcomes Study evaluated massage impact on pain, disability, and health-related quality of life for primary care patients with chronic low back pain. We report effectiveness and feasibility results, and make comparisons with established minimal clinically important differences. Primary care providers referred eligible patients for 10 massage sessions with community practicing licensed massage therapists. Oswestry Disability Index and SF-36v2 measures obtained at baseline and postintervention at 12 and 24 weeks were analyzed with mixed linear models and Tukey's tests. Additional analyses examined clinically significant improvement and predictive patient characteristics. Of 104 enrolled patients, 85 and 76 completed 12 and 24 weeks of data collection, respectively. Group means improved at 12 weeks for all outcomes and at 24 weeks for SF-36v2's Physical Component Summary and Bodily Pain Domain. Of those with clinically improved disability at 12 weeks, 75% were still clinically improved at 24 weeks ( P  < 0.01). For SF-36v2 Physical and Mental Component Summaries, 55.4% and 43.4%, respectively, showed clinically meaningful improvement at 12 weeks, 46.1% and 30.3% at 24 weeks. For Bodily Pain Domain, 49.4% were clinically improved at 12 weeks, 40% at 24 weeks. Adults older than age 49 years had better pain and disability outcomes than younger adults. Results provide a meaningful signal of massage effect for primary care patients with chronic low back pain and call for further research in practice settings using pragmatic designs with control groups. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  20. Real-World Evidence: What It Is and What It Can Tell Us According to the International Society for Pharmacoepidemiology (ISPE) Comparative Effectiveness Research (CER) Special Interest Group (SIG).

    Science.gov (United States)

    Yuan, Hongbo; Ali, M Sanni; Brouwer, Emily S; Girman, Cynthia J; Guo, Jeff J; Lund, Jennifer L; Patorno, Elisabetta; Slaughter, Jonathan L; Wen, Xuerong; Bennett, Dimitri

    2018-05-07

    On December 8, 2016, the New England Journal of Medicine published a sounding board on Real World Evidence (RWE) 1 by the US Food and Drug Administration (FDA) leadership. While the value of RWE based on nonrandomized observational studies was appreciated, such as for hypothesis generating, safety, and measuring quality in healthcare delivery, the authors expressed concerns on the quality of data sources and the ability of methodologies to control for confounding. In response, we offer a few considerations regarding these concerns. © 2018, The American Society for Clinical Pharmacology and Therapeutics.

  1. Safety and effectiveness of rivaroxaban and warfarin in moderate-to-advanced CKD: real world data.

    Science.gov (United States)

    Di Lullo, Luca; Tripepi, Giovanni; Ronco, Claudio; De Pascalis, Antonio; Barbera, Vincenzo; Granata, Antonio; Russo, Domenico; Di Iorio, Biagio Raffaele; Paoletti, Ernesto; Ravera, Maura; Fusaro, Maria; Bellasi, Antonio

    2018-06-07

    In recent years, novel anticoagulant drugs have been introduced in the clinical armamentarium and have progressively gained momentum. Although their use is increasing among CKD patients, some skepticism about their risk-benefit ratio still persists. We sought to investigate the safety and effectiveness of rivaroxaban in a cohort of moderate-to-advanced CKD patients. This observational, retrospective, longitudinal study involved 347 consecutive CKD stage 3b-4 (according to NKF-KDOQI guidelines) patients enrolled from 8 cardiac outpatient clinics between March 2015 and October 2017. All patients received anticoagulation (100 warfarin vs. 247 rivaroxaban) as part of their non-valvular atrial fibrillation management at the attending physician's discretion. Clinical effectiveness (defined as the occurrence of ischemic stroke, venous thromboembolism, or transient ischemic attack) and safety (intracranial hemorrhage, gastrointestinal or other bleeding) were assessed separately. Over a mean follow-up period of 16 ± 0.3 months, 25 stroke episodes (15 hemorrhagic, and 10 ischemic) occurred in 24 warfarin treated patients vs. none in the rivaroxaban arm. There were 5 vs. 0 episodes of deep venous thrombosis and 8 vs. 2 major episodes of bleeding in the warfarin and rivaroxaban groups, respectively. In contrast, the proportion of minor episodes of bleeding was similar between groups. Rivaroxaban seems a safe and effective therapeutic option in CKD stage 3b-4 patients. However, future randomized controlled trials are needed to definitively establish the role of rivaroxaban in CKD patients.

  2. [Family interventions in schizophrenia. From theory to the real world in Portugal today].

    Science.gov (United States)

    Gonçalves-Pereira, Manuel; Xavier, Miguel; Neves, António; Barahona-Correa, Bernardo; Fadden, Gráinne

    2006-01-01

    In the field of pychoeducational interventions in schizophrenia, terminology is sometimes misleading and further efforts are needed to specify and operationalise terms such as psychoeducation or family intervention, especially wherever they are adapted, for example, for use in non-English speaking countries. On the other hand, in spite of growing evidence of their clinical effectiveness, family interventions for schizophrenia are still not routinely implemented in real life clinical settings. Furthermore, the current poverty of original literature or replication studies in Portugal in the field of family interventions is astonishing. Several high-quality review papers have been published in the last two decades, summarising or meta-analysing data concerning efficacy, effectiveness and efficiency of these family interventions worldwide, but mostly in Anglo-Saxon literature. These findings were indeed incorporated in several clinical guidelines, namely in the United Kingdom. But there seems to exist, in a considerable number of settings, a lack of will to implement scientific findings established for more than twenty years. In developed countries, this should be addressed as a true paradox.

  3. Randomized controlled trials and real-world observational studies in evaluating cardiovascular safety of inhaled bronchodilator therapy in COPD

    Directory of Open Access Journals (Sweden)

    Kardos P

    2016-11-01

    Full Text Available Peter Kardos,1 Sally Worsley,2 Dave Singh,3 Miguel Román-Rodríguez,4 David E Newby,5 Hana Müllerová2 1Group Practice and Respiratory, Allergy and Sleep Unit, Red Cross Maingau Hospital, Frankfurt, Germany; 2GSK, Stockley Park, Middlesex, 3University of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; 4Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Palma IdisPa, Palma de Mallorca, Spain; 5BHF Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK Abstract: Long-acting muscarinic antagonist (LAMA or long-acting β2-agonist (LABA bronchodilators and their combination are recommended for the maintenance treatment of chronic obstructive pulmonary disease (COPD. Although the efficacy of LAMAs and LABAs has been well established through randomized controlled trials (RCTs, questions remain regarding their cardiovascular (CV safety. Furthermore, while the safety of LAMA and LABA monotherapy has been extensively studied, data are lacking for LAMA/LABA combination therapy, and the majority of the studies that have reported on the CV safety of LAMA/LABA combination therapy were not specifically designed to assess this. Evaluation of CV safety for COPD treatments is important because many patients with COPD have underlying CV comorbidities. However, severe CV and other comorbidities are often exclusion criteria for RCTs, contributing to a lack in external validity and generalizability. Real-world observational studies are another important tool to evaluate the effectiveness and safety of COPD therapies in a broader population of patients and can improve upon the external validity limitations of RCTs. We examine what is already known regarding the CV and cerebrovascular safety of LAMA/LABA combination therapy from RCTs and real-world observational studies, and explore the advantages and

  4. Real-World Assessment of Renal and Bone Safety among Patients with HIV Infection Exposed to Tenofovir Disoproxil Fumarate-Containing Single-Tablet Regimens.

    Science.gov (United States)

    Nkhoma, Ella T; Rosenblatt, Lisa; Myers, Joel; Villasis-Keever, Angelina; Coumbis, John

    2016-01-01

    Tenofovir disoproxil fumarate (TDF)-containing antiretroviral regimens have been associated with an increased incidence of renal and bone adverse outcomes. Here, we estimated the real-world incidence of renal and bone adverse outcomes among patients with HIV infection receiving different TDF-containing single-tablet regimens (STRs). This cohort study used US health insurance data spanning the years 2008-2014. We identified HIV-infected patients aged ≥18 years (all HIV patients) and those with ≥6 months of continuous enrollment prior to initiating efavirenz/emtricitabine/TDF (EFV/FTC/TDF), rilpivirine/FTC/TDF (RPV/FTC/TDF) or elvitegravir/cobicistat/FTC/TDF (EVG/COBI/FTC/TDF). Renal adverse outcomes were identified using renal International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Bone adverse outcomes were identified using ICD-9-CM diagnosis codes for fracture. Incidence rates (IRs) and associated 95% confidence intervals (CIs) were estimated assuming a Poisson distribution, and outcomes between STRs were compared using IR ratios (IRRs) and IR differences (IRDs). We identified 9876 and 10,383 eligible patients for the renal and fracture analyses, respectively. Observed IRs for renal adverse outcomes were 9.7, 10.5, 13.6, and 18.0 per 1000 person-years among those receiving EFV/FTC/TDF, RPV/FTC/TDF, or EVG/COBI/FTC/TDF, or all HIV patients, respectively. Corresponding values for IRs of fracture were 3.4, 3.6, 7.2, and 4.4 per 1000 person-years, respectively. Renal adverse outcomes with EFV/FTC/TDF were significantly less frequent than with EVG/COBI/FTC/TDF (IRD -3.96; 95% CI: -7.31, -1.06). No IRR differences were identified for the renal analysis. Fractures with EFV/FTC/TDF were significantly less frequent than with EVG/COBI/FTC/TDF (IRR 0.47; 95% CI: 0.27, 0.81 and IRD -3.85; 95% CI: -5.02, -2.78). In this large real-world database, observed IRs for renal adverse outcomes with TDF-containing STRs were lower

  5. An Early View of Real-World Patient Response to Sacubitril/Valsartan: A Retrospective Study of Patients with Heart Failure with Reduced Ejection Fraction.

    Science.gov (United States)

    Antol, Dana Drzayich; Casebeer, Adrianne Waldman; DeClue, Richard W; Stemkowski, Stephen; Russo, Patricia A

    2018-06-01

    Sacubitril/valsartan has been established as an effective treatment for heart failure (HF) with reduced ejection fraction based on clinical trial data; however, little is known about its use or impact in real-world practice. This study included data from medical and pharmacy claims and medical records review for patients (n = 200) who initiated sacubitril/valsartan between August 2015 and March 2016 preceding issuance of American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) focused update on new pharmacological therapy for HF (May 2016), which included recommendations for sacubitril/valsartan. A within-subject analysis compared symptoms and healthcare resource utilization before and after treatment initiation. Patients treated with sacubitril/valsartan had multiple comorbidities, and nearly all had previous treatment for HF. Most patients initiated sacubitril/valsartan at the lowest dose of 24/26 mg twice a day (BID), which remained unchanged during the observation period for half of the patients. During the first 6 weeks of treatment, few patients discontinued sacubitril/valsartan treatment (5.5%), and only 17% achieved the target dose of 97/103 mg BID after 4 months of treatment. The proportion of patients with ≥ 1 all-cause inpatient stay decreased significantly between the pre-initiation period (27.5%) and the post-initiation period (17.0%), P = 0.009. Fatigue was noted in 51.8% of patients pre-initiation and 39.5% post-initiation, P = 0.027. Shortness of breath was documented for 66.7% of patients pre-initiation and 51.8% post-initiation, P = 0.008. The findings of this real-world investigation suggest sacubitril/valsartan is associated with symptom improvements and a reduction in hospitalizations within 4 months of treatment for patients with HF and reduced ejection fraction. Novartis Pharmaceuticals Corporation.

  6. Real-world glycemic outcomes in patients with type 2 diabetes initiating exenatide once weekly and liraglutide once daily: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Saunders WB

    2016-07-01

    Full Text Available William B Saunders,1 Hiep Nguyen,2 Iftekhar Kalsekar2 1Department of Public Health Sciences, College of Health and Human Services, The University of North Carolina at Charlotte, Charlotte, NC, 2AstraZeneca, Fort Washington, PA, USA Aim: The glucagon-like peptide-1 receptor agonists exenatide once weekly (QW and liraglutide once daily (QD have demonstrated improvements in glycemic outcomes in patients with type 2 diabetes mellitus in randomized clinical trials. However, little is known about their real-world comparative effectiveness. This retrospective cohort study used the Quintiles Electronic Medical Record database to evaluate the 6-month change in glycated hemoglobin (A1C for patients initiating exenatide QW or liraglutide QD.Methods: Patients with type 2 diabetes mellitus prescribed exenatide QW (n=664 or liraglutide QD (n=3,283 between February 1, 2012 and May 31, 2013 were identified. Baseline A1C measures were from 75 days before to 15 days after initiating exenatide QW or liraglutide QD, with follow-up measures documented at 6 months (±45 days. Adjusted linear regression models compared the difference in mean A1C change. A priori defined sensitivity analysis was performed in the subgroup of patients with baseline A1C ≥7.0% and no prescription for insulin during the 12-month pre-index period.Results: For exenatide QW and liraglutide QD, respectively, mean (SD age of the main study cohort was 58.01 (10.97 and 58.12 (11.05 years, mean (SD baseline A1C was 8.4% (1.6 and 8.4% (1.6, and 48.2% and 54.2% of patients were women. In adjusted models, change in A1C did not differ between exenatide QW and liraglutide QD during 6 months of follow-up. Results were consistent in the subgroup analyses.Conclusion: In a real-world setting, A1C similarly improves in patients initiating exenatide QW or liraglutide QD. Keywords: diabetes, exenatide, outcomes

  7. Wearable motion sensors to continuously measure real-world physical activities.

    Science.gov (United States)

    Dobkin, Bruce H

    2013-12-01

    Rehabilitation for sensorimotor impairments aims to improve daily activities, walking, exercise, and motor skills. Monitoring of practice and measuring outcomes, however, is usually restricted to laboratory-based procedures and self-reports. Mobile health devices may reverse these confounders of daily care and research trials. Wearable, wireless motion sensor data, analyzed by activity pattern-recognition algorithms, can describe the type, quantity, and quality of mobility-related activities in the community. Data transmission from the sensors to a cell phone and the Internet enable continuous monitoring. Remote access to laboratory quality data about walking speed, duration and distance, gait asymmetry and smoothness of movements, as well as cycling, exercise, and skills practice, opens new opportunities to engage patients in progressive, personalized therapies with feedback about the performance. Clinical trial designs will be able to include remote verification of the integrity of complex physical interventions and compliance with practice, as well as capture repeated, ecologically sound, ratio scale outcome measures. Given the progressively falling cost of miniaturized wearable gyroscopes, accelerometers, and other physiologic sensors, as well as inexpensive data transmission, sensing systems may become as ubiquitous as cell phones for healthcare. Neurorehabilitation can develop these mobile health platforms for daily care and clinical trials to improve exercise and fitness, skills learning, and physical functioning.

  8. Implementing Cognitive Behavioral Therapy in the real world: A case study of two mental health centers

    Directory of Open Access Journals (Sweden)

    Burns Barbara J

    2008-02-01

    Full Text Available Abstract Background Behavioral health services for children and adolescents in the U.S. are lacking in accessibility, availability and quality. Evidence-based interventions for emotional and behavioral disorders can improve quality, yet few studies have systematically examined their implementation in routine care settings. Methods Using quantitative and qualitative data, we evaluated a multi-faceted implementation strategy to implement cognitive-behavioral therapy (CBT for depressed adolescents into two publicly-funded mental healthcare centers. Extent of implementation during the study's duration and variables influencing implementation were explored. Results Of the 35 clinicians eligible to participate, 25 (71% were randomized into intervention (n = 11 or usual care (n = 14. Nine intervention clinicians completed the CBT training. Sixteen adolescents were enrolled in CBT with six of the intervention clinicians; half of these received at least six CBT manually-based sessions. Multiple barriers to CBT adoption and sustained use were identified by clinicians in qualitative interviews. Conclusion Strategies to implement evidence-based interventions into routine clinical settings should include multi-method, pre-implementation assessments of the clinical environment and address multiple barriers to initial uptake as well as long-term sustainability.

  9. An Observational Study to Assess Brain MRI Change and Disease Progression in Multiple Sclerosis Clinical Practice-The MS-MRIUS Study.

    Science.gov (United States)

    Zivadinov, Robert; Khan, Nasreen; Medin, Jennie; Christoffersen, Pia; Price, Jennifer; Korn, Jonathan R; Bonzani, Ian; Dwyer, Michael G; Bergsland, Niels; Carl, Ellen; Silva, Diego; Weinstock-Guttman, Bianca

    2017-05-01

    To describe methodology, interim baseline, and longitudinal magnetic resonance imaging (MRI) acquisition parameter characteristics of the multiple sclerosis clinical outcome and MRI in the United States (MS-MRIUS). The MS-MRIUS is an ongoing longitudinal and retrospective study of MS patients on fingolimod. Clinical and brain MRI image scan data were collected from 600 patients across 33 MS centers in the United States. MRI brain outcomes included change in whole-brain volume, lateral ventricle volume, T2- and T1-lesion volumes, and new/enlarging T2 and gadolinium-enhancing lesions. Interim baseline and longitudinal MRI acquisition parameters results are presented for 252 patients. Mean age was 44 years and 81% were female. Forty percent of scans had 3-dimensional (3D) T1 sequence in the preindex period, increasing to 50% in the postindex period. Use of 2-dimensional (2D) T1 sequence decreased over time from 85% in the preindex period to 65% in the postindex. About 95% of the scans with FLAIR and 2D T1-WI were considered acceptable or good quality compared to 99-100% with 3D T1-WI. There were notable changes in MRI hardware, software, and coil (39.5% in preindex to index and 50% in index to postindex). MRI sequence parameters (orientation, thickness, or protocol) differed for 36%, 29%, and 20% of index/postindex scans for FLAIR, 2D T1-WI, and 3D T1-WI, respectively. The MS-MRIUS study linked the clinical and brain MRI outcomes into an integrated database to create a cohort of fingolimod patients in real-world practice. Variability was observed in MRI acquisition protocols overtime. © 2016 The Authors. Journal of Neuroimaging published by Wiley Periodicals, Inc. on behalf of American Society of Neuroimaging.

  10. Percutaneous Tibial Nerve Stimulation in the Office Setting: Real-world Experience of Over 100 Patients.

    Science.gov (United States)

    Sirls, Evan R; Killinger, Kim A; Boura, Judith A; Peters, Kenneth M

    2018-03-01

    To examine the outcomes and compliance with percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) symptoms. Adults who had PTNS from June 30, 2011, to October 8, 2015, were retrospectively reviewed for demographics, copay, travel distance, employment status, history, symptoms, and treatments used before, during, and after PTNS. Pearson chi-square test, Fisher exact test, Wilcoxon rank and paired t test were performed. Of 113 patients (mean age 75 ± 12 years), most were women (65.5%), married (78.1%), and retired or unemployed (80.2%). The median distance to the clinic was 8.1 mi, and the median copay was $0. The most common indication for PTNS was nocturia (92.9%) followed by OAB with urgency urinary incontinence (75.2%) and urinary urgency and/or frequency (24.8%). Prior treatments included anticholinergics (75.2%), mirabegron (36.6%), behavioral modification (29.2%), pelvic floor physical therapy (18.6%), and others (19.5%). Patients completed a mean of 10.5 ± 3 of 12 planned weekly PTNS treatments. Of 105 patients, 40 (38.1%) used concomitant treatments (most commonly anticholinergics). Of 87 patients, 62 (71.3%) had decreased symptoms at 6 weeks, and of 85 patients, 60 (70.6%) had decreased symptoms at 12 weeks. The majority (82; 75.6%) completed all 12 weekly treatments and 45 (54.9%) completed 3 (median) monthly maintenance treatments. The most common reason for noncompliance was lack of efficacy. Visit copay, employment status, and distance to the clinic were not associated with failure to complete weekly treatments or progression to monthly maintenance. Although most patients' symptoms decreased after weekly PTNS, nonadherence to maintenance and lack of efficacy may limit long-term feasibility. Copay and distance traveled were not associated with noncompliance. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Real-World Effectiveness of Pentavalent Rotavirus Vaccine Among Bedouin and Jewish Children in Southern Israel.

    Science.gov (United States)

    Leshem, Eyal; Givon-Lavi, Noga; Tate, Jacqueline E; Greenberg, David; Parashar, Umesh D; Dagan, Ron

    2016-05-01

    Pentavalent rotavirus vaccine (RV5) was introduced into the Israeli National Immunization Program in January 2011. We determined RV5 vaccine effectiveness (VE) in southern Israel, a region characterized by 2 distinct populations: Bedouins living in a low- to middle-income, semirural setting, and Jews living in a high-income, urban setting. We enrolled vaccine-eligible children who visited the emergency department (ED) or were hospitalized due to acute gastroenteritis (AGE) during the first 3 rotavirus seasons after RV5 vaccine introduction (2011-2013). Fecal specimens were tested for rotavirus by enzyme immunoassay and genotyped. Vaccination among laboratory-confirmed rotavirus cases was compared with rotavirus-negative AGE controls. Regression models were used to calculate VE estimates by age, clinical setting, and ethnicity. Of 515 enrolled patients, 359 (70%) were Bedouin. Overall, 185 (36%) patients were rotavirus positive; 79 of 119 (66%) were G1P[8] genotype. The adjusted VE for a full 3-dose course of RV5 against ED visit or hospitalization was 63% (95% confidence interval [CI], 38%-78%). RV5 provided G1P[8] genotype-specific effectiveness of 78% (95% CI, 58%-88%). By age, RV5 VE was 64% (95% CI, 21%-84%) and 71% (95% CI, 39%-86%) among children aged 6-11 months and 12-23 months, respectively. By clinical setting, RV5 VE was 59% (95% CI, 23%-78%) against hospitalization, and 67% (95% CI, 11%-88%) against ED visit. The adjusted VE of a full RV5 course among Bedouin children was 62% (95% CI, 29%-79%). RV5 significantly protected against rotavirus-associated ED visits and hospitalizations in a diverse population of vaccine-eligible children living in southern Israel. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  12. Identifying factors that predict the choice and success rate of radial artery catheterisation in contemporary real world cardiology practice: a sub-analysis of the PREVAIL study data.

    Science.gov (United States)

    Pristipino, Christian; Roncella, Adriana; Trani, Carlo; Nazzaro, Marco S; Berni, Andrea; Di Sciascio, Germano; Sciahbasi, Alessandro; Musarò, Salvatore Donato; Mazzarotto, Pietro; Gioffrè, Gaetano; Speciale, Giulio

    2010-06-01

    To assess: the reasons behind an operator choosing to perform radial artery catheterisation (RAC) as against femoral arterial catheterisation, and to explore why RAC may fail in the real world. A pre-determined analysis of PREVAIL study database was performed. Relevant data were collected in a prospective, observational survey of 1,052 consecutive patients undergoing invasive cardiovascular procedures at nine Italian hospitals over a one month observation period. By multivariate analysis, the independent predictors of RAC choice were having the procedure performed: (1) at a high procedural volume centre; and (2) by an operator who performs a high volume of radial procedures; clinical variables played no statistically significant role. RAC failure was predicted independently by (1) a lower operator propensity to use RAC; and (2) the presence of obstructive peripheral artery disease. A 10-fold lower rate of RAC failure was observed among operators who perform RAC for > 85% of their personal caseload than among those who use RAC < 25% of the time (3.8% vs. 33.0%, respectively); by receiver operator characteristic (ROC) analysis, no threshold value for operator RAC volume predicted RAC failure. A routine RAC in all-comers is superior to a selective strategy in terms of feasibility and success rate.

  13. Sexual Self-Schemas in the Real World: Investigating the Ecological Validity of Language-Based Markers of Childhood Sexual Abuse.

    Science.gov (United States)

    Stanton, Amelia M; Meston, Cindy M; Boyd, Ryan L

    2017-06-01

    This is the first study to examine language use and sexual self-schemas in natural language data extracted from posts to a large online forum. Recently, two studies applied advanced text analysis techniques to examine differences in language use and sexual self-schemas between women with and without a history of childhood sexual abuse. The aim of the current study was to test the ecological validity of the differences in language use and sexual self-schema themes that emerged between these two groups of women in the laboratory. Archival natural language data were extracted from a social media website and analyzed using LIWC2015, a computerized text analysis program, and other word counting approaches. The differences in both language use and sexual self-schema themes that manifested in recent laboratory research were replicated and validated in the large online sample. To our knowledge, these results provide the first empirical examination of sexual cognitions as they occur in the real world. These results also suggest that natural language analysis of text extracted from social media sites may be a potentially viable precursor or alternative to laboratory measurement of sexual trauma phenomena, as well as clinical phenomena, more generally.

  14. Reporting on the Strategies Needed to Implement Proven Interventions: An Example From a "Real-World" Cross-Setting Implementation Study.

    Science.gov (United States)

    Gold, Rachel; Bunce, Arwen E; Cohen, Deborah J; Hollombe, Celine; Nelson, Christine A; Proctor, Enola K; Pope, Jill A; DeVoe, Jennifer E

    2016-08-01

    The objective of this study was to empirically demonstrate the use of a new framework for describing the strategies used to implement quality improvement interventions and provide an example that others may follow. Implementation strategies are the specific approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention's components. Such strategies have not been regularly reported in descriptions of interventions' effectiveness, or in assessments of how proven interventions are implemented in new settings. This lack of reporting may hinder efforts to successfully translate effective interventions into "real-world" practice. A recently published framework was designed to standardize reporting on implementation strategies in the implementation science literature. We applied this framework to describe the strategies used to implement a single intervention in its original commercial care setting, and when implemented in community health centers from September 2010 through May 2015. Per this framework, the target (clinic staff) and outcome (prescribing rates) remained the same across settings; the actor, action, temporality, and dose were adapted to fit local context. The framework proved helpful in articulating which of the implementation strategies were kept constant and which were tailored to fit diverse settings, and simplified our reporting of their effects. Researchers should consider consistently reporting this information, which could be crucial to the success or failure of implementing proven interventions effectively across diverse care settings. clinicaltrials.gov Identifier: NCT02299791. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  15. 15-month-olds' transfer of learning between touch screen and real-world displays: language cues and cognitive loads.

    Science.gov (United States)

    Zack, Elizabeth; Gerhardstein, Peter; Meltzoff, Andrew N; Barr, Rachel

    2013-02-01

    Infants have difficulty transferring information between 2D and 3D sources. The current study extends Zack, Barr, Gerhardstein, Dickerson & Meltzoff's (2009) touch screen imitation task to examine whether the addition of specific language cues significantly facilitates 15-month-olds' transfer of learning between touch screens and real-world 3D objects. The addition of two kinds of linguistic cues (object label plus verb or nonsense name) did not elevate action imitation significantly above levels observed when such language cues were not used. Language cues hindered infants' performance in the 3D→2D direction of transfer, but only for the object label plus verb condition. The lack of a facilitative effect of language is discussed in terms of competing cognitive loads imposed by conjointly transferring information across dimensions and processing linguistic cues in an action imitation task at this age. © 2012 The Authors. Scandinavian Journal of Psychology © 2012 The Scandinavian Psychological Associations.

  16. 15-Month-Olds’ Transfer of Learning between Touch Screen and Real-World Displays: Language Cues and Cognitive Loads

    Science.gov (United States)

    Zack, Elizabeth; Gerhardstein, Peter; Meltzoff, Andrew N.; Barr, Rachel

    2012-01-01

    Infants have difficulty transferring information between 2D and 3D sources. The current study extends Zack et al.’s (2009) touch screen imitation task to examine whether the addition of specific language cues significantly facilitates 15-month-olds’ transfer of learning between touch screens and real-world 3D objects. The addition of two kinds of linguistic cues (object label plus verb or nonsense name) did not elevate action imitation significantly above levels observed when such language cues were not used. Language cues hindered infants’ performance in the 3D→2D direction of transfer, but only for the object label plus verb condition. The lack of a facilitative effect of language is discussed in terms of competing cognitive loads imposed by conjointly transferring information across dimensions and processing linguistic cues in an action imitation task at this age. PMID:23121508

  17. Modelling a real-world buried valley system with vertical non-stationarity u