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Sample records for reduce unnecessary testing

  1. Reducing unnecessary lab testing in the ICU with artificial intelligence.

    Science.gov (United States)

    Cismondi, F; Celi, L A; Fialho, A S; Vieira, S M; Reti, S R; Sousa, J M C; Finkelstein, S N

    2013-05-01

    To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1-3]. Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the likely information to be gained from proposed future

  2. Reducing unnecessary lab testing in the ICU with artificial intelligence

    Science.gov (United States)

    Cismondi, F.; Celi, L.A.; Fialho, A.S.; Vieira, S.M.; Reti, S.R.; Sousa, J.M.C.; Finkelstein, S.N.

    2017-01-01

    Objectives To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Design Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Patients Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Main results Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1–3]. Conclusions Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the

  3. How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

    NARCIS (Netherlands)

    Vegting, I.L.; van Beneden, M.; Kramer, M.H.H.; Thijs, A.; Kostense, P.J.; Nanayakkara, P.W.B.

    2012-01-01

    Background: The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic

  4. Implementation of a Computerized Order Entry Tool to Reduce the Inappropriate and Unnecessary Use of Cardiac Stress Tests With Imaging in Hospitalized Patients.

    Science.gov (United States)

    Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Balderston, Jessica R; Litwack, Andrew J; Goldberg, Lee R

    2016-10-15

    The rising use of imaging cardiac stress tests has led to potentially unnecessary testing. Interventions designed to reduce inappropriate stress testing have focused on the ambulatory setting. We developed a computerized order entry tool intended to reduce the use of imaging cardiac stress tests and improve appropriate use in hospitalized patients. The tool was evaluated using preimplementation and postimplementation cohorts at a single urban academic teaching hospital. All hospitalized patients referred for testing were included. The co-primary outcomes were the use of imaging stress tests as a percentage of all stress tests and the percentage of inappropriate tests, compared between the 2 cohorts. There were 478 patients in the precohort and 463 in the postcohort. The indication was chest pain in 66% and preoperative in 18% and was not significantly different between groups. The use of nonimaging stress tests increased from 4% in the pregroup to 15% in the postgroup (p nonimaging stress tests increased from 7% to 25% (p nonimaging cardiac stress tests and reduced the use of imaging tests yet was not able to reduce inappropriate use. Our study highlights the differences in cardiac stress testing between hospitalized and ambulatory patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Allergy testing in atopic dermatitis: often unnecessary

    NARCIS (Netherlands)

    Thijs, J.L.; Damoiseaux, R.A.; Lucassen, P.L.; Pasmans, S.G.; Bruin-Weller, M. de; Bruijnzeel-Koomen, C.A.

    2013-01-01

    Atopic dermatitis (AD) is a chronic inflammatory skin disease from which many children and adults suffer. In the Netherlands, the majority of patients with AD are treated in the primary health care setting. There is no clear consensus about whether or not to conduct allergy testing in patients with

  6. Effective diagnostic DAQ systems to reduce unnecessary data in KSTAR

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Taegu, E-mail: glory@nfri.re.kr; Lee, Woongryol; Hong, Jaesic; Park, Kaprai

    2016-11-15

    Highlights: • When plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. • To overcome this problem, some KSTAR’s library were upgraded to monitor the plasma status in real-time. • With the real-time information of plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. • We were able to reduce the refuse data of approximately 698 GByte in the KSTAR 7th campaign. • It was a very effective way to store useful data, and it was helpful to analysts after shot. - Abstract: The plasma status of Korea Superconducting Tokamak Advanced Research (KSTAR) is measured by various diagnostics systems. The measured data size has been increasing every year due to increasing plasma pulse lengths, higher diagnostics operating frequencies, the additions of new diagnostic systems, and an increasing number of diagnostics channels. At times, when plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. In addition, the analysis time was affected, as these data need to be separated from the relevant data set. To overcome this problem, KSTAR’s Standard Framework (SFW), Real Time Monitoring (RTMON), and Pulse Automation and Scheduling System (PASS) were upgraded to monitor the plasma status in real-time. When the plasma current is less than 200kA, RTMON sends the plasma status information every second to the SFW via EPICS Channel Access. With the real-time information on plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. This paper describes a method for reducing the storage of unnecessary data and its results in the KSTAR 7th campaign.

  7. [Unnecessary routine laboratory tests in patients referred for surgical services].

    Science.gov (United States)

    Mata-Miranda, María del Pilar; Cano-Matus, Norberto; Rodriguez-Murrieta, Margarita; Guarneros-Zapata, Idalia; Ortiz, Mario

    2016-01-01

    To question the usefulness of the lab analysis considered routine testing for the identification of abnormalities in the surgical care. To determine the percentage of unnecessary laboratory tests in the preoperative assessment as well as to estimate the unnecessary expenses. A descriptive, cross-sectional study of patients referred for surgical evaluation between January 1st and March 31st 2013. The database of laboratory testing and electronic files were reviewed. Reference criteria from surgical services were compared with the tests requested by the family doctor. In 65% of the patients (n=175) unnecessary examinations were requested, 25% (n=68) were not requested the tests that they required, and only 10% of the patients were requested laboratory tests in accordance with the reference criteria (n=27). The estimated cost in unnecessary examinations was $1,129,552 in a year. The results were similar to others related to this theme, however, they had not been revised from the perspective of the first level of attention regarding the importance of adherence to the reference criteria which could prevent major expenditures. It is a priority for leaders and operational consultants in medical units to establish strategies and lines of action that ensure compliance with institutional policies so as to contain spending on comprehensive services, and which in turn can improve the medical care. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  8. Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Directory of Open Access Journals (Sweden)

    MUHAMMAD AZAM ISHAQUE CHAUDHARY

    2017-07-01

    Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.

  9. "Send & Hold" Clinical Decision Support Rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C.

    Science.gov (United States)

    Rodriguez-Borja, Enrique; Corchon-Peyrallo, Africa; Barba-Serrano, Esther; Villalba Martínez, Celia; Carratala Calvo, Arturo

    2018-02-03

    We assessed the impact of several "send & hold" clinical decision support rules (CDSRs) within the electronical request system for vitamins A, E, K, B1, B2, B3, B6 and C for all outpatients at a large health department. When ordered through electronical request, providers (except for all our primary care physicians who worked as a non-intervention control group) were always asked to answer several compulsory questions regarding main indication, symptomatology, suspected diagnosis, vitamin active treatments, etc., for each vitamin test using a drop-down list format. After samples arrival, tests were later put on hold internally by our laboratory information system (LIS) until review for their appropriateness was made by two staff pathologists according to the provided answers and LIS records (i.e. "send & hold"). The number of tests for each analyte was compared between the 10-month period before and after CDSRs implementation in both groups. After implementation, vitamins test volumes decreased by 40% for vitamin A, 29% for vitamin E, 42% for vitamin K, 37% for vitamin B1, 85% for vitamin B2, 68% for vitamin B3, 65% for vitamin B6 and 59% for vitamin C (all p values 0.03 or lower except for vitamin B3), whereas in control group, the majority increased or remained stable. In patients with rejected vitamins, no new requests and/or adverse clinical outcome comments due to this fact were identified. "Send & hold" CDSRs are a promising informatics tool that can support in utilization management and enhance the pathologist's leadership role as tests specialist.

  10. [An initiative to reduce the use of unnecessary medication in infants with bronchiolitis in primary care].

    Science.gov (United States)

    Montejo Fernández, Marta; Benito Manrique, Iñaki; Montiel Eguía, Arantza; Benito Fernández, Javier

    2018-05-23

    Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged initiative may be applied to the settings where the majority of infants with acute bronchiolitis are attended in western countries. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  11. Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

    Science.gov (United States)

    Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M

    2016-03-01

    To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.

  12. Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.

    Science.gov (United States)

    Malmartel, A; Dutron, M; Ghasarossian, C

    2017-09-01

    About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.

  13. A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

    Science.gov (United States)

    Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

    2018-03-01

    Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program.

    Science.gov (United States)

    Sadana, Divyajot; Pratzer, Ariella; Scher, Lauren J; Saag, Harry S; Adler, Nicole; Volpicelli, Frank M; Auron, Moises; Frank, Steven M

    2018-01-01

    Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized. We review the most recent transfusion practice guidelines and the evidence supporting these guidelines. We also discuss several medical societies' Choosing Wisely campaigns to reduce or eliminate overuse of transfusions. A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice.

  15. The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain.

    Science.gov (United States)

    Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun

    2018-06-01

    The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.

  16. Routine preoperative blood group and save testing is unnecessary for elective laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Tandon, A.; Shahzad, K.; Nunes, Q.; Shrotri, M.; Lunevicius, R.

    2017-01-01

    Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes. (author)

  17. The criteria for the decision of transrectal US-guided prostate biopsy: Can we reduce the number of unnecessary biopsies?

    International Nuclear Information System (INIS)

    Cho, Joon Hyung; Cho, Jae Ho; Ahn, Jay Hong; Chang, Jay Chun

    2001-01-01

    To establish the criteria which can safely reduce the number of unnecessary biopsies by comparing the transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and prostate specific antigen density (PSAD) in the decision of criteria for the prostatic biopsy using TRUS. Two hundred and twenty patients underwent TRUS- guided prostate biopsy due to elevated PSA and/or focal nodule on TRUS were included. Sixty five (27.5%) patients were confirmed as prostate cancer, and remained 155 (70.5%) patients were reported as benign diseases including benign prostate hyperplasia. The sensitivity, specificity and accuracy of TRUS, PSA and PSAD were evaluated and the single criterion or the combination of the criteria which can safely reduce the unnecessary biopsies without missing prostatic cancer were investigated. The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4 ng/ml) and PSAD (cut-off level, 0.2 ng/ml/cm 3 ) were 78.5%/95.4%/95.4%/27.8%/51.6%/64/5%, 42.7%/64.5%/73.6%, respectively. PSAD cut-off level 0.2 ng/ml/cm 3 was the most excellent single criterion for the decision of prostatic biopsy and the number of unnecessary biopsies was 100 cases. But 3 cases of prostatic cancer which the PSAD level was below 0.2 ng/ml/cm 3 were included and in all these 3 cases, a focal nodule was detected on TRUS. Therefore, we applied these two criteria at once and the biopsies of 30 cases (13.6%) are unnecessary. With the single criterion, we could not obtain the satisfactory results but by the combinations of criteria (TRUS and PSAD), 30 (13.6%) cases are unnecessary biopsies without missing cancer. We think that the short term follow-up may be a substitute for the immediate when nodular lesion is suspicious on TRUS and serum PSAD level is below 0.2 ng/ml/cm 3 .

  18. "No zone" approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations.

    Science.gov (United States)

    Ibraheem, Kareem; Khan, Muhammad; Rhee, Peter; Azim, Asad; O'Keeffe, Terence; Tang, Andrew; Kulvatunyou, Narong; Joseph, Bellal

    2018-01-01

    The most recent management guidelines advocate computed tomography angiography (CTA) for any suspected vascular or aero-digestive injuries in all zones and give zone II injuries special consideration. We hypothesized that physical examination can safely guide CTA use in a "no zone" approach. An 8-year retrospective analysis of all adult trauma patients with penetrating neck trauma (PNT) was performed. We included all patients in whom the platysma was violated. Patients were classified into three groups as follows: hard signs, soft signs, and asymptomatic. CTA use, positive CTA (contrast extravasation, dissection, or intimal flap) and operative details were reported. Primary outcomes were positive CTA and therapeutic neck exploration (TNE) (defined by repair of major vascular or aero-digestive injuries). A total of 337 patients with PNT met the inclusion criteria. Eighty-two patients had hard signs and all of them went to the operating room, of which 59 (72%) had TNE. One hundred fifty-six patients had soft signs, of which CTA was performed in 121 (78%), with positive findings in 12 (10%) patients. The remaining 35 (22%) underwent initial neck exploration, of which 14 (40%) were therapeutic yielding a high rate of negative exploration. Ninty-nine patients were asymptomatic, of which CTA was performed in 79 (80%), with positive findings in 3 (4%), however, none of these patients required TNE. On sub analysis based on symptoms, there was no difference in the rate of TNE between the neck zones in patients with hard signs (P = 0.23) or soft signs (P = 0.51). Regardless of the zone of injury, asymptomatic patients did not require a TNE. Physical examination regardless of the zone of injury should be the primary guide to CTA or TNE in patients with PNT. Following traditional zone-based guidelines can result in unnecessary negative explorations in patients with soft signs and may need rethinking. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Reduction in unnecessary red blood cell folate testing by restricting computerized physician order entry in the electronic health record.

    Science.gov (United States)

    MacMillan, Thomas E; Gudgeon, Patrick; Yip, Paul M; Cavalcanti, Rodrigo B

    2018-05-02

    Red blood cell folate is a laboratory test with limited clinical utility. Previous attempts to reduce physician ordering of unnecessary laboratory tests, including folate, have resulted in only modest success. The objective of this study was to assess the effectiveness and impacts of restricting red blood cell folate ordering in the electronic health record. This was a retrospective observational study from January 2010 to December 2016 at a large academic healthcare network in Toronto, Canada. All inpatients and outpatients who underwent at least 1 red blood cell folate or vitamin B12 test during the study period were included. Red blood cell folate ordering was restricted to clincians in gastroenterology and hematology and was removed from other physicians' computerized order entry screen in the electronic health record in June 2013. Red blood cell folate testing decreased by 94.4% during the study, from a mean of 493.0 (SD 48.0) tests/month before intervention to 27.6 (SD 10.3) tests/month after intervention (P<.001). Restricting red blood cell folate ordering in the electronic health record resulted in a large and sustained reduction in red blood cell folate testing. Significant cost savings estimated at over a quarter-million dollars (CAD) over three years were achieved. There was no significant clinical impact of the intervention on the diagnosis of folate deficiency. Copyright © 2018. Published by Elsevier Inc.

  20. Impact of an educational intervention designed to reduce unnecessary recall during screening mammography.

    Science.gov (United States)

    Carney, Patricia A; Abraham, Linn; Cook, Andrea; Feig, Stephen A; Sickles, Edward A; Miglioretti, Diana L; Geller, Berta M; Yankaskas, Bonnie C; Elmore, Joann G

    2012-09-01

    The aim of this study was to describe the impact of a tailored Web-based educational program designed to reduce excessive screening mammography recall. Radiologists enrolled in one of four mammography registries in the United States were invited to take part and were randomly assigned to receive the intervention or to serve as controls. The controls were offered the intervention at the end of the study, and data collection included an assessment of their clinical practice as well. The intervention provided each radiologist with individual audit data for his or her sensitivity, specificity, recall rate, positive predictive value, and cancer detection rate compared to national benchmarks and peer comparisons for the same measures; profiled breast cancer risk in each radiologist's respective patient populations to illustrate how low breast cancer risk is in population-based settings; and evaluated the possible impact of medical malpractice concerns on recall rates. Participants' recall rates from actual practice were evaluated for three time periods: the 9 months before the intervention was delivered to the intervention group (baseline period), the 9 months between the intervention and control groups (T1), and the 9 months after completion of the intervention by the controls (T2). Logistic regression models examining the probability that a mammogram was recalled included indication of intervention versus control and time period (baseline, T1, and T2). Interactions between the groups and time period were also included to determine if the association between time period and the probability of a positive result differed across groups. Thirty-one radiologists who completed the continuing medical education intervention were included in the adjusted model comparing radiologists in the intervention group (n = 22) to radiologists who completed the intervention in the control group (n = 9). At T1, the intervention group had 12% higher odds of positive mammographic results

  1. Assessing social values for California's efforts to reduce the overuse of unnecessary medical care.

    Science.gov (United States)

    Perez, Susan L; Backman, Desiree; Ginsburg, Marge

    2018-04-01

    A partnership of large health-care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California. Employ a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse. Use of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost-sharing or taking no definitive action. Five themes were identified, including strong support for physicians' leadership role to reduce overuse; nuanced enthusiasm for increasing patient cost-sharing to discourage excessive demand; and marked disapproval of physician compensation as a motivator. Most but not all of the perspectives voiced by participants are congruent with efforts to reduce overuse that is being initiated or discussed at the state, provider and health plan level. As health-care policymakers and leaders consider more targeted approaches to reducing overuse, these findings will inform decision-making. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  2. The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns.

    Science.gov (United States)

    Kahvecioglu, Dilek; Erdeve, Omer; Alan, Serdar; Cakir, Ufuk; Yildiz, Duran; Atasay, Begum; Arsan, Saadet

    2014-11-01

    Almost 95% of the platelet transfusions (PTs) conducted in the neonatal intensive care unit (NICU) are prophylactic transfusions. Guidelines for prophylactic PTs are based on platelet counts, but not on platelet functions. Nowadays, in order to reduce unnecessary transfusions, utilizing platelet mass index (PMI) was investigated. The aim of study is to find out whether PTs performed in our NICU during last 2 years were in accordance with the current guideline and to evaluate whether the frequency of PTs should be reduced if PMI was considered. Forty-three infants who received 96 prophylactic PTs were enrolled in the study. The guideline utilized in our NICU advocate keeping the platelet count: (a) >100 000 in pre/post-operative, (b) >50 000 in unstable and (c) >20 000 in stable patients. According to PMI criteria, PT should be performed if PMI: (a) platelet functions into account may yield lower transfusion rate, lower costs and better conservation of blood bank resources.

  3. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.

    Science.gov (United States)

    Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

    2014-04-01

    Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, pSMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; pSMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.

  4. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

    Science.gov (United States)

    Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J; Main, Cheryl; Mertz, Dominik

    2015-01-01

    Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Quasi-experimental study with a control group. Two tertiary teaching adult care hospitals. Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline) and January 30th and April 30th, 2013 (intervention). In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly) on one clinical teaching unit (CTU) at one hospital site, with the CTU of the other hospital serving as the control. During the baseline period, 160/341 (46.9%) positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8%) were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3), absence of a catheter (OR 2.5, 1.2-5), bacteriuria versus candiduria (OR 10.6, 3.8-29.4), pyuria (OR 2.0, 1.1-3.8), and positive nitrites (OR 2.2, 1.1-4.5). In 2013, only 2/24 (8%) of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52%) on the control CTU (OR 0.10; 95% CI 0.02-0.49). A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7) with no significant change noted on the control CTU (OR 0.47, 0.13-1.7). A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

  5. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

    Directory of Open Access Journals (Sweden)

    Neal Irfan

    Full Text Available Asymptomatic bacteriuria (ABU should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice.To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU.Quasi-experimental study with a control group.Two tertiary teaching adult care hospitals.Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline and January 30th and April 30th, 2013 (intervention.In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly on one clinical teaching unit (CTU at one hospital site, with the CTU of the other hospital serving as the control.During the baseline period, 160/341 (46.9% positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8% were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3, absence of a catheter (OR 2.5, 1.2-5, bacteriuria versus candiduria (OR 10.6, 3.8-29.4, pyuria (OR 2.0, 1.1-3.8, and positive nitrites (OR 2.2, 1.1-4.5. In 2013, only 2/24 (8% of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52% on the control CTU (OR 0.10; 95% CI 0.02-0.49. A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7 with no significant change noted on the control CTU (OR 0.47, 0.13-1.7.A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

  6. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

    Science.gov (United States)

    Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

    2014-01-01

    Background Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. Methods To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. Results 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. Conclusions UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits. PMID:24077850

  7. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria

    OpenAIRE

    Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J.; Main, Cheryl; Mertz, Dominik

    2015-01-01

    Background Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. Objective To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Design Quasi-experimental study with a control group. Setting Two tertiary teaching adult care hospitals. Participants Consec...

  8. High-Risk Breast Lesions: A Machine Learning Model to Predict Pathologic Upgrade and Reduce Unnecessary Surgical Excision.

    Science.gov (United States)

    Bahl, Manisha; Barzilay, Regina; Yedidia, Adam B; Locascio, Nicholas J; Yu, Lili; Lehman, Constance D

    2018-03-01

    Purpose To develop a machine learning model that allows high-risk breast lesions (HRLs) diagnosed with image-guided needle biopsy that require surgical excision to be distinguished from HRLs that are at low risk for upgrade to cancer at surgery and thus could be surveilled. Materials and Methods Consecutive patients with biopsy-proven HRLs who underwent surgery or at least 2 years of imaging follow-up from June 2006 to April 2015 were identified. A random forest machine learning model was developed to identify HRLs at low risk for upgrade to cancer. Traditional features such as age and HRL histologic results were used in the model, as were text features from the biopsy pathologic report. Results One thousand six HRLs were identified, with a cancer upgrade rate of 11.4% (115 of 1006). A machine learning random forest model was developed with 671 HRLs and tested with an independent set of 335 HRLs. Among the most important traditional features were age and HRL histologic results (eg, atypical ductal hyperplasia). An important text feature from the pathologic reports was "severely atypical." Instead of surgical excision of all HRLs, if those categorized with the model to be at low risk for upgrade were surveilled and the remainder were excised, then 97.4% (37 of 38) of malignancies would have been diagnosed at surgery, and 30.6% (91 of 297) of surgeries of benign lesions could have been avoided. Conclusion This study provides proof of concept that a machine learning model can be applied to predict the risk of upgrade of HRLs to cancer. Use of this model could decrease unnecessary surgery by nearly one-third and could help guide clinical decision making with regard to surveillance versus surgical excision of HRLs. © RSNA, 2017.

  9. Long Detection Programming in Single-Chamber Defibrillators Reduces Unnecessary Therapies and Mortality: The ADVANCE III Trial.

    Science.gov (United States)

    Gasparini, Maurizio; Lunati, Maurizio G; Proclemer, Alessandro; Arenal, Angel; Kloppe, Axel; Martínez Ferrer, Josè B; Hersi, Ahmad S; Gulaj, Marcin; Wijffels, Maurits C E; Santi, Elisabetta; Manotta, Laura; Varma, Niraj

    2017-11-01

    This study sought to evaluate the effects of programming a long detection in single-chamber (VVI) implantable cardioverter-defibrillators (ICDs) in the multicenter prospective ADVANCE III (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III) trial. Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs. A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length functions enabled. Therapies delivered were compared using a negative binomial regression model. A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm. Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175). Copyright © 2017 The Authors. Published by Elsevier Inc. All

  10. Serological biomarker testing helps avoiding unnecessary endoscopies in obese patients before bariatric surgery

    Directory of Open Access Journals (Sweden)

    Jaanus Suumann

    2018-02-01

    Full Text Available Abstract Background To assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS in pre-operative assessment of patients referred for bariatric surgery. Methods Sixty-five obese patients with a mean age of 43 years (range: 21–65 and a mean body mass index (BMI of 44 (range: 36–59 were studied. The patients were tested with a four-biomarker panel: pepsinogen I and II, gastrin-17 (basal and stimulated, and Helicobacter pylori (HP antibodies (GastroPanel®, Biohit Oyj, Finland. On the basis of the biomarker test, the patients were classified into the HS (healthy stomach group (n = 22 with the normal biomarker profile and the NHS (non-healthy stomach group (n = 43. The classification of patients into HS and NHS was evaluated against the gold standard, i.e. EGDS with biopsies. Results The concordance (Cohen’s kappa between the biomarker test and gastric histology was 0.68; 95% CI 0.504–0.854, with an overall agreement of 84.6% (95% CI 73.9–91.4%. In the NHS group, all 43 patients had biopsy-confirmed chronic gastritis: 39 non-atrophic HP-gastritis, 4 atrophic antrum gastritis (AGA of moderate severity. In the HS group only 6 patients had mild superficial H.pylori negative gastritis. Of the 22 HS subjects with the normal biomarker profile, 20 (31% of all 65 had no complaints either, while the remaining two had reflux symptoms with esophagitis. In the NHS group 10 patients had esophagitis and 8 had also reflux symptoms. Conclusions The normal biomarker profile is an excellent surrogate for healthy stomach, implicating that pre-operative EGDS could have been avoided in 31% of our asymptomatic bariatric surgery patients who had the normal biomarker profile.

  11. Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Beets-Tan, R.G.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Essers, B.A.B. [Maastricht University Medical Centre, Department of Epidemiology and Medical Technology, Maastricht (Netherlands); Breukink, S.; Beets, G.L. [Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Cappendijk, V.C. [Jeroen Bosch Hospital, Department of Radiology, ' s Hertogenbosch (Netherlands)

    2015-05-01

    To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 EUR from 2,482 to 1,888 EUR (CL:-1081; -143). Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. (orig.)

  12. Reducing Unnecessary and Duplicate Ordering for Ovum and Parasite Examinations and Clostridium difficile PCR in Immunocompromised Patients by Using an Alert at the Time of Request in the Order Management System.

    Science.gov (United States)

    Otto, Caitlin C; Shuptar, Susan L; Milord, Philippe; Essick, Connor J; Nevrekar, Reshma; Granovsky, Svetlana L; Seo, Susan K; Babady, N Esther; Martin, Steven C; Tang, Yi-Wei; Pessin, Melissa S

    2015-08-01

    We implemented hospital information system (HIS) alerts to deter unnecessary test orders for ovum and parasite (O&P) exams and Clostridium difficile PCR. The HIS alerts decreased noncompliant O&P orders (orders after >72 h of hospitalization) from 49.8% to 30.9%, an overall decrease of 19%, and reduced noncompliant C. difficile PCR orders (orders <7 days after a previous positive result) from 30.6% to 19.2%, an overall decrease of 31.9%. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  13. Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain

    Directory of Open Access Journals (Sweden)

    Jeremiah S. Hinson

    2017-02-01

    Full Text Available Introduction: Our goal was to reduce ordering of coagulation studies in the emergency department (ED that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR. Methods: We used a pre and post quasi-experimental study design to evaluate the impact of an EMRbased intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis. Results: Pre-intervention, 73.8% (76/103 of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76 were non-value added. Post-intervention, 38.5% (40/104 of patients with chest pain had coagulation studies ordered, of which 60% (24/40 were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0% in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0% in non-value added order placement. Conclusion: Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies. [West J Emerg Med. 2017;18(2267-269.

  14. A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics in primary care patients with cough and fever

    Directory of Open Access Journals (Sweden)

    Hunziker Roger

    2011-05-01

    Full Text Available Abstract Background Physicians fear missing cases of pneumonia and treat many patients with signs of respiratory infection unnecessarily with antibiotics. This is an avoidable cause for the increasing worldwide problem of antibiotic resistance. We developed a user-friendly decision aid to rule out pneumonia and thus reduce the rate of needless prescriptions of antibiotics. Methods This was a prospective cohort study in which we enrolled patients older than 18 years with a new or worsened cough and fever without serious co-morbidities. Physicians recorded results of a standardized medical history and physical examination. C-reactive protein was measured and chest radiographs were obtained. We used Classification and Regression Trees to derive the decision tool. Results A total of 621 consenting eligible patients were studied, 598 were attending a primary care facility, were 48 years on average and 50% were male. Radiographic signs for pneumonia were present in 127 (20.5% of patients. Antibiotics were prescribed to 234 (48.3% of patients without pneumonia. In patients with C-reactive protein values below 10 μg/ml or patients presenting with C-reactive protein between 11 and 50 μg/ml, but without dyspnoea and daily fever, pneumonia can be ruled out. By applying this rule in clinical practice antibiotic prescription could be reduced by 9.1% (95% confidence interval (CI: 6.4 to 11.8. Conclusions Following validation and confirmation in new patient samples, this tool could help rule out pneumonia and be used to reduce unnecessary antibiotic prescriptions in patients presenting with cough and fever in primary care. The algorithm might be especially useful in those instances where taking a medical history and physical examination alone are inconclusive for ruling out pneumonia

  15. Does reducing unnecessary right ventricular pacing improve sympathetic activity and innervation of heart in sinus node disease patients? MVP and SafeR study.

    Science.gov (United States)

    Miyamoto, Mihoko; Kimura, Yuichiro; Hosoda, Junya; Matsumoto, Katsumi; Matsushita, Kohei; Ishikawa, Toshiyuki; Umemura, Satoshi

    2012-01-01

    Ventricular desynchronization imposed by ventricular pacing causes regional disturbances of adrenergic innervation in the left ventricular myocardium and increases the risk of heart failure and atrial fibrillation (AF) in patients with sinus node disease (SND). As a result, decreased iodine-123 metaiodobenzylguanidine (I-(123 )MIBG) uptake occurs in patients with an implanted permanent pacemaker. Fourteen SND patients with an implanted pacemaker equipped with an algorithm for reducing unnecessary right ventricular pacing (RURVP) were enrolled. Pacemakers were programmed to RURVP mode for the first 12 weeks, and then reprogrammed to DDD for the last 12 weeks. At the end of each mode, data on cumulative percent ventricular pacing (%Vp), atrial high rate episodes (%AHR), I-(123 )MIBG myocardial scintigraphy, brain natriuretic peptide (BNP), human atrial natriuretic peptide (hANP), and myocardial damage indices typified by troponin T and C-reactive protein (CRP) were collected. %Vp was lower in RURVP than in DDD (0.2% versus 95.7%, P = 0.00098). BNP, hANP, troponin T, and CRP did not differ significantly between the pacing modes. However, I-(123 )MIBG findings of patients with full ventricular pacing in DDD improved in RURVP. In contrast, among patients without full ventricular pacing in DDD, their I-(123 )MIBG findings did not differ significantly between the pacing modes. In SND patients with normal cardiac function and intact atrioventricular conduction, the reduction of %Vp in RURVP was due to the reduction of ineffective pacing and fusion pacing in DDD. Therefore, these 2 types of pacing do not affect cardiac pump function.

  16. Can Prostate Imaging Reporting and Data System Version 2 reduce unnecessary prostate biopsies in men with PSA levels of 4-10 ng/ml?

    Science.gov (United States)

    Xu, Ning; Wu, Yu-Peng; Chen, Dong-Ning; Ke, Zhi-Bin; Cai, Hai; Wei, Yong; Zheng, Qing-Shui; Huang, Jin-Bei; Li, Xiao-Dong; Xue, Xue-Yi

    2018-05-01

    To explore the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) for predicting prostate biopsy results in patients with prostate specific antigen (PSA) levels of 4-10 ng/ml. We retrospectively reviewed multi-parameter magnetic resonance images from 528 patients with PSA levels of 4-10 ng/ml who underwent transrectal ultrasound-guided prostate biopsies between May 2015 and May 2017. Among them, 137 were diagnosed with prostate cancer (PCa), and we further subdivided them according to pathological results into the significant PCa (S-PCa) and insignificant significant PCa (Ins-PCa) groups (121 cases were defined by surgical pathological specimen and 16 by biopsy). Age, PSA, percent free PSA, PSA density (PSAD), prostate volume (PV), and PI-RADS score were collected. Logistic regression analysis was performed to determine predictors of pathological results. Receiver operating characteristic curves were constructed to analyze the diagnostic value of PI-RADS v2 in PCa. Multivariate analysis indicated that age, PV, percent free PSA, and PI-RADS score were independent predictors of biopsy findings, while only PI-RADS score was an independent predictor of S-PCa (P PSA, and PI-RADS score were 0.570, 0.430, 0.589 and 0.836, respectively. The area under the curve for diagnosing S-PCa with respect to PI-RADS score was 0.732. A PI-RADS score of 3 was the best cutoff for predicting PCa, and 4 was the best cutoff for predicting S-PCa. Thus, 92.8% of patients with PI-RADS scores of 1-2 would have avoided biopsy, but at the cost of missing 2.2% of the potential PCa cases. Similarly, 83.82% of patients with a PI-RADS score ≤ 3 would have avoided biopsy, but at the cost of missing 3.3% of the potential S-PCa cases. PI-RADS v2 could be used to reduce unnecessary prostate biopsies in patients with PSA levels of 4-10 ng/ml.

  17. Developing a nomogram based on multiparametric magnetic resonance imaging for forecasting high-grade prostate cancer to reduce unnecessary biopsies within the prostate-specific antigen gray zone.

    Science.gov (United States)

    Niu, Xiang-Ke; Li, Jun; Das, Susant Kumar; Xiong, Yan; Yang, Chao-Bing; Peng, Tao

    2017-02-01

    .001, respectively). The nomogram based on multiparametric magnetic resonance imaging (mp-MRI) for forecasting HGPCa is effective, which could reduce unnecessary prostate biopsies in patients with PSA 4-10 ng/ml and nomogram-based risk-score could provide a more robust parameter of assessing the aggressiveness of HGPCa in PSA gray zone.

  18. Dynamic Stress Testing Is Unnecessary for Unimalleolar Supination-External Rotation Ankle Fractures with Minimal Fracture Displacement on Lateral Radiographs.

    Science.gov (United States)

    Nortunen, Simo; Leskelä, Hannu-Ville; Haapasalo, Heidi; Flinkkilä, Tapio; Ohtonen, Pasi; Pakarinen, Harri

    2017-03-15

    This study aimed to identify factors from standard radiographs that contributed to the stability of the ankle mortise in patients with isolated supination-external rotation fractures of the lateral malleolus (OTA/AO 44-B). Non-stress radiographs of the mortise and lateral views, without medial clear space widening or incongruity, were prospectively collected for 286 consecutive patients (mean age, 45 years [range, 16 to 85 years]), including 144 female patients (mean age, 50 years [range, 17 to 85 years]) and 142 male patients (mean age, 40 years [range, 16 to 84 years]) from 2 trauma centers. The radiographs were analyzed for fracture morphology by 2 orthopaedic surgeons, who were blinded to each other's measurements and to the results of external rotation stress radiographs (the reference for stability). Factors significantly associated with ankle mortise stability were tested in multiple logistic regression. Receiver operating characteristic analyses were performed for continuous variables to determine optimal thresholds. A sensitivity of >90% was used as the criterion for an optimal threshold. According to external rotation stress radiographs, 217 patients (75.9%) had a stable injury, defined as that with a medial clear space of ankle mortise were female sex (odds ratio [OR], 2.5 [95% confidence interval (CI), 1.4 to 4.6]), a posterior diastasis of fracture fragments (OR, 7.3 [95% CI, 2.1 to 26.3]). When the posterior diastasis was fracture fragments were present, the probability of a stable ankle mortise was 0.98 for 48 female patients (16.8%) and 0.94 for 37 male patients (12.9%). Patients with noncomminuted lateral malleolar fractures (85 patients [29.7%]) could be diagnosed with a stable ankle mortise without further stress testing, when the fracture line widths were <2 mm on lateral radiographs. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  19. The evaluation of enhanced feedback interventions to reduce unnecessary blood transfusions (AFFINITIE): protocol for two linked cluster randomised factorial controlled trials.

    Science.gov (United States)

    Hartley, Suzanne; Foy, Robbie; Walwyn, Rebecca E A; Cicero, Robert; Farrin, Amanda J; Francis, Jill J; Lorencatto, Fabiana; Gould, Natalie J; Grant-Casey, John; Grimshaw, Jeremy M; Glidewell, Liz; Michie, Susan; Morris, Stephen; Stanworth, Simon J

    2017-07-03

    Blood for transfusion is a frequently used clinical intervention, and is also a costly and limited resource with risks. Many transfusions are given to stable and non-bleeding patients despite no clear evidence of benefit from clinical studies. Audit and feedback (A&F) is widely used to improve the quality of healthcare, including appropriate use of blood. However, its effects are often inconsistent, indicating the need for coordinated research including more head-to-head trials comparing different ways of delivering feedback. A programmatic series of research projects, termed the 'Audit and Feedback INterventions to Increase evidence-based Transfusion practIcE' (AFFINITIE) programme, aims to test different ways of developing and delivering feedback within an existing national audit structure. The evaluation will comprise two linked 2×2 factorial, cross-sectional cluster-randomised controlled trials. Each trial will estimate the effects of two feedback interventions, 'enhanced content' and 'enhanced follow-on support', designed in earlier stages of the AFFINITIE programme, compared to current practice. The interventions will be embedded within two rounds of the UK National Comparative Audit of Blood Transfusion (NCABT) focusing on patient blood management in surgery and use of blood transfusions in patients with haematological malignancies. The unit of randomisation will be National Health Service (NHS) trust or health board. Clusters providing care relevant to the audit topics will be randomised following each baseline audit (separately for each trial), with stratification for size (volume of blood transfusions) and region (Regional Transfusion Committee). The primary outcome for each topic will be the proportion of patients receiving a transfusion coded as unnecessary. For each audit topic a linked, mixed-method fidelity assessment and cost-effectiveness analysis will be conducted in parallel to the trial. AFFINITIE involves a series of studies to explore how A

  20. A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions

    Energy Technology Data Exchange (ETDEWEB)

    Woitek, Ramona; Spick, Claudio; Schernthaner, Melanie; Kapetas, Panagiotis; Bernathova, Maria; Furtner, Julia; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria)

    2017-09-15

    To assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI. This retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients. There were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%). Using the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. (orig.)

  1. Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings

    Directory of Open Access Journals (Sweden)

    Robert Redwood

    2018-01-01

    Full Text Available Abstract Background Inappropriate ordering and acquisition of urine cultures leads to unnecessary treatment of asymptomatic bacteriuria (ASB. Treatment of ASB contributes to antimicrobial resistance particularly among hospital-acquired organisms. Our objective was to investigate urine culture ordering and collection practices among nurses to identify key system-level and human factor barriers and facilitators that affect optimal ordering and collection practices. Methods We conducted two focus groups, one with ED nurses and the other with ICU nurses. Questions were developed using the Systems Engineering Initiative for Patient Safety (SEIPS framework. We used iterative categorization (directed content analysis followed by summative content analysis to code and analyze the data both deductively (using SEIPS domains and inductively (emerging themes. Results Factors affecting optimal urine ordering and collection included barriers at the person, process, and task levels. For ED nurses, barriers included patient factors, physician communication, reflex culture protocols, the electronic health record, urinary symptoms, and ED throughput. For ICU nurses, barriers included physician notification of urinalysis results, personal protective equipment, collection technique, patient body habitus, and Foley catheter issues. Conclusions We identified multiple potential process barriers to nurse adherence with evidence-based recommendations for ordering and collecting urine cultures in the ICU and ED. A systems approach to identifying barriers and facilitators can be useful to design interventions for improving urine ordering and collection practices.

  2. Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for Advanced Risk Modeling of Prostate Cancer-Patient-tailored Risk Stratification Can Reduce Unnecessary Biopsies.

    Science.gov (United States)

    Radtke, Jan Philipp; Wiesenfarth, Manuel; Kesch, Claudia; Freitag, Martin T; Alt, Celine D; Celik, Kamil; Distler, Florian; Roth, Wilfried; Wieczorek, Kathrin; Stock, Christian; Duensing, Stefan; Roethke, Matthias C; Teber, Dogu; Schlemmer, Heinz-Peter; Hohenfellner, Markus; Bonekamp, David; Hadaschik, Boris A

    2017-12-01

    Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC; Gleason score≥3+4) detection. Decision making based on European Randomised Study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome prostate-specific antigen (PSA) limitations. We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models (RMs) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy. We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015. Multivariate regression analyses were used to determine significant sPC predictors for RM development. The prediction performance was compared with ERSPC-RCs, RCs refitted on our cohort, Prostate Imaging Reporting and Data System (PI-RADS) v1.0, and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics (ROCs). Discrimination and calibration of the RM, as well as net decision and reduction curve analyses were evaluated based on resampling methods. PSA, prostate volume, digital-rectal examination, and PI-RADS were significant sPC predictors and included in the RMs together with age. The ROC area under the curve of the RM for biopsy-naïve men was comparable with ERSPC-RC3 plus PI-RADSv1.0 (0.83 vs 0.84) but larger compared with ERSPC-RC3 (0.81), refitted RC3 (0.80), and PI-RADS (0.76). For postbiopsy men, the novel RM's discrimination (0.81) was higher, compared with PI-RADS (0.78), ERSPC-RC4 (0.66), refitted RC4 (0.76), and ERSPC-RC4 plus PI-RADSv1.0 (0.78). Both RM benefits exceeded those of ERSPC-RCs and PI-RADS in the decision regarding which patient to receive biopsy and enabled the highest reduction rate of unnecessary biopsies. Limitations include a monocentric design and a lack of PI-RADSv2.0. The novel RMs, incorporating clinical parameters and PI-RADS, performed significantly better

  3. Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with psa levels between 2.6 and 10.0 ng/mL.

    Science.gov (United States)

    Castro, Hugo A Socrates; Iared, Wagner; Santos, José Eduardo Mourão; Solha, Raphael Sandes; Shigueoka, David Carlos; Ajzen, Sergio Aron

    2018-04-10

    To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 - 10.0 ng/mL and its ability to reduce unnecessary biopsies. This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 - 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0,806) (PPSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies. Copyright® by the International Brazilian Journal of Urology.

  4. Long-term wireless pH monitoring of the distal esophagus: prolonging the test beyond 48 hours is unnecessary and may be misleading.

    Science.gov (United States)

    Capovilla, G; Salvador, R; Spadotto, L; Voltarel, G; Pesenti, E; Perazzolo, A; Nicoletti, L; Merigliano, S; Costantini, M

    2017-10-01

    Wireless pH monitoring of the esophagus has been widely used to detect GERD for more than a decade. It is generally well tolerated and accepted by patients, but it is still unclear whether prolonging a recording beyond the usual 48 hours can improve the test's diagnostic value. The aim of this study is to examine the diagnostic yield of 96-hour pH monitoring vis-à-vis 24- and 48-hour tests, and to ascertain whether any gain in diagnostic terms was of genuine clinical utility. Patients with suspected GERD underwent 4-day PPI-off wireless pH monitoring of the distal esophagus. The capsule was inserted under endoscopic control, 6 cm above the squamocolumnar junction. Average acid exposure time was calculated after 24, 48, and 96 hours of recording. Ninety-nine patients completed the 96 hour test, and formed the study sample. The wireless test method was used in 42 patients (42.4%) unable to tolerate the traditional pH-monitoring catheter, and in 57 (57.6%) with a previous negative pH study despite symptoms suggestive of GERD. On complete analysis, 47 patients (47.5%) had a pathological test result: 19 patients within the first 24 hours (19.2%, 24 hour group); another 16 after 48 hours (+16.2%, 48 hour group), and a further 12 (+12.1%, 96 hour group) only after 96 hours of monitoring. All 47 patients with an abnormal acid exposure were offered and accepted surgery (10 patients) or medical therapy (37 patients). Clinical follow-up was obtained in all patients with a positive Bravo test result after a median 67 months (IQR: 38-98) using a validated symptom questionnaire. A good outcome after fundoplication or medical therapy was achieved in 73.7% of patients in the 24 hour group, in 62.5% of those in the 48 hour group, and in only 25% of those in the 96 hour group, P = 0.02. Long-term wireless pH monitoring enables an increase in the diagnostic yield over traditional 24- and 48-hour pH studies, but prolonging the test may constitute an unwanted bias and prompt the

  5. Reduced Clostridium difficile Tests and Laboratory-Identified Events With a Computerized Clinical Decision Support Tool and Financial Incentive.

    Science.gov (United States)

    Madden, Gregory R; German Mesner, Ian; Cox, Heather L; Mathers, Amy J; Lyman, Jason A; Sifri, Costi D; Enfield, Kyle B

    2018-06-01

    We hypothesized that a computerized clinical decision support tool for Clostridium difficile testing would reduce unnecessary inpatient tests, resulting in fewer laboratory-identified events. Census-adjusted interrupted time-series analyses demonstrated significant reductions of 41% fewer tests and 31% fewer hospital-onset C. difficile infection laboratory-identified events following this intervention.Infect Control Hosp Epidemiol 2018;39:737-740.

  6. Unnecessary work tasks and mental health

    DEFF Research Database (Denmark)

    Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne

    2014-01-01

    OBJECTIVES: According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated...... with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association...... is modified by sex, age, occupational position, and baseline mental health status. METHODS: The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed...

  7. [For active dermatocosmetics and free of unnecessary animal experimentation].

    Science.gov (United States)

    Piérard, G E; Piérard-Franchimont, C

    1998-06-01

    At the dawn of this century, dermocosmetology is at cross-roads because new European regulations are changing its face. The proof of claims must be given and the entire composition of the product must be released. In addition, animal testing is about to be banned. Such new regulations incite to search for and validate predictive tests aiming at the objective evaluation of the activity and tolerance claimed by dermocosmetic products. Such tests must be an alternative to unnecessary animal experimentation. These aspects are scrutinized scientifically by the EEMCO experts in combination with the ECVAM and COLIPA organizations.

  8. Ice load reducer for dams : laboratory tests

    Energy Technology Data Exchange (ETDEWEB)

    Lupien, R.; Cote, A.; Robert, A. [Institut de Recherche d' Hydro-Quebec, Varennes, PQ (Canada)

    2009-07-01

    Many studies have focused on measuring static ice loads on various hydraulic structures in Canada. This paper discussed a Hydro-Quebec research project whose main purpose was to harmonize the ice thrust value in load combinations for use in general hydraulic works or for specific cases. The objectives of the project were to obtain a better understanding of existing data and to characterize sites and their influence on ice thrust; study the structural mechanisms involved in the generation of ice thrust, their consequences on the structural behaviour of ice and the natural mitigating circumstances that may be offered by ice properties or site operating procedures; and examine the relevance of developing an ice load reducer for works that might not fit the harmonized design value. The paper presented the main research goals and ice load reducer goals, with particular focus on the four pipe samples that were planned, built and tested. The experimental program involved checking the pipe shape behaviour in terms of flexibility-stiffness; maximum deformations; maximum load reduction; permanent deformations; and, ability to shape recovering. The testing also involved examining the strength versus strain rate; creep versus strain rate; and creep capacity under biaxial state of tension and compression. It was concluded that the two phenomena involved in generation of ice thrust, notably thermal expansion and water level changes, had very low strain rates. 8 refs., 2 tabs., 16 figs.

  9. Re-evaluating the relationships among filtering activity, unnecessary storage, and visual working memory capacity.

    Science.gov (United States)

    Emrich, Stephen M; Busseri, Michael A

    2015-09-01

    The amount of task-irrelevant information encoded in visual working memory (VWM), referred to as unnecessary storage, has been proposed as a potential mechanism underlying individual differences in VWM capacity. In addition, a number of studies have provided evidence for additional activity that initiates the filtering process originating in the frontal cortex and basal ganglia, and is therefore a crucial step in the link between unnecessary storage and VWM capacity. Here, we re-examine data from two prominent studies that identified unnecessary storage activity as a predictor of VWM capacity by directly testing the implied path model linking filtering-related activity, unnecessary storage, and VWM capacity. Across both studies, we found that unnecessary storage was not a significant predictor of individual differences in VWM capacity once activity associated with filtering was accounted for; instead, activity associated with filtering better explained variation in VWM capacity. These findings suggest that unnecessary storage is not a limiting factor in VWM performance, whereas neural activity associated with filtering may play a more central role in determining VWM performance that goes beyond preventing unnecessary storage.

  10. Re: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

    Science.gov (United States)

    Durand-Moreau, Quentin; Loddé, Brice; Dewitte, Jean-Dominique

    2015-03-01

    is to reduce the size of questionnaires because they are too long and cannot be used in a routine practice. But an analysis performed on a single question is quite risky: in psychometrics, redundancy is used to confirm a measurement. We lose precision on what exactly we are testing by asking a single question. Madsen et al's results show that among workers saying they are always or often performing unnecessary tasks, the MHI mean score was 74.00 versus 78.20 for people who never or almost never perform unnecessary tasks (P=0.0038). Even though it is a statistically significant result, its clinical relevance is never questioned. What is the impact of losing 4.20 points at MHI test instead of losing 20 points for instance? Statistical difference does not mean clinical relevance. These results show a statistical association, not a causality relationship. The authors did not show that performing unnecessary tasks lowers the level of mental health. It may be the exact opposite. Maybe having poorer mental health (eg, depression, with anhedonia) may make the workers think that what they're doing is useless. In their conclusion, Madsen et al suggest that the elimination of unnecessary work tasks may be beneficial for employees' mental health. To our mind, on the contrary, it may increase psychic suffering. If we suggest to fight unnecessary tasks in workplaces, this may encourage reduction of the margin of manoeuvre (3). The principle of removing unnecessary tasks is part of a Taylorized organization. Some tasks may seem unnecessary or bothersome, but may correspond to work periods that allow for temporary rest. Concretely, in the workplace, managers rather than the employee will be the ones to decide whether a task is useless or not. To improve well-being in the workplace, a global vision of work organization is required. From our point of view, the conclusion drawn from this study should not be that we must eliminate unnecessary tasks, but that we should focus on what

  11. Plan for Reducing Unnecessary use of Social Security Numbers

    Science.gov (United States)

    Recognizing that training and awareness are critical to protecting agency Personally Identifiable Information (PII), the EPA is developing online training for privacy contacts in its programs and regions.

  12. New EPA Guidance for Testing Pesticides Will Reduce Animal Testing

    Science.gov (United States)

    EPA is issuing guidance for requesting waivers of acute dermal toxicity testing requirements for pesticide formulations, which will lead to fewer animal tests for acute dermal toxicity for pesticides.

  13. Medical innovation laws: an unnecessary innovation.

    Science.gov (United States)

    Richards, Bernadette

    2016-06-01

    Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position

  14. 33 CFR 117.11 - Unnecessary opening of the draw.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Unnecessary opening of the draw. 117.11 Section 117.11 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS General Requirements § 117.11 Unnecessary opening of the draw. No...

  15. Reduced Interference from Memory Testing: A Postretrieval Monitoring Account

    Science.gov (United States)

    Pierce, Benton H.; Gallo, David A.; McCain, Jason L.

    2017-01-01

    Initial learning can interfere with subsequent learning (proactive interference [PI]), but recent work indicates initial testing can reduce PI. Here, we tested 2 alternative hypotheses of this effect: Does testing reduce PI by constraining retrieval to the target list, or by facilitating a postretrieval monitoring process? Participants first…

  16. Immunostimulation asa method limiting unnecessary antibiotic therapy

    Directory of Open Access Journals (Sweden)

    Agnieszka Szczukocka-Zych

    2015-12-01

    Full Text Available Recurring respiratory tract infections are typical of childhood. This results from the fact that children are exposed to pathogens, usually in groups of people, and from the immaturity of the immune system. Most upper and lower respiratory tract infections are caused by viruses. Nevertheless, antibiotics, which target bacteria, are often prescribed. Antibiotic overuse leads to increased microbial resistance to these drugs, resulting in their inefficacy. Improper treatment of respiratory infections with antibiotics ultimately leads to treatment failure. An increase in antibiotic resistance of many bacterial strains is becoming a serious global problem and makes treatment much more difficult. It is a responsibility of each physician to use antibiotics properly and implement adequate prevention of recurring respiratory tract infections. For many years, it has been attempted to find effective agents that improve immunity in children. The pharmaceutical market offers various preparations advertised as immunostimulants, such as bacterial lysates, vitamins, dietary supplements, probiotics or herbal, animal and homeopathic products. The role of immunomodulatory substances is to promote the immune system to fight pathogens, reduce the frequency of infections and decrease the demand for antibiotics. Unfortunately, most immunomodulators do not have sufficiently reliable clinical trials that would confirm their efficacy.

  17. [Necessary and unnecessary treatment options for hemorrhoids].

    Science.gov (United States)

    Zindel, Joel; Inglin, Roman; Brügger, Lukas

    2014-12-01

    Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the

  18. Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?

    Directory of Open Access Journals (Sweden)

    Mahmoud F. Sakr

    2012-08-01

    Results: Sixty-seven patients (65.9% were female and 35 (34.1% were male. Their ages ranged between 16 and 49 years (mean 27.5 years. Most patients (87.3% had their symptoms for 12-36 hours before hospital admission. The mean values for TLC, NP, and CRP were 7,573/ and micro;L, 54.53%, and 0.61 mg/L, respectively. Of the 102 patients with NTT, 101 (99% proved not to have appendiceal inflammation (NPV=99%. Only 39 patients were operated upon, of whom 38 (97.4% had a normal appendix, and the remaining 63 patients were either discharged (n=47 or referred to other specialties (n=16. There were significantly more women (76.3%, 29/38 with negative appendectomy than men (24.7%, 9/38 (X2= 21.1, p=0.0001. Gynecological causes were the most common (60.5%, 23/38 and in 11 cases, the exact etiology could not be identified. Conclusions: From the data presented, it may be concluded that TLC, NP and CRP blood levels (triple test should be measured upon hospital admission of adult patients with clinically suspected acute appendicitis. If used judiciously, they may spare the group of patients with an NTT an unnecessary surgical operation, hence markedly reducing the NAR with its potential risks. [Arch Clin Exp Surg 2012; 1(4.000: 229-236

  19. Reduced enrichment for research and test reactors: Proceedings

    International Nuclear Information System (INIS)

    1993-07-01

    The 15th annual Reduced Enrichment for Research and Test Reactors (RERTR) international meeting was organized by Ris oe National Laboratory in cooperation with the International Atomic Energy Agency and Argonne National Laboratory. The topics of the meeting were the following: National Programs, Fuel Fabrication, Licensing Aspects, States of Conversion, Fuel Testing, and Fuel Cycle. Individual papers have been cataloged separately

  20. Reduced enrichment for research and test reactors: Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    1993-07-01

    The 15th annual Reduced Enrichment for Research and Test Reactors (RERTR) international meeting was organized by Ris{o} National Laboratory in cooperation with the International Atomic Energy Agency and Argonne National Laboratory. The topics of the meeting were the following: National Programs, Fuel Fabrication, Licensing Aspects, States of Conversion, Fuel Testing, and Fuel Cycle. Individual papers have been cataloged separately.

  1. [The unnecessary application of central venous catheterization in surgical patients].

    Science.gov (United States)

    Uemura, Keiko; Inoue, Satoki; Kawaguchi, Masahiko

    2018-04-06

    Perioperative physicians occasionally encounter situations where central venous catheters placed preoperatively turn out to be unnecessary. The purpose of this retrospective study is to identify the unnecessary application of central venous catheter placement and determine the factors associated with the unnecessary application of central venous catheter placement. Using data from institutional perioperative central venous catheter surveillance, we analysed data from 1,141 patients who underwent central venous catheter placement. We reviewed the central venous catheter registry and medical charts and allocated registered patients into those with the proper or with unnecessary application of central venous catheter according to standard indications. Multivariate analysis was used to identify factors associated with the unnecessary application of central venous catheter placement. In 107 patients, representing 9.38% of the overall population, we identified the unnecessary application of central venous catheter placement. Multivariate analysis identified emergencies at night or on holidays (odds ratio [OR] 2.109, 95% confidence interval [95% CI] 1.021-4.359), low surgical risk (OR=1.729, 95% CI 1.038-2.881), short duration of anesthesia (OR=0.961/10min increase, 95% CI 0.945-0.979), and postoperative care outside of the intensive care unit (OR=2.197, 95% CI 1.402-3.441) all to be independently associated with the unnecessary application of catheterization. Complications related to central venous catheter placement when the procedure consequently turned out to be unnecessary were frequently observed (9/107) compared with when the procedure was necessary (40/1034) (p=0.032, OR=2.282, 95% CI 1.076-4.842). However, the subsequent multivariate logistic model did not hold this significant difference (p=0.0536, OR=2.115, 95% CI 0.988-4.526). More careful consideration for the application of central venous catheter is required in cases of emergency surgery at night or on

  2. Efficacy test of a toothpaste in reducing extrinsic dental stain

    Science.gov (United States)

    Agustanti, A.; Ramadhani, S. A.; Adiatman, M.; Rahardjo, A.; Callea, M.; Yavuz, I.; Maharani, D. A.

    2017-08-01

    This clinical trial compared the external dental stain reduction achieved by tested toothpaste versus placebo in adult patients. In this double-blind, parallel, randomised clinical trial, 45 female volunteers with a mean age of 20 years old were included. All study subjects front teeth were topically applicated with Silver Diamine Fluoride (SDF) to create external dental stains. Subjects were randomized into test (n=22) and control (n=23) groups. Toothpastes were used for two days to analyse the effects of removing external stains on the labial surfaces of all anterior teeth. VITA Easyshade Advance 4.0 was used to measure dental extrinsic stains changes. The analysis showed statistically significant efficacy of the tested toothpaste in reducing external dental stain caused by SDF, comparing to the placebo toothpaste, after one and two days of usage. The tested toothpaste was effective in reducing dental stain.

  3. "Unnecessary suffering": the cornerstone of animal protection legislation considered.

    Science.gov (United States)

    Radford, M

    1999-09-01

    Causing "unnecessary suffering" has been widely adopted in legislation to define criminal liability in respect of the treatment of animals. This article examines the way in which the term has been interpreted and applied by the courts, and considers its effectiveness in affording animals protection from abuse.

  4. Combined approach to reduced duration integrated leakage rate testing

    International Nuclear Information System (INIS)

    Galanti, P.J.

    1987-01-01

    Even though primary reactor containment allowable leakage rates are expressed in weight percent per day of contained air, engineers have been attempting to define acceptable methods to test in < 24 h as long as these tests have been performed. The reasons to reduce testing duration are obvious, because time not generating electricity is time not generating revenue for the utilities. The latest proposed revision to 10CFR50 Appendix J, concerning integrated leakage rate testing (ILRTs), was supplemented with a draft regulatory guide proposing yet another method. This paper proposes a method that includes elements of currently accepted concepts for short duration testing with a standard statistical check for criteria acceptance. Following presentation of the method, several cases are presented showing the results of these combined criteria

  5. Satellite Vibration Testing: Angle optimisation method to Reduce Overtesting

    Science.gov (United States)

    Knight, Charly; Remedia, Marcello; Aglietti, Guglielmo S.; Richardson, Guy

    2018-06-01

    Spacecraft overtesting is a long running problem, and the main focus of most attempts to reduce it has been to adjust the base vibration input (i.e. notching). Instead this paper examines testing alternatives for secondary structures (equipment) coupled to the main structure (satellite) when they are tested separately. Even if the vibration source is applied along one of the orthogonal axes at the base of the coupled system (satellite plus equipment), the dynamics of the system and potentially the interface configuration mean the vibration at the interface may not occur all along one axis much less the corresponding orthogonal axis of the base excitation. This paper proposes an alternative testing methodology in which the testing of a piece of equipment occurs at an offset angle. This Angle Optimisation method may have multiple tests but each with an altered input direction allowing for the best match between all specified equipment system responses with coupled system tests. An optimisation process that compares the calculated equipment RMS values for a range of inputs with the maximum coupled system RMS values, and is used to find the optimal testing configuration for the given parameters. A case study was performed to find the best testing angles to match the acceleration responses of the centre of mass and sum of interface forces for all three axes, as well as the von Mises stress for an element by a fastening point. The angle optimisation method resulted in RMS values and PSD responses that were much closer to the coupled system when compared with traditional testing. The optimum testing configuration resulted in an overall average error significantly smaller than the traditional method. Crucially, this case study shows that the optimum test campaign could be a single equipment level test opposed to the traditional three orthogonal direction tests.

  6. Innovative approaches to reduce animal testing : replace whenever possible, reduce through refinement and mechanistic understanding

    NARCIS (Netherlands)

    Ravenzwaay, van B.

    2013-01-01

    'Many of the in vitro toxicological studies have not been sufficiently validated to determine their applicability domain, even less have gained regulatory acceptance. Major advantage of in vitro testing today is the early identification of significant hazards in compound development and reduced and

  7. Thermosyphon Flooding in Reduced Gravity Environments Test Results

    Science.gov (United States)

    Gibson, Marc A.; Jaworske, Donald A.; Sanzi, Jim; Ljubanovic, Damir

    2013-01-01

    The condenser flooding phenomenon associated with gravity aided two-phase thermosyphons was studied using parabolic flights to obtain the desired reduced gravity environment (RGE). The experiment was designed and built to test a total of twelve titanium water thermosyphons in multiple gravity environments with the goal of developing a model that would accurately explain the correlation between gravitational forces and the maximum axial heat transfer limit associated with condenser flooding. Results from laboratory testing and parabolic flights are included in this report as part I of a two part series. The data analysis and correlations are included in a follow on paper.

  8. Removing Unnecessary Variables from Horn Clause Verification Conditions

    Directory of Open Access Journals (Sweden)

    Emanuele De Angelis

    2016-07-01

    Full Text Available Verification conditions (VCs are logical formulas whose satisfiability guarantees program correctness. We consider VCs in the form of constrained Horn clauses (CHC which are automatically generated from the encoding of (an interpreter of the operational semantics of the programming language. VCs are derived through program specialization based on the unfold/fold transformation rules and, as it often happens when specializing interpreters, they contain unnecessary variables, that is, variables which are not required for the correctness proofs of the programs under verification. In this paper we adapt to the CHC setting some of the techniques that were developed for removing unnecessary variables from logic programs, and we show that, in some cases, the application of these techniques increases the effectiveness of Horn clause solvers when proving program correctness.

  9. Reducing duplicate testing: a comparison of two clinical decision support tools.

    Science.gov (United States)

    Procop, Gary W; Keating, Catherine; Stagno, Paul; Kottke-Marchant, Kandice; Partin, Mary; Tuttle, Robert; Wyllie, Robert

    2015-05-01

    Unnecessary duplicate laboratory testing is common and costly. Systems-based means to avert unnecessary testing should be investigated and employed. We compared the effectiveness and cost savings associated with two clinical decision support tools to stop duplicate testing. The Hard Stop required telephone contact with the laboratory and justification to have the duplicate test performed, whereas the Smart Alert allowed the provider to bypass the alert at the point of order entry without justification. The Hard Stop alert was significantly more effective than the Smart Alert (92.3% vs 42.6%, respectively; P < .0001). The cost savings realized per alert activation was $16.08/alert for the Hard Stop alert vs $3.52/alert for the Smart Alert. Structural and process changes that require laboratory contact and justification for duplicate testing are more effective than interventions that allow providers to bypass alerts without justification at point of computerized physician order entry. Copyright© by the American Society for Clinical Pathology.

  10. Instrumented impact testing machine with reduced specimen oscillation effects

    International Nuclear Information System (INIS)

    Rintamaa, R.; Rahka, K.; Wallin, K.

    1984-07-01

    Owing to small and inexpensive specimens the Charpy impact test is widely used in quality control and alloy development. Limitations in power reactor survellance capsules it is also widely used for safety analysis purposes. Instrumenting the tup and computerizing data acquisition, makes dynamic fracture mechanics data measurement possible and convenient. However, the dynamic effects (inertia forces, specimen oscillations) in the impact test cause inaccuracies in the recorded load-time diagram and hence diminish the reliability of the calculated dynamic fracture mechanics parameters. To decrease inaccuracies a new pendulum type of instrumented impact test apparatus has been developed and constructed in the Metals Laboratory of the Technical Research Centre of Finland. This tester is based on a new principle involving inverted test geometry. The purpose of the geometry inversion is to reduce inertia load and specimen oscillation effects. Further, the new impact tester has some other novel features: e.g. the available initia impact energy is about double compared to the conventional standard (300 J) impact tester allowing the use of larger (10 x 20 x 110 mm) bend specimens than normal Charpy specimens. Also, the rotation asix in the three point bending is nearly stationary making COD-measurements possible. An experimental test series is described in which the inertia effects and specimen oscillations are compared in the conventional and new impact tester utilizing Charpy V-notch specimens. Comparison of the two test geometries is also made with the aid of an analytical model using finite element method (FEM) analysis. (author)

  11. Reduced enrichment for research and test reactors: Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    November 9--10, 1978, marked the first of what has become an annual event--the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and it established the basis for all later meetings. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort. This report provides presentations and discussions of this original meeting. Individual papers have been cataloged separately.

  12. Reduced enrichment for research and test reactors: Proceedings

    International Nuclear Information System (INIS)

    1993-08-01

    November 9--10, 1978, marked the first of what has become an annual event--the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and it established the basis for all later meetings. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort. This report provides presentations and discussions of this original meeting. Individual papers have been cataloged separately

  13. Reduced enrichment for research and test reactors: Proceedings

    International Nuclear Information System (INIS)

    1988-05-01

    The international effort to develop new research reactor fuel materials and designs based on the use of low-enriched uranium, instead of highly-enriched uranium, has made much progress during the eight years since its inception. To foster direct communication and exchange of ideas among the specialist in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the ninth of a series which began in 1978. All previous meetings of this series are listed on the facing page. The focus of this meeting was on the LEU fuel demonstration which was in progress at the Oak Ridge Research (ORR) reactor, not far from where the meeting was held. The visit to the ORR, where a silicide LEU fuel with 4.8 g A/cm 3 was by then in routine use, illustrated how far work has progressed

  14. Reduced enrichment for research and test reactors: Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    1988-05-01

    The international effort to develop new research reactor fuel materials and designs based on the use of low-enriched uranium, instead of highly-enriched uranium, has made much progress during the eight years since its inception. To foster direct communication and exchange of ideas among the specialist in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the ninth of a series which began in 1978. All previous meetings of this series are listed on the facing page. The focus of this meeting was on the LEU fuel demonstration which was in progress at the Oak Ridge Research (ORR) reactor, not far from where the meeting was held. The visit to the ORR, where a silicide LEU fuel with 4.8 g A/cm/sup 3/ was by then in routine use, illustrated how far work has progressed.

  15. The RERTR [Reduced Enrichment Research and Test Reactor] program:

    International Nuclear Information System (INIS)

    Travelli, A.

    1987-01-01

    The progress of the Reduced Enrichment Research and Test Reactor (RERTR) program is described. After a brief summary of the results which the RERTR program, in collaboration with its many international partners, had achieved by the end of 1986, the activities, results and new developments which ocurred in 1987 are reviewed. Irradiation of the second miniplate series, concentrating on U 3 Si 2 -Al and U 3 Si-Al fuels was completed and postirradiation examinations were performed on many of its miniplates. The whole-core ORR demonstration with U 3 Si 2 -Al fuel at 4.8 g U/cm 3 was completed at the end of March with excellent results and with 29 elements estimated to have reached at least 40 % average burnup. Good progress was made in the area of LEU usage for the production of fission 99 Mo, and in the coordination of safety evaluations related to LEU conversions of U.S. university reactors. Planned activities include testing and demonstrating advanced fuels intended to allow use of reduced enrichment uranium in very-high-performance reactors. Two candidate fuels are U 3 Si-Al with 19.75 % enrichment and U 3 Si 2 -Al with 45 % enrichment. Demonstration of these fuels will include irradiation of full-size elements and, possibly, a full-core demonstration. Achievement of the final program goals is still projected for 1990. This progress could not have been possible without the close international cooperation which has existed from the beginning, and which is essential to the ultimate success of the RERTR program. (Author)

  16. The Relationship Between the Status of Unnecessary Accommodations Being Made to Unconfirmed Food Allergy Students and the Presence or Absence of a Doctor’s Diagnosis

    Directory of Open Access Journals (Sweden)

    Yurika Ganaha

    2015-06-01

    Full Text Available The present study investigated the current state of unnecessary children food allergy accommodation and the medical efforts to confirm the existence of food allergies in school lunch service kitchens in Okinawa, Japan, including kitchens accommodating food allergy students by requiring medical documentation at the start and during provisions being made (Double Diagnosis, requiring medical documentation at the start only (Single Diagnosis, and with no medical documentation (Non-Diagnosis. Unnecessary accommodations are being made to unconfirmed food allergy students, wherein the more medical consultation was required, the lower the food allergy incident rate was and the more food allergens were diagnosed (Non-Diagnosis > Single Diagnosis > Double Diagnosis. This study suggests the possibility that unconfirmed food allergy students may be receiving unnecessary food allergy accommodations per school lunches, and the number of unnecessary food allergy provisions being made could be reduced by requiring medical documentation at the start and during these provisions.

  17. Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing

    DEFF Research Database (Denmark)

    Nielsen, L. H.; Markenvard, John; Jensen, Jesper Møller

    2011-01-01

    It has been proposed that the increasing use of coronary computed tomographic angiography (CTA) may introduce additional unnecessary diagnostic procedures. However, no previous study has assessed the impact on downstream test utilization of conventional diagnostic testing relative to CTA in patie...... prospective trials are needed in order to define the most cost-effective diagnostic use of CTA relative to conventional ischemia testing....

  18. Testing the effects of educational toilet posters: a novel way of reducing haemolysis of blood samples within ED.

    Science.gov (United States)

    Corkill, David

    2012-02-01

    Haemolysed blood samples are an unnecessary burden on Emergency Departments (ED) as they increase workloads and drive down efficiencies. Little empirical data exists that demonstrates the effectiveness of educational posters displayed in staff toilet cubicles. This study explored the impact educational toilet posters have on reducing haemolysis rates within the ED. A time series study of the clinical effect of educational toilet posters on reducing haemolysis rates throughout a 12 month period at the Gold Coast Hospital ED was undertaken. The GCH ED is a tertiary emergency service that has approximately 66,000 patient presentations per year. Data was collected prospectively. Analysis was undertaken to investigate the effects on total number of haemolysed samples and those clinically significant samples with a haemolytic index >3. Further investigation explored the specific effects on medical and nursing staff. Analysis undertaken using an independent t-test found that the pre-intervention data demonstrates a medium haemolysis rate of 4.92% (SD=1.04). This is a statistically significantly different (t=3.56, df=50, p=0.001) from the median post intervention data of 3.95% (SD=0.84). The difference of 0.97% (95%CI=0.42, 1.52) represents a 19.72% reduction in clinically significant haemolysed samples over the study period. This study reveals that the use of educational toilet posters had a positive impact on reducing the rates of haemolysed samples collected within the ED. This simple and cost effective educational initiative changed the behaviour of clinical staff. Further investigation is warranted to examine the impact of educational toilet posters on additional clinical scenarios. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  19. Experiences of the REACH testing proposals system to reduce animal testing.

    Science.gov (United States)

    Taylor, Katy; Stengel, Wolfgang; Casalegno, Carlotta; Andrew, David

    2014-01-01

    In order to reduce animal testing, companies registering chemical substances under the EU REACH legislation must propose rather than conduct certain tests on animals. Third parties can submit 'scientifically valid information' relevant to these proposals to the Agency responsible, the European Chemicals Agency (ECHA), who are obliged to take the information into account. The European Coalition to End Animal Experiments (ECEAE) provided comments on nearly half of the 817 proposals for vertebrate tests on 480 substances published for comment for the first REACH deadline (between 1 August 2009 and 31 July 2012). The paper summarises the response by registrants and the Agency to third party comments and highlights issues with the use of read across, in vitro tests, QSAR and weight of evidence approaches. Use of existing data and evidence that testing is legally or scientifically unjustified remain the most successful comments for third parties to submit. There is a worrying conservatism within the Agency regarding the acceptance of alternative approaches and examples of where registrants have also failed to maximise opportunities to avoid testing.

  20. Treatability Test Plan for an In Situ Biostimulation Reducing Barrier

    Energy Technology Data Exchange (ETDEWEB)

    Truex, Michael J.; Vermeul, Vince R.; Long, Philip E.; Brockman, Fred J.; Oostrom, Mart; Hubbard, Susan; Borden, Robert C.; Fruchter, Jonathan S.

    2007-07-21

    This treatability test plan supports a new, integrated strategy to accelerate cleanup of chromium in the Hanford 100 Areas. This plan includes performing a field-scale treatability test for bioreduction of chromate, nitrate, and dissolved oxygen. In addition to remediating a portion of the plume and demonstrating reduction of electron acceptors in the plume, the data from this test will be valuable for designing a full-scale bioremediation system to apply at this and other chromium plumes at Hanford.

  1. In vitro vaccine potency testing: a proposal for reducing animal use for requalification testing.

    Science.gov (United States)

    Brown, K; Stokes, W

    2012-01-01

    This paper proposes a program under which the use of animals for requalification of in vitro potency tests could be eliminated. Standard References (USDA/CVB nomenclature) would be developed, characterized, stored and monitored by selected reference laboratories worldwide. These laboratories would employ scientists skilled in protein and glycoprotein chemistry and equipped with state-of-the-art instruments for required analyses. After Standard References are established, the reference laboratories would provide them to the animal health industry as "gold standards". Companies would then establish and validate a correlation between the Standard Reference and the company Master Reference (USDA/CVB nomenclature) using an internal in vitro assay. After this correlation is established, the company could use the Standard References for qualifying, monitoring and requalifying company Master References without the use of animals. Such a program would eliminate the need for animals for requalification of Master References and the need for each company to develop and validate a battery of Master Reference Monitoring assays. It would also provide advantages in terms of reduced costs and reduced time for requalification testing. As such it would provide a strong incentive for companies to develop and use in vitro assays for potency testing.

  2. Treatability Test Plan for an In Situ Biostimulation Reducing Barrier

    Energy Technology Data Exchange (ETDEWEB)

    Truex, Michael J.; Vermeul, Vince R.; Long, Philip E.; Brockman, Fred J.; Oostrom, Mart; Hubbard, Susan; Borden, Robert C.; Fruchter, Jonathan S.

    2007-10-26

    This treatability test plan supports a new, integrated strategy to accelerate cleanup of chromium in the 100 Areas at the Hanford Site. This plan includes performing a field-scale treatability test for bioreduction of chromate, nitrate, and dissolved oxygen. In addition to remediating a portion of the plume and demonstrating reduction of electron acceptors in the plume, the data from this test will be valuable for designing a full-scale bioremediation system to apply at this and other chromium plumes at the Hanford Site.

  3. Cryomdoule Test Stand Reduced-Magnetic Support Design at Fermilab

    Energy Technology Data Exchange (ETDEWEB)

    McGee, Mike [Fermilab; Chandrasekaran, Saravan Kumar [Fermilab; Crawford, Anthony [Fermilab; Harms, Elvin [Fermilab; Leibfritz, Jerry [Fermilab; Wu, Genfa [Fermilab

    2016-06-01

    In a partnership with SLAC National Accelerator Laboratory (SLAC) and Jefferson Lab, Fermilab will assemble and test 17 of the 35 total 1.3 GHz cryomodules for the Linac Coherent Light Source II (LCLS-II) Project. These devices will be tested at Fermilab's Cryomodule Test Facility (CMTF) within the Cryomodule Test Stand (CMTS-1) cave. The problem of magnetic pollution became one of major issues during design stage of the LCLS-II cryomodule as the average quality factor of the accelerating cavities is specified to be 2.7 x 10¹⁰. One of the possible ways to mitigate the effect of stray magnetic fields and to keep it below the goal of 5 mGauss involves the application of low permeable materials. Initial permeability and magnetic measurement studies regarding the use of 316L stainless steel material indicated that cold work (machining) and heat affected zones from welding would be acceptable.

  4. Generalized reduced rank tests using the singular value decomposition

    NARCIS (Netherlands)

    Kleibergen, F.R.; Paap, R.

    2002-01-01

    We propose a novel statistic to test the rank of a matrix. The rank statistic overcomes deficiencies of existing rank statistics, like: necessity of a Kronecker covariance matrix for the canonical correlation rank statistic of Anderson (1951), sensitivity to the ordering of the variables for the LDU

  5. Generalized Reduced Rank Tests using the Singular Value Decomposition

    NARCIS (Netherlands)

    F.R. Kleibergen (Frank); R. Paap (Richard)

    2003-01-01

    textabstractWe propose a novel statistic to test the rank of a matrix. The rank statistic overcomes deficiencies of existing rank statistics, like: necessity of a Kronecker covariance matrix for the canonical correlation rank statistic of Anderson (1951), sensitivity to the ordering of the variables

  6. How to reduce errors in applying impairment tests

    OpenAIRE

    Petersen, Christian; Plenborg, Thomas

    2007-01-01

    Fair value accounting has become predominant in accounting as a vast number of IAS/IFRS standards are based on fair value accounting, including IAS 36 Impairment of assets. Fair value accounting for goodwill is technically challenging, since market prices are not observable. Thus, valuation technologies must be applied in order to test goodwill for impairment. While prior research on goodwill has concentrated on either the (dis)advantages for each accounting procedure for goodwill or exami...

  7. Testing a flexible method to reduce false monsoon onsets.

    Directory of Open Access Journals (Sweden)

    Mathew Alexander Stiller-Reeve

    Full Text Available To generate information about the monsoon onset and withdrawal we have to choose a monsoon definition and apply it to data. One problem that arises is that false monsoon onsets can hamper our analysis, which is often alleviated by smoothing the data in time or space. Another problem is that local communities or stakeholder groups may define the monsoon differently. We therefore aim to develop a technique that reduces false onsets for high-resolution gridded data, while also being flexible for different requirements that can be tailored to particular end-users. In this study, we explain how we developed our technique and demonstrate how it successfully reduces false onsets and withdrawals. The presented results yield improved information about the monsoon length and its interannual variability. Due to this improvement, we are able to extract information from higher resolution data sets. This implies that we can potentially get a more detailed picture of local climate variations that can be used in more local climate application projects such as community-based adaptations.

  8. Reducing uncertainty in geostatistical description with well testing pressure data

    Energy Technology Data Exchange (ETDEWEB)

    Reynolds, A.C.; He, Nanqun [Univ. of Tulsa, OK (United States); Oliver, D.S. [Chevron Petroleum Technology Company, La Habra, CA (United States)

    1997-08-01

    Geostatistics has proven to be an effective tool for generating realizations of reservoir properties conditioned to static data, e.g., core and log data and geologic knowledge. Due to the lack of closely spaced data in the lateral directions, there will be significant variability in reservoir descriptions generated by geostatistical simulation, i.e., significant uncertainty in the reservoir descriptions. In past work, we have presented procedures based on inverse problem theory for generating reservoir descriptions (rock property fields) conditioned to pressure data and geostatistical information represented as prior means for log-permeability and porosity and variograms. Although we have shown that the incorporation of pressure data reduces the uncertainty below the level contained in the geostatistical model based only on static information (the prior model), our previous results assumed did not explicitly account for uncertainties in the prior means and the parameters defining the variogram model. In this work, we investigate how pressure data can help detect errors in the prior means. If errors in the prior means are large and are not taken into account, realizations conditioned to pressure data represent incorrect samples of the a posteriori probability density function for the rock property fields, whereas, if the uncertainty in the prior mean is incorporated properly into the model, one obtains realistic realizations of the rock property fields.

  9. Testing of Baker Flo-XS Pipeline Drag-Reducing Additive. Compilation of Tests and Results

    National Research Council Canada - National Science Library

    Guiliano, John

    2000-01-01

    ... 0.8 ppm for errors in injection). Through a CRADA with Buckeye Pipeline Inc, thermal stability testing of the additive was completed. Additionally, low temperature testing, additive/additive compatibility testing and specification testing of additized fuel was also completed. Material compatibility testing was also taken into consideration.

  10. Author response to letter. Ref: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

    Science.gov (United States)

    Madsen, Ida Eh; Rugulies, Reiner

    2015-03-01

    unnecessary or bothersome, but may correspond to work periods that allow for temporary rest". We find this suggestion curious and are not aware of any empirical studies to support this claim. Consequently, we encourage the authors of the commentary to test their hypothesis empirically. Any such empirical evidence would be a welcome advancement to the scientific knowledge concerning the mental health consequences of unnecessary work tasks. As the results of our study do not indicate that unnecessary work tasks could be beneficial to mental health, but indeed that they could be harmful, we find no reason to modify the conclusions of our article. References 1. Durand-Moreau Q, Loddé B, Dewitte J-D. Ref: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers". Scand J Work Environ Health - online first. http://dx.doi.org/10.5271/sjweh.3473. 2. Madsen IEH, Tripathi M, Borritz M, Rugulies R, Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers, Scand J Work Environ Health. 2014;40(6):631-8. http://dx.doi.org/10.5271/sjweh.3453.  3. Semmer NK, Tschan F, Meier LL, Facchin S, Jacobshagen N, Illegitimate tasks and counterproductive work behavior, Appl Psychol. 2010;59:70-96. http://dx.doi.org/10.1111/j.1464-0597.2009.00416.x.  4. Durand MJ, Vézina N, Baril R, Loisel P, Richard MC, Ngomo S, Margin of manoeuvre indicators in the workplace during the rehabilitation process: a qualitative analysis, J Occup Rehab. 2009;19:194-202. http://dx.doi.org/10.1007/s10926-009-9173-4.

  11. 75 FR 8375 - Device Improvements to Reduce Unnecessary Radiation Exposure From Medical Imaging; Public Meeting...

    Science.gov (United States)

    2010-02-24

    ... hardware and software features should manufacturers build into CT and fluoroscopic devices in order to... ALARA concept (maintaining dose As Low As Reasonably Achievable) and utilize or provide for...

  12. Can procalcitonin reduce unnecessary voiding cystoureterography in children with first febrile urinary tract infection?

    Science.gov (United States)

    Halimi-Asl, Aliasghar; Hosseini, Amir Hossein; Nabavizadeh, Pooneh

    2014-08-01

    Recently, new predictors of vesicoureteral reflux (VUR) in children with a first febrile UTI such as Procalcitonin (PCT) were introduced as selective approaches for cystography. This study wants to show the capability of PCT in predicting presence of VUR at the first febrile UTI in children. Patients between 1 month and 15 years of age with febrile UTI were included in this prospective study. PCT values were measured through a semi-quantitative method in four grades comprising values less than 0.5, 0.5-2.0, 2.0-10.0 and above 10.0 ng/ml. The independence of PCT levels in predicting VUR were assessed after adjustment for all potential confounders using a logistic-regression model. A total of 68 patients, 54 (79.4%) girls and 14 (20.6%) boys were evaluated. PCT level demonstrated a significant difference between patients with positive VUR and those with negative VUR (P=0.012). To calculate the independent factors that may predict the presence of VUR, all included variables were adjusted for age and sex. Results of logistic regression showed that a PCT level between 2.0 and 10.0 ng/mL could independently predict presence of VUR (Odds ratio=6.11, CI 95%= 1.22-30.77, P=0.03). Our finding in this study showed that readily available semi-quantitative measures for PCT are feasible for detecting patients with VUR. We suggest that in semi-quantitative measurements of PCT, levels between 2.0 and 10.0 ng/ml could be an independent predictor of positive VUR.

  13. Tailgate test kit for determining appropriate sediment reducing chemicals and dose rates : final report.

    Science.gov (United States)

    2017-07-01

    This study develops a Tailgate Test Kit to be used in the field to test flocculants for reducing turbidity in construction stormwater discharge. Turbidity of stormwater runoff at construction sites varies depending on which site soils are exposed to ...

  14. Advanced Gas Cooled Reactor Materials Program. Reducing helium impurity depletion in HTGR materials testing

    International Nuclear Information System (INIS)

    Baldwin, D.H.

    1984-08-01

    Moisture depletion in HTGR materials testing rigs has been empirically studied in the GE High Temperature Reactor Materials Testing Laboratory (HTRMTL). Tests have shown that increased helium flow rates and reduction in reactive (oxidizable) surface area are effective means of reducing depletion. Further, a portion of the depletion has been shown to be due to the presence of free C released by the dissociation of CH 4 . This depletion component can be reduced by reducing the helium residence time (increasing the helium flow rate) or by reducing the CH 4 concentration in the test gas. Equipment modifications to reduce depletion have been developed, tested, and in most cases implemented in the HTRMTL to date. These include increasing the Helium Loop No. 1 pumping capacity, conversion of metallic retorts and radiation shields to alumina, isolation of thermocouple probes from the test gas by alumina thermowells, and substitution of non-reactive Mo-TZM for reactive metallic structural components

  15. Effectiveness of Structured Psychodrama and Systematic Desensitization in Reducing Test Anxiety.

    Science.gov (United States)

    Kipper, David A.; Giladi, Daniel

    1978-01-01

    Students with examination anxiety took part in study of effectiveness of two kinds of treatment, structured psychodrama and systematic desensitization, in reducing test anxiety. Results showed that subjects in both treatment groups significantly reduced test-anxiety scores. Structured psychodrama is as effective as systematic desensitization in…

  16. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa.

    Science.gov (United States)

    Sigaloff, Kim C E; Hamers, Raph L; Wallis, Carole L; Kityo, Cissy; Siwale, Margaret; Ive, Prudence; Botes, Mariette E; Mandaliya, Kishor; Wellington, Maureen; Osibogun, Akin; Stevens, Wendy S; van Vugt, Michèle; de Wit, Tobias F Rinke

    2011-09-01

    This study aimed to investigate the consequences of using clinicoimmunological criteria to detect antiretroviral treatment (ART) failure and guide regimen switches in HIV-infected adults in sub-Saharan Africa. Frequencies of unnecessary switches, patterns of HIV drug resistance, and risk factors for the accumulation of nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were evaluated. Cross-sectional analysis of adults switching ART regimens at 13 clinical sites in 6 African countries was performed. Two types of failure identification were compared: diagnosis of clinicoimmunological failure without viral load testing (CIF only) or CIF with local targeted viral load testing (targeted VL). After study enrollment, reference HIV RNA and genotype were determined retrospectively. Logistic regression assessed factors associated with multiple thymidine analogue mutations (TAMs) and NRTI cross-resistance (≥2 TAMs or Q151M or K65R/K70E). Of 250 patients with CIF switching to second-line ART, targeted VL was performed in 186. Unnecessary switch at reference HIV RNA <1000 copies per milliliter occurred in 46.9% of CIF only patients versus 12.4% of patients with targeted VL (P < 0.001). NRTI cross-resistance was observed in 48.0% of 183 specimens available for genotypic analysis, comprising ≥2 TAMs (37.7%), K65R (7.1%), K70E (3.3%), or Q151M (3.3%). The presence of NRTI cross-resistance was associated with the duration of ART exposure and zidovudine use. Clinicoimmunological monitoring without viral load testing resulted in frequent unnecessary regimen switches. Prolonged treatment failure was indicated by extensive NRTI cross-resistance. Access to virological monitoring should be expanded to prevent inappropriate switches, enable early failure detection and preserve second-line treatment options in Africa.

  17. NDT: Replication avoids unnecessary replacement of power plant components

    International Nuclear Information System (INIS)

    Neubauer, B.; Wedel, U.

    1984-01-01

    Effective fracture prevention for components operating at high temperatures can be achieved without sacrificing useful life. This is done by nondestructive-metallographic examination at crack-susceptible locations of the components. Creep microcracks approximately one micron in size can be detected. RWTUV experience shows that, in general, the components need not be replaced or repaired until these microcracks have grown to form small creep macrocracks. The long prewarning period before macrocracks form provides assurance of safe operation for the full useful life of the components tested. The economic benefit achieved is considerable. Replication techniques have been widely applied by the authors in operating power plants since 1977. This nondestructive-evaluation method involves polishing small areas of selected piping-system components, preparing replicas of the polished areas, and examining the replicas under microscope for evidence of cavities, microcracks, or macrocracks

  18. Reducing test-data volume and test-power simultaneously in LFSR reseeding-based compression environment

    Energy Technology Data Exchange (ETDEWEB)

    Wang Weizheng; Kuang Jishun; You Zhiqiang; Liu Peng, E-mail: jshkuang@163.com [College of Information Science and Engineering, Hunan University, Changsha 410082 (China)

    2011-07-15

    This paper presents a new test scheme based on scan block encoding in a linear feedback shift register (LFSR) reseeding-based compression environment. Meanwhile, our paper also introduces a novel algorithm of scan-block clustering. The main contribution of this paper is a flexible test-application framework that achieves significant reductions in switching activity during scan shift and the number of specified bits that need to be generated via LFSR reseeding. Thus, it can significantly reduce the test power and test data volume. Experimental results using Mintest test set on the larger ISCAS'89 benchmarks show that the proposed method reduces the switching activity significantly by 72%-94% and provides a best possible test compression of 74%-94% with little hardware overhead. (semiconductor integrated circuits)

  19. 76 FR 69595 - Application of Third Party Testing Requirements; Reducing Third Party Testing Burdens

    Science.gov (United States)

    2011-11-08

    ... material change in the product's design or manufacturing process, including the sourcing of component parts...)) defines a ``children's product,'' in relevant part, as a consumer product designed or intended primarily... testing by a third party) be designed to show the similarity between the products? Also, sampling...

  20. Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers.

    Science.gov (United States)

    Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne; Rugulies, Reiner

    2014-11-01

    According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association is modified by sex, age, occupational position, and baseline mental health status. The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed mental health using the 5-item mental health inventory from the Short form 36 questionnaire. We analyzed data using multi-level modeling, adjusting for potential confounding by sex, age, cohabitation, occupational position, and baseline mental health. Unnecessary work tasks were prospectively associated with a decreased level of mental health. This association was stronger for employees with poor baseline mental health and tended to be more pronounced among older employees. Among participants with poor baseline mental health, the association was explained by neither psychological demands nor decision latitude. Our findings suggest that the prevention of unnecessary work tasks may benefit employee mental health, particularly among employees with pre-existing mental health problems.

  1. NASA Lewis Stirling SPRE testing and analysis with reduced number of cooler tubes

    International Nuclear Information System (INIS)

    Wong, W.A.; Cairelli, J.E.; Swec, D.M.; Doeberling, T.J.; Lakatos, T.F.; Madi, F.J.

    1994-01-01

    Free-piston Stirling power converters are a candidate for high capacity space power applications. The Space Power Research Engine (SPRE), a free-piston Stirling engine coupled with a linear alternator, is being tested at the NASA Lewis Research Center in support of the Civil Space Technology Initiative. The SPRE is used as a test bed for evaluating converter modifications which have the potential to improve converter performance and for validating computer code predictions. Reducing the number of cooler tubes on the SPRE has been identified as a modification with the potential to significantly improve power and efficiency. This paper describes experimental tests designed to investigate the effects of reducing the number of cooler tubes on converter power, efficiency and dynamics. Presented are test results from the converter operating with a reduced number of cooler tubes and comparisons between this data and both baseline test data and computer code predictions

  2. Optimizing human semen cryopreservation by reducing test vial volume and repetitive test vial sampling

    DEFF Research Database (Denmark)

    Jensen, Christian F S; Ohl, Dana A; Parker, Walter R

    2015-01-01

    OBJECTIVE: To investigate optimal test vial (TV) volume, utility and reliability of TVs, intermediate temperature exposure (-88°C to -93°C) before cryostorage, cryostorage in nitrogen vapor (VN2) and liquid nitrogen (LN2), and long-term stability of VN2 cryostorage of human semen. DESIGN......: Prospective clinical laboratory study. SETTING: University assisted reproductive technology (ART) laboratory. PATIENT(S): A total of 594 patients undergoing semen analysis and cryopreservation. INTERVENTION(S): Semen analysis, cryopreservation with different intermediate steps and in different volumes (50......-1,000 μL), and long-term storage in LN2 or VN2. MAIN OUTCOME MEASURE(S): Optimal TV volume, prediction of cryosurvival (CS) in ART procedure vials (ARTVs) with pre-freeze semen parameters and TV CS, post-thaw motility after two- or three-step semen cryopreservation and cryostorage in VN2 and LN2. RESULT...

  3. Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report.

    Science.gov (United States)

    Huh, Jong-Ki; Shin, Su-Jung

    2013-08-01

    This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

  4. Comparison of Anxiety Management Training and Desensitization in Reducing Test and Other Anxieties.

    Science.gov (United States)

    Deffenbacher, Jerry L.; Shelton, John L.

    1978-01-01

    Effects of systematic desensitization and anxiety management training in reducing test anxiety and generalizing to other anxieties were compared. Both desensitization and anxiety management training produced significant reduction of text anxiety, but by follow-up, anxiety management training produced significantly more test-anxiety reduction on…

  5. The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis.

    Science.gov (United States)

    Tak, Casey R; Malheiro, Marty C; Bennett, Heather K W; Crouch, Barbara I

    2017-03-01

    The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually. Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Feedback enhances the positive effects and reduces the negative effects of multiple-choice testing.

    Science.gov (United States)

    Butler, Andrew C; Roediger, Henry L

    2008-04-01

    Multiple-choice tests are used frequently in higher education without much consideration of the impact this form of assessment has on learning. Multiple-choice testing enhances retention of the material tested (the testing effect); however, unlike other tests, multiple-choice can also be detrimental because it exposes students to misinformation in the form of lures. The selection of lures can lead students to acquire false knowledge (Roediger & Marsh, 2005). The present research investigated whether feedback could be used to boost the positive effects and reduce the negative effects of multiple-choice testing. Subjects studied passages and then received a multiple-choice test with immediate feedback, delayed feedback, or no feedback. In comparison with the no-feedback condition, both immediate and delayed feedback increased the proportion of correct responses and reduced the proportion of intrusions (i.e., lure responses from the initial multiple-choice test) on a delayed cued recall test. Educators should provide feedback when using multiple-choice tests.

  7. Optimal testing input sets for reduced diagnosis time of nuclear power plant digital electronic circuits

    International Nuclear Information System (INIS)

    Kim, D.S.; Seong, P.H.

    1994-01-01

    This paper describes the optimal testing input sets required for the fault diagnosis of the nuclear power plant digital electronic circuits. With the complicated systems such as very large scale integration (VLSI), nuclear power plant (NPP), and aircraft, testing is the major factor of the maintenance of the system. Particularly, diagnosis time grows quickly with the complexity of the component. In this research, for reduce diagnosis time the authors derived the optimal testing sets that are the minimal testing sets required for detecting the failure and for locating of the failed component. For reduced diagnosis time, the technique presented by Hayes fits best for the approach to testing sets generation among many conventional methods. However, this method has the following disadvantages: (a) it considers only the simple network (b) it concerns only whether the system is in failed state or not and does not provide the way to locate the failed component. Therefore the authors have derived the optimal testing input sets that resolve these problems by Hayes while preserving its advantages. When they applied the optimal testing sets to the automatic fault diagnosis system (AFDS) which incorporates the advanced fault diagnosis method of artificial intelligence technique, they found that the fault diagnosis using the optimal testing sets makes testing the digital electronic circuits much faster than that using exhaustive testing input sets; when they applied them to test the Universal (UV) Card which is a nuclear power plant digital input/output solid state protection system card, they reduced the testing time up to about 100 times

  8. Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents unnecessary surgery.

    Science.gov (United States)

    Avolio, Luigi; Fusillo, Mario; Ferrari, Giovanna; Chiara, Alberto; Bragheri, Romano

    2002-04-01

    Neonatal adrenal hemorrhage presenting as scrotal swelling has been reported in 17 cases, with unnecessary surgical exploration in 7. We report 2 new cases, emphasizing the knowledge of this clinical association and the role of ultrasonography in the differential diagnosis for this specific condition and in all cases of neonatal acute scrotum.

  9. 77 FR 29579 - Removing Unnecessary Office on Violence Against Women Regulations

    Science.gov (United States)

    2012-05-18

    ... now unnecessary STOP VAIW Program regulations. Higher Education Amendments of 1998 Violence against... Office on Violence Against Women Regulations AGENCY: Office on Violence Against Women, Justice. ACTION: Proposed rule. SUMMARY: This rule proposes to remove the regulations for the STOP Violence Against Indian...

  10. Visual determinants of reduced performance on the Stroop color-word test in normal aging individuals.

    Science.gov (United States)

    van Boxtel, M P; ten Tusscher, M P; Metsemakers, J F; Willems, B; Jolles, J

    2001-10-01

    It is unknown to what extent the performance on the Stroop color-word test is affected by reduced visual function in older individuals. We tested the impact of common deficiencies in visual function (reduced distant and close acuity, reduced contrast sensitivity, and color weakness) on Stroop performance among 821 normal individuals aged 53 and older. After adjustment for age, sex, and educational level, low contrast sensitivity was associated with more time needed on card I (word naming), red/green color weakness with slower card 2 performance (color naming), and reduced distant acuity with slower performance on card 3 (interference). Half of the age-related variance in speed performance was shared with visual function. The actual impact of reduced visual function may be underestimated in this study when some of this age-related variance in Stroop performance is mediated by visual function decrements. It is suggested that reduced visual function has differential effects on Stroop performance which need to be accounted for when the Stroop test is used both in research and in clinical settings. Stroop performance measured from older individuals with unknown visual status should be interpreted with caution.

  11. Effects of Reducing the Cognitive Load of Mathematics Test Items on Student Performance

    Directory of Open Access Journals (Sweden)

    Susan C. Gillmor

    2015-01-01

    Full Text Available This study explores a new item-writing framework for improving the validity of math assessment items. The authors transfer insights from Cognitive Load Theory (CLT, traditionally used in instructional design, to educational measurement. Fifteen, multiple-choice math assessment items were modified using research-based strategies for reducing extraneous cognitive load. An experimental design with 222 middle-school students tested the effects of the reduced cognitive load items on student performance and anxiety. Significant findings confirm the main research hypothesis that reducing the cognitive load of math assessment items improves student performance. Three load-reducing item modifications are identified as particularly effective for reducing item difficulty: signalling important information, aesthetic item organization, and removing extraneous content. Load reduction was not shown to impact student anxiety. Implications for classroom assessment and future research are discussed.

  12. Antisense to the glucocorticoid receptor in hippocampal dentate gyrus reduces immobility in forced swim test

    NARCIS (Netherlands)

    Korte, S.M.; de Kloet, E.R.; Buwalda, B; Bouman, S.D.; Bohus, B

    1996-01-01

    Immobility time of rats in the forced swim test was reduced after bilateral infusion of an 18-mer antisense phosphorothioate oligodeoxynucleotide targeted to the glucocorticoid receptor mRNA into the dentate gyrus of the hippocampus. Vehicle-, sense- and scrambled sequence-treated animals spent

  13. Tuberculin skin testing in patients with HIV infection: limited benefit of reduced cutoff values

    NARCIS (Netherlands)

    Cobelens, Frank G.; Egwaga, Saidi M.; van Ginkel, Tessa; Muwinge, Hemed; Matee, Mecky I.; Borgdorff, Martien W.

    2006-01-01

    BACKGROUND: When determining eligibility for isoniazid preventive therapy of human immunodeficiency virus (HIV)-infected patients, the cutoff value of the tuberculin skin test (TST) is often reduced from an induration of 10 mm in diameter to one of 5 mm in diameter to compensate for loss of

  14. Comparison of Three Methods of Reducing Test Anxiety: Systematic Desensitization, Implosive Therapy, and Study Counseling

    Science.gov (United States)

    Cornish, Richard D.; Dilley, Josiah S.

    1973-01-01

    Systematic desensitization, implosive therapy, and study counseling have all been effective in reducing test anxiety. In addition, systematic desensitization has been compared to study counseling for effectiveness. This study compares all three methods and suggests that systematic desentization is more effective than the others, and that implosive…

  15. Characterization of test specimens produced in reduced size for X-ray microtomography (µ-CT tests

    Directory of Open Access Journals (Sweden)

    E. E. BERNARDES

    Full Text Available Abstract The need to use reduced sample sizes, in order to attain improved spatial resolution in (µ-CT tests applied in Portland cement composites, makes researchers perform the fractionation of materials to obtain samples with dimensions compatible with the capacity of the scanning equipment, which might cause alterations in the microstructure under analysis. Therefore, a test specimen (TS with dimensions compatible with the scanning capacity of a microtomography system that operates with an X-ray tube and voltage ranging from 20 to 100 kV was proposed. Axial compression strength tests were made and their total porosity was assessed by an apparent density and solid fraction density ratio, which were obtained by means of mercury and helium pycnometry and µ-CT technique, respectively. The adoption of that TS has shown to be viable for providing a sample with a higher level of representation.

  16. Seismic tests on a reduced scale mock-up of a reprocessing plant cooling pond

    International Nuclear Information System (INIS)

    Queval, J.C.; Gantenbein, F.; Lebelle, M.

    1995-01-01

    In conjunction with COGEMA and SGN, CEA has launched an important research program to validate the reprocessing plant cooling pond calculation mainly for the effect of the racks on the fluid-pond interaction. The paper presents the tests performed on a reduced scale mock-up (scale 1/5). The tests are composed by: -random excitations at very low excitation level to measure the natural frequencies, especially the first sloshing mode frequency; -sinusoidal tests to measure the damping; -seismic tests performed with 3 different time reduction scales (1, 1/5, 1/√5) and 3 different synthetic accelerograms. Two types of simplified model with added masses and finite element model were developed. Comparisons of measured and calculated pressure fields against the panels will be presented. The measured frequencies, obtained during tests, are in good agreement with Housner's results. (authors). 2 refs., 4 figs., 5 tabs

  17. Evaluation of the performance of the reduced local lymph node assay for skin sensitization testing.

    Science.gov (United States)

    Ezendam, Janine; Muller, Andre; Hakkert, Betty C; van Loveren, Henk

    2013-06-01

    The local lymph node assay (LLNA) is the preferred method for classification of sensitizers within REACH. To reduce the number of mice for the identification of sensitizers the reduced LLNA was proposed, which uses only the high dose group of the LLNA. To evaluate the performance of this method for classification, LLNA data from REACH registrations were used and classification based on all dose groups was compared to classification based on the high dose group. We confirmed previous examinations of the reduced LLNA showing that this method is less sensitive compared to the LLNA. The reduced LLNA misclassified 3.3% of the sensitizers identified in the LLNA and misclassification occurred in all potency classes and that there was no clear association with irritant properties. It is therefore not possible to predict beforehand which substances might be misclassified. Another limitation of the reduced LLNA is that skin sensitizing potency cannot be assessed. For these reasons, it is not recommended to use the reduced LLNA as a stand-alone assay for skin sensitization testing within REACH. In the future, the reduced LLNA might be of added value in a weight of evidence approach to confirm negative results obtained with non-animal approaches. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. The role of parental health care utilization in children's unnecessary utilization in China: evidence from Shaanxi province.

    Science.gov (United States)

    Zhang, Yi; Zhou, Zhongliang; Si, Yafei

    2017-03-09

    children's health care use was more prominent among younger children. Chinese children whose parents were high health care users were more likely to overuse health care services, holding other factors constant. Parents can play an important role in reducing children's unnecessary outpatient visits, infusion use, and inpatient visits. The results suggest that interventions aimed at affecting patterns of parental use may be helpful in improving appropriate health care utilization for children.

  19. The Careful Puppet Master: Reducing risk and fortifying acceptance testing with Jenkins CI

    Science.gov (United States)

    Smith, Jason A.; Richman, Gabriel; DeStefano, John; Pryor, James; Rao, Tejas; Strecker-Kellogg, William; Wong, Tony

    2015-12-01

    Centralized configuration management, including the use of automation tools such as Puppet, can greatly increase provisioning speed and efficiency when configuring new systems or making changes to existing systems, reduce duplication of work, and improve automated processes. However, centralized management also brings with it a level of inherent risk: a single change in just one file can quickly be pushed out to thousands of computers and, if that change is not properly and thoroughly tested and contains an error, could result in catastrophic damage to many services, potentially bringing an entire computer facility offline. Change management procedures can—and should—be formalized in order to prevent such accidents. However, like the configuration management process itself, if such procedures are not automated, they can be difficult to enforce strictly. Therefore, to reduce the risk of merging potentially harmful changes into our production Puppet environment, we have created an automated testing system, which includes the Jenkins CI tool, to manage our Puppet testing process. This system includes the proposed changes and runs Puppet on a pool of dozens of RedHat Enterprise Virtualization (RHEV) virtual machines (VMs) that replicate most of our important production services for the purpose of testing. This paper describes our automated test system and how it hooks into our production approval process for automatic acceptance testing. All pending changes that have been pushed to production must pass this validation process before they can be approved and merged into production.

  20. Design and test of aircraft engine isolators for reduced interior noise

    Science.gov (United States)

    Unruh, J. F.; Scheidt, D. C.

    1982-01-01

    Improved engine vibration isolation was proposed to be the most weight and cost efficient retrofit structure-borne noise control measure for single engine general aviation aircraft. A study was carried out the objectives: (1) to develop an engine isolator design specification for reduced interior noise transmission, (2) select/design candidate isolators to meet a 15 dB noise reduction design goal, and (3) carry out a proof of concept evaluation test. Analytical model of the engine, vibration isolators and engine mount structure were coupled to an empirical model of the fuselage for noise transmission evaluation. The model was used to develop engine isolator dynamic properties design specification for reduced noise transmission. Candidate isolators ere chosen from available product literature and retrofit to a test aircraft. A laboratory based test procedure was then developed to simulate engine induced noise transmission in the aircraft for a proof of concept evaluation test. Three candidate isolator configurations were evaluated for reduced structure-borne noise transmission relative to the original equipment isolators.

  1. Opportunities and strategies to further reduce animal use for Leptospira vaccine potency testing.

    Science.gov (United States)

    Walker, A; Srinivas, G B

    2013-09-01

    Hamsters are routinely infected with virulent Leptospira for two purposes in the regulation of biologics: the performance of Codified potency tests and maintenance of challenge culture for the Codified potency tests. Options for reducing animal use in these processes were explored in a plenary lecture at the "International Workshop on Alternative Methods for Leptospira Vaccine Potency Testing: State of the Science and the Way Forward" held at the Center for Veterinary Biologics in September 2012. The use of validated in vitro potency assays such as those developed by the U.S. Department of Agriculture for Leptospira (L.) canicola, Leptospira grippotyphosa, Leptospira pomona, and Leptospira icterohaemorrhagiae rather than the Codified hamster vaccination-challenge assay was encouraged. Alternatives such as reduced animal numbers in the hamster vaccination-challenge testing were considered for problematic situations. Specifically, the merits of sharing challenge controls, reducing group sizes, and eliminating animals for concurrent challenge dose titration were assessed. Options for maintaining virulent, stable cultures without serial passage through hamsters or with decreased hamster use were also discussed. The maintenance of virulent Leptospira without the use of live animals is especially difficult since a reliable means to maintain virulence after multiple in vitro passages has not yet been identified. Published by Elsevier Ltd.

  2. Proceedings of the 1988 International Meeting on Reduced Enrichment for Research and Test Reactors

    Energy Technology Data Exchange (ETDEWEB)

    1993-07-01

    The international effort to develop and implement new research reactor fuels utilizing low-enriched uranium, instead of highly- enriched uranium, continues to make solid progress. This effort is the cornerstone of a widely shared policy aimed at reducing, and possibly eliminating, international traffic in highly-enriched uranium and the nuclear weapon proliferation concerns associated with this traffic. To foster direct communication and exchange of ideas among the specialists in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the eleventh of a series which began 1978. Individual papers presented at the meeting have been cataloged separately.

  3. Proceedings of the 1988 International Meeting on Reduced Enrichment for Research and Test Reactors

    International Nuclear Information System (INIS)

    1993-07-01

    The international effort to develop and implement new research reactor fuels utilizing low-enriched uranium, instead of highly- enriched uranium, continues to make solid progress. This effort is the cornerstone of a widely shared policy aimed at reducing, and possibly eliminating, international traffic in highly-enriched uranium and the nuclear weapon proliferation concerns associated with this traffic. To foster direct communication and exchange of ideas among the specialists in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the eleventh of a series which began 1978. Individual papers presented at the meeting have been cataloged separately

  4. Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

    Science.gov (United States)

    Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

    2018-03-01

    Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

  5. Reducing patient identification errors related to glucose point-of-care testing

    Directory of Open Access Journals (Sweden)

    Gaurav Alreja

    2011-01-01

    Full Text Available Background: Patient identification (ID errors in point-of-care testing (POCT can cause test results to be transferred to the wrong patient′s chart or prevent results from being transmitted and reported. Despite the implementation of patient barcoding and ongoing operator training at our institution, patient ID errors still occur with glucose POCT. The aim of this study was to develop a solution to reduce identification errors with POCT. Materials and Methods: Glucose POCT was performed by approximately 2,400 clinical operators throughout our health system. Patients are identified by scanning in wristband barcodes or by manual data entry using portable glucose meters. Meters are docked to upload data to a database server which then transmits data to any medical record matching the financial number of the test result. With a new model, meters connect to an interface manager where the patient ID (a nine-digit account number is checked against patient registration data from admission, discharge, and transfer (ADT feeds and only matched results are transferred to the patient′s electronic medical record. With the new process, the patient ID is checked prior to testing, and testing is prevented until ID errors are resolved. Results: When averaged over a period of a month, ID errors were reduced to 3 errors/month (0.015% in comparison with 61.5 errors/month (0.319% before implementing the new meters. Conclusion: Patient ID errors may occur with glucose POCT despite patient barcoding. The verification of patient identification should ideally take place at the bedside before testing occurs so that the errors can be addressed in real time. The introduction of an ADT feed directly to glucose meters reduced patient ID errors in POCT.

  6. A computational environment for creating and testing reduced chemical kinetic mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Montgomery, C.J.; Swensen, D.A.; Harding, T.V.; Cremer, M.A.; Bockelie, M.J. [Reaction Engineering International, Salt Lake City, UT (USA)

    2002-02-01

    This paper describes software called computer assisted reduced mechanism problem solving environment (CARM-PSE) that gives the engineer the ability to rapidly set up, run and examine large numbers of problems comparing detailed and reduced (approximate) chemistry. CARM-PSE integrates the automatic chemical mechanism reduction code CARM and the codes that simulate perfectly stirred reactors and plug flow reactors into a user-friendly computational environment. CARM-PSE gives the combustion engineer the ability to easily test chemical approximations over many hundreds of combinations of inputs in a multidimensional parameter space. The demonstration problems compare detailed and reduced chemical kinetic calculations for methane-air combustion, including nitrogen oxide formation, in a stirred reactor and selective non-catalytic reduction of NOx, in coal combustion flue gas.

  7. A Study Protocol for Testing the Effectiveness of User-Generated Content in Reducing Excessive Consumption

    OpenAIRE

    Atar Herziger; Amel Benzerga; Jana Berkessel; Niken L. Dinartika; Matija Franklin; Kamilla K. Steinnes; Felicia Sundström

    2017-01-01

    Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing soc...

  8. Taiwan experience suggests that RhD typing for blood transfusion is unnecessary in southeast Asian populations.

    Science.gov (United States)

    Lin, Marie

    2006-01-01

    The high frequency of RhD (D) antigen among Taiwanese persons (99.67%) often imposes unnecessary risks of under-transfusion on D- patients awaiting D- blood. Also because of the rare occurrence of anti-D among Taiwanese persons, routine pretransfusion D typing has been discontinued in the Mackay Memorial Hospital since 1988. This report is the retrospective evaluation of the outcome of abolishing RhD typing for Taiwanese. More than 10 years of alloantibody data at Mackay Memorial Hospital Blood Bank were reviewed. The cases with anti-D were further used to analyze the potency of D antigen and to observe whether there were differences in the incidence of anti-D before and after discontinuation of routine D typing among Taiwanese individuals. The incidence of anti-D before and after discontinuation of routine pretransfusion D typing has remained unchanged. The immunogenicity of D and "Mi(a)" in Taiwanese persons is found to be similar. In terms of opportunity for immunization, however, the "Mi(a)" antigen (phenotype frequency 7.3% in Taiwanese persons) has become the most important blood group antigen in Taiwan. The results strongly support the exclusion of D typing from routine compatibility testing for individuals of Taiwanese origin. Because the low incidence of D- and relatively high incidence of "Mi(a)"+ phenotypes are common findings throughout southeast Asia, and because a population genetic study revealed that the Taiwanese people are genetically related to southern Asian populations, it is suggested that RhD typing for blood transfusion is unnecessary among southeast Asian populations.

  9. Reduced Enrichment for Research and Test Reactors. Proceedings of the XIV international meeting

    Energy Technology Data Exchange (ETDEWEB)

    Suripto, Asmedi; Hastowo, Hudi; Hersubeno, J B [eds.

    1995-07-01

    Apart from the progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program the national programs of Indonesia, Japan and China were presented. The major events, findings, and activities of 1991 are reviewed with a brief summary of the results which the RERTR Program had achieved by the end of 1990 in collaboration with its many international partners. The RERTR program, has concentrated its efforts on technology transfer and implementation activities consistent with the guidance received from the Department of Energy at the end of 1990. A number of presentations were devoted to development of new fuel uranium silicide fuel elements, fuel irradiation testing and reactor core conversions from highly enriched (HEU) to slightly enriched uranium (LEU). Calculations and measurements of converted reactor core parameters were shown related to safety test and analysis. Fuel cycle issue were discussed as well. One should note that a significant number of papers were devoted to Indonesian GA SIWABESSY reactor core conversion and related topics.

  10. Testing increases suggestibility for narrative-based misinformation but reduces suggestibility for question-based misinformation.

    Science.gov (United States)

    LaPaglia, Jessica A; Chan, Jason C K

    2013-01-01

    A number of recent studies have found that recalling details of an event following its occurrence can increase people's suggestibility to later presented misinformation. However, several other studies have reported the opposite result, whereby earlier retrieval can reduce subsequent eyewitness suggestibility. In the present study, we investigated whether differences in the way misinformation is presented can modulate the effects of testing on suggestibility. Participants watched a video of a robbery and some were questioned about the event immediately afterwards. Later, participants were exposed to misinformation in a narrative (Experiment 1) or in questions (Experiment 2). Consistent with previous studies, we found that testing increased suggestibility when misinformation was presented via a narrative. Remarkably, when misinformation was presented in questions, testing decreased suggestibility. Copyright © 2013 John Wiley & Sons, Ltd.

  11. Reduced Enrichment for Research and Test Reactors. Proceedings of the XIV international meeting

    International Nuclear Information System (INIS)

    Suripto, Asmedi; Hastowo, Hudi; Hersubeno, J.B.

    1995-01-01

    Apart from the progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program the national programs of Indonesia, Japan and China were presented. The major events, findings, and activities of 1991 are reviewed with a brief summary of the results which the RERTR Program had achieved by the end of 1990 in collaboration with its many international partners. The RERTR program, has concentrated its efforts on technology transfer and implementation activities consistent with the guidance received from the Department of Energy at the end of 1990. A number of presentations were devoted to development of new fuel uranium silicide fuel elements, fuel irradiation testing and reactor core conversions from highly enriched (HEU) to slightly enriched uranium (LEU). Calculations and measurements of converted reactor core parameters were shown related to safety test and analysis. Fuel cycle issue were discussed as well. One should note that a significant number of papers were devoted to Indonesian GA SIWABESSY reactor core conversion and related topics

  12. A unique laboratory test rig reduces the need for offshore tests to combat calcium naphthenate deposition in oilfield process equipment.

    Energy Technology Data Exchange (ETDEWEB)

    Mediaas, Heidi; Grande, Knut; Hustad, Britt-Marie; Hoevik, Kim Reidar; Kummernes, Hege; Nergaard, Bjoern; Vindstad, Jens Emil

    2006-03-15

    Producing and refining high-TAN crude oils introduces a number of challenges, among which calcium naphthenate deposition in process facilities is the most serious production issue. Until recently, the only option for studying chemicals and process parameters in order to prevent naphthenate deposition has been field tests. Statoil has now developed a small scale pilot plant where these experiments can be performed in the laboratory at Statoil's Research and Technology Center in Trondheim, Norway. The results from the pilot plant are in full agreement with the extensive naphthenate experience obtained from almost 9 years operation of the Heidrun oilfield. The design and operational procedures for this test facility are based on the recent discovery by Statoil and ConocoPhillips of the ARN acid. The ARN acid is a prerequisite for calcium naphthenate deposition. The new continuous flow pilot plant, the Naphthenate Rig, is used to develop new environmental friendly naphthenate inhibitors and to optimize process operating conditions. Since it operates on real crudes the need for field tests in qualifying new naphthenate inhibitors is reduced. To the best of our knowledge, the rig is the first of its kind in the world. (Author)

  13. A Study Protocol for Testing the Effectiveness of User-Generated Content in Reducing Excessive Consumption

    Directory of Open Access Journals (Sweden)

    Atar Herziger

    2017-06-01

    Full Text Available Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing social media trend (Minimalism in an empirical research design. The project will test (a whether the Minimalism trend could benefit consumers interested in reducing their consumption, and (b whether self-transcendence (i.e., biospheric and self-enhancement (i.e., egoistic and hedonic values and goals have a similar impact in promoting voluntary simplicity. A one-week intervention program will test the efficacy of watching user-generated voluntary simplicity videos in reducing non-essential consumption. Each of the two intervention conditions will present participants with similar tutorial videos on consumption reduction (e.g., decluttering, donating, while priming the relevant values and goals (self-transcendence or self-enhancement. These interventions will be compared to a control condition, involving no user-generated content. Participants will undergo baseline and post-intervention evaluations of: voluntary simplicity attitudes and behaviors, buying and shopping behaviors, values and goals in reducing consumption, and life satisfaction. Experience sampling will monitor affective state during the intervention. We provide a detailed stepwise procedure, materials, and equipment necessary for executing this intervention. The outlined research design is expected to contribute to the limited literature on voluntary simplicity, online behavioral change interventions, and the use of social marketing principles in consumer interventions.

  14. A Study Protocol for Testing the Effectiveness of User-Generated Content in Reducing Excessive Consumption

    Science.gov (United States)

    Herziger, Atar; Benzerga, Amel; Berkessel, Jana; Dinartika, Niken L.; Franklin, Matija; Steinnes, Kamilla K.; Sundström, Felicia

    2017-01-01

    Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing social media trend (Minimalism) in an empirical research design. The project will test (a) whether the Minimalism trend could benefit consumers interested in reducing their consumption, and (b) whether self-transcendence (i.e., biospheric) and self-enhancement (i.e., egoistic and hedonic) values and goals have a similar impact in promoting voluntary simplicity. A one-week intervention program will test the efficacy of watching user-generated voluntary simplicity videos in reducing non-essential consumption. Each of the two intervention conditions will present participants with similar tutorial videos on consumption reduction (e.g., decluttering, donating), while priming the relevant values and goals (self-transcendence or self-enhancement). These interventions will be compared to a control condition, involving no user-generated content. Participants will undergo baseline and post-intervention evaluations of: voluntary simplicity attitudes and behaviors, buying and shopping behaviors, values and goals in reducing consumption, and life satisfaction. Experience sampling will monitor affective state during the intervention. We provide a detailed stepwise procedure, materials, and equipment necessary for executing this intervention. The outlined research design is expected to contribute to the limited literature on voluntary simplicity, online behavioral change interventions, and the use of social marketing principles in consumer interventions. PMID:28649220

  15. A Study Protocol for Testing the Effectiveness of User-Generated Content in Reducing Excessive Consumption.

    Science.gov (United States)

    Herziger, Atar; Benzerga, Amel; Berkessel, Jana; Dinartika, Niken L; Franklin, Matija; Steinnes, Kamilla K; Sundström, Felicia

    2017-01-01

    Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing social media trend (Minimalism) in an empirical research design. The project will test (a) whether the Minimalism trend could benefit consumers interested in reducing their consumption, and (b) whether self-transcendence (i.e., biospheric) and self-enhancement (i.e., egoistic and hedonic) values and goals have a similar impact in promoting voluntary simplicity. A one-week intervention program will test the efficacy of watching user-generated voluntary simplicity videos in reducing non-essential consumption. Each of the two intervention conditions will present participants with similar tutorial videos on consumption reduction (e.g., decluttering, donating), while priming the relevant values and goals (self-transcendence or self-enhancement). These interventions will be compared to a control condition, involving no user-generated content. Participants will undergo baseline and post-intervention evaluations of: voluntary simplicity attitudes and behaviors, buying and shopping behaviors, values and goals in reducing consumption, and life satisfaction. Experience sampling will monitor affective state during the intervention. We provide a detailed stepwise procedure, materials, and equipment necessary for executing this intervention. The outlined research design is expected to contribute to the limited literature on voluntary simplicity, online behavioral change interventions, and the use of social marketing principles in consumer interventions.

  16. Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users

    Directory of Open Access Journals (Sweden)

    Jameel Sughair

    2018-02-01

    Full Text Available Introduction: Case management is an effective, short-term means to reduce emergency department (ED visits in frequent users of the ED. This study sought to determine the effectiveness of case management on frequent ED users, in terms of reducing ED and hospital length of stay (LOS, accrued costs, and utilization of diagnostic tests. Methods: The study consisted of a retrospective chart review of ED and inpatient visits in our hospital’s ED case management program, comparing patient visits made in the one year prior to enrollment in the program, to the visits made in the one year after enrollment in the program. We examined the LOS, use of diagnostic testing, and monetary charges incurred by these patients one year prior and one year after enrollment into case management. Results: The study consisted of 158 patients in case management. Comparing the one year prior to enrollment to the one year after enrollment, ED visits decreased by 49%, inpatient admissions decreased by 39%, the use of computed tomography imaging decreased 41%, the use of ultrasound imaging decreased 52%, and the use of radiographs decreased 38%. LOS in the ED and for inpatient admissions decreased by 39%, reducing total LOS for these patients by 178 days. ED and hospital charges incurred by these patients decreased by 5.8 million dollars, a 41% reduction. All differences were statistically significant. Conclusion: Case management for frequent users of the ED is an effective method to reduce patient visits, the use of diagnostic testing, length of stay, and cost within our institution.

  17. Benefits of expressive writing in reducing test anxiety: A randomized controlled trial in Chinese samples.

    Science.gov (United States)

    Shen, Lujun; Yang, Lei; Zhang, Jing; Zhang, Meng

    2018-01-01

    To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students. The Test Anxiety Scale (TAS) was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants' writing manuscripts. Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P 0.05). Students' writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days' manuscripts and the last 10 days' ones. Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study.

  18. Benefits of expressive writing in reducing test anxiety: A randomized controlled trial in Chinese samples.

    Directory of Open Access Journals (Sweden)

    Lujun Shen

    Full Text Available To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students.The Test Anxiety Scale (TAS was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants' writing manuscripts.Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P 0.05. Students' writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days' manuscripts and the last 10 days' ones.Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study.

  19. Benefits of expressive writing in reducing test anxiety: A randomized controlled trial in Chinese samples

    Science.gov (United States)

    Zhang, Jing; Zhang, Meng

    2018-01-01

    Purpose To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students. Methods The Test Anxiety Scale (TAS) was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants’ writing manuscripts. Results Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P 0.05). Students’ writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days’ manuscripts and the last 10 days’ ones. Conclusions Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study. PMID:29401473

  20. Identification of reduced-order model for an aeroelastic system from flutter test data

    Directory of Open Access Journals (Sweden)

    Wei Tang

    2017-02-01

    Full Text Available Recently, flutter active control using linear parameter varying (LPV framework has attracted a lot of attention. LPV control synthesis usually generates controllers that are at least of the same order as the aeroelastic models. Therefore, the reduced-order model is required by synthesis for avoidance of large computation cost and high-order controller. This paper proposes a new procedure for generation of accurate reduced-order linear time-invariant (LTI models by using system identification from flutter testing data. The proposed approach is in two steps. The well-known poly-reference least squares complex frequency (p-LSCF algorithm is firstly employed for modal parameter identification from frequency response measurement. After parameter identification, the dominant physical modes are determined by clear stabilization diagrams and clustering technique. In the second step, with prior knowledge of physical poles, the improved frequency-domain maximum likelihood (ML estimator is presented for building accurate reduced-order model. Before ML estimation, an improved subspace identification considering the poles constraint is also proposed for initializing the iterative procedure. Finally, the performance of the proposed procedure is validated by real flight flutter test data.

  1. Reducing and Sustaining Duplicate Medical Record Creation by Usability Testing and System Redesign.

    Science.gov (United States)

    Khunlertkit, Adjhaporn; Dorissaint, Leonard; Chen, Allen; Paine, Lori; Pronovost, Peter J

    2017-10-25

    Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training. We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation. To evaluate system effectiveness, we compared the monthly potential duplicate medical record rates for preimplementation and postimplementation months. The existing system could not effectively handle a misspelling, which led to failed search and duplicate medical record creation. Using the existing system, 96% of registrars found commonly spelled patient names whereas only 69% successfully found complicated names. Registrars lacked knowledge and usage of a phonetic matching function to assist in misspelling. The new system consistently captured the correct patient regardless of misspelling, but search returned more potential matches, resulting in, on average, 4 seconds longer to select common names. Potential monthly duplicate medical record rate reduced by 38%, from 4% to 2.3% after implementation of the new system, and has sustained at an average of 2.5% for 2 years. Usability testing was an effective method to reveal problems and aid system redesign to deliver a more user friendly system, hence reducing the potential for medical record duplication. Greater standards for usability would ensure that these improvements can be realized before rather than after exposing patients to risks.

  2. Cortisol response to the Trier Social Stress Test in obese and reduced obese individuals.

    Science.gov (United States)

    Therrien, Fanny; Drapeau, Vicky; Lalonde, Josée; Lupien, Sonia J; Beaulieu, Serge; Doré, Jean; Tremblay, Angelo; Richard, Denis

    2010-05-01

    Impact of body weight loss, body fat distribution and the nutritional status on the cortisol response to the Trier Social Stress Test (TSST) was investigated in this study. Fifty-one men (17 non-obese, 20 abdominally obese and 14 reduced obese) and 28 women (12 non-obese, 10 peripherally obese and 6 reduced obese) were subjected to the TSST in fed and fasted states. The TSST response was determined using salivary cortisol measurements. The nutritional status (being fed or fasted) had no effect on the cortisol levels during and following the TSST. Reduced obese men exhibited lower cortisol levels than non-obese men. Cortisol levels in obese men were not different from those of non-obese and reduced obese subjects. In women, there was no significant difference between groups. These finding suggest that weight status in men influences cortisol reactivity to a psychological stress and the different responses seen among genders could be linked to the different fat distributions that characterize men and women. Copyright 2010 Elsevier B.V. All rights reserved.

  3. Status of the RERTR [Reduced Enrichment Research and Test Reactor] program in Argentina

    International Nuclear Information System (INIS)

    Giorsetti, D.R.

    1987-01-01

    The Argentine Atomic Energy Commission started in 1978 the Reduced Enrichment Research and Test Reactors in the field of reactor engineering; engineering, development and manufacturing of fuel elements and research reactors operators. This program was initiated with the conviction that it would contribute to the international efforts to reduce risks of nuclear weapons proliferation owing to an uncontrolled use of highly enriched uranium. It was intended to convert RA-3 reactor to make possible its operation with low enriched fuel (LEU), instead of high enriched fuel (HEU) and to develop manufacturing techniques for said LEU. Afterwards, this program was adapted to assist other countries in reactors conversion, development of the corresponding fuel elements and supply of fuel elements to other countries. (Author)

  4. Determination of kinetic constants from tests of reducibility and their application for modelling in metallurgy

    International Nuclear Information System (INIS)

    Pustejovska, P.; Silvie, B.

    2013-01-01

    The paper analyses details for renewal of the research in blast furnace process within Research Centre ENET at VSB - Technical University of Ostrava. A newly established laboratory for reducibility testing is an impuls to overcome the former limits and renew a research in its coherence after years. The paper deals with the possibilities of optimization of blast furnace operation. In the introduction, it sums up different approaches how to model blast furnace operation. It discusses the variety of optimal operation for different kinds of iron making technologies. It evaluates reduction course and reducing gas consumption in the stack of reduction aggregate. In the experimental, it creates kinetics model of blast furnace operating using Matlab mathematical library. It determines kinetic and heat limits of carbon consumption for different process conditions. (author)

  5. A preoperative cotininury test for abdominoplasty reduces peri-operative complications.

    Science.gov (United States)

    Delaunay, F; Coquerel-Beghin, D; Magalon, G; Cohen, S R; Casanova, D; Niddam, J; Milliez, P-Y; Peillon, C; Delpierre, V; Auquit-Auckbur, I

    2018-05-16

    Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001). The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  6. Reply to: Mounting evidence indicates that escalating doses of allopurinol are unnecessary for cardiovascular protection.

    Science.gov (United States)

    Coburn, Brian W; Michaud, Kaleb; Bergman, Debra A; Mikuls, Ted R

    2018-05-08

    We thank Dr. Bredemeier for his comments regarding our manuscript on allopurinol dose escalation and mortality. He raises important evidence to consider in support of an interesting hypothesis that dose escalation may be unnecessary for allopurinol's cardiovascular (CV) protection and may actually be related to adverse CV outcomes. While we agree that evidence exists suggesting that low doses of allopurinol may be sufficient for CV protection, we believe that the studies cited highlight a number of areas where knowledge gaps remain which preclude any definitive conclusions about the effect of dose escalation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  7. Progress of the RERTR [Reduced Enrichment Research and Test Reactor] Program in 1989

    International Nuclear Information System (INIS)

    Travelli, A.

    1989-01-01

    The progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program is described. After a brief summary of the results which the RERTR Program, in collaboration with its many international partners, had achieved by the end of 1988, the major events, findings, and activities of 1989 are reviewed. The scope of the RERTR Program activities was curtailed, in 1989, by an unexpected legislative restriction which limited the ability of the Arms Control and Disarmament Agency to adequately fund the program. Nevertheless, the thrust of the major planned program activities was maintained, and meaningful results were obtained in several areas of great significance for future work. 15 refs., 12 figs

  8. CONCENTRATION OF HARMFUL SUBSTANCES REDUCING IN SURFACE LAYER OF ATMOSPHERE AT RHEOSTAT LOCOMOTIVE TESTS

    Directory of Open Access Journals (Sweden)

    E. A. Bondar

    2010-06-01

    Full Text Available It is shown that at present an acceptable way of reducing the concentration of harmful substances in the surface layer of the atmosphere at rheostat tests of locomotives is their dispersion in a large volume of air. Channels, installed above an exhaust pipe of diesel locomotive with a break at the gas flow, work as ejectors. We have solved jointly the equation of aerodynamic characteristics of the ejector device and the equation of diffusion of gases; as a result the calculated dependence for determining the necessary height of ejector device has been obtained.

  9. Genomic testing interacts with reproductive surplus in reducing genetic lag and increasing economic net return

    DEFF Research Database (Denmark)

    Hjortø, Line; Ettema, Jehan Frans; Kargo, Morten

    2015-01-01

    Until now, genomic information has mainly been used to improve the accuracy of genomic breeding values for breeding animals at a population level. However, we hypothesize that the use of information from genotyped females also opens up the possibility of reducing genetic lag in a dairy herd......, especially if genomic tests are used in combination with sexed semen or a high management level for reproductive performance, because both factors provide the opportunity for generating a reproductive surplus in the herd. In this study, sexed semen is used in combination with beef semen to produce high......-value crossbred beef calves. Thus, on average there is no surplus of and selection among replacement heifers whether to go into the herd or to be sold. In this situation, the selection opportunities arise when deciding which cows to inseminate with sexed semen, conventional semen, or beef semen. We tested...

  10. Performance and durability tests of smart icephobic coatings to reduce ice adhesion

    Energy Technology Data Exchange (ETDEWEB)

    Janjua, Zaid A.; Turnbull, Barbara [Faculty of Engineering, University of Nottingham (United Kingdom); Choy, Kwang-Leong; Pandis, Christos [Institute for Materials Discovery, University College London (UCL) (United Kingdom); Liu, Junpeng; Hou, Xianghui; Choi, Kwing-So [Faculty of Engineering, University of Nottingham (United Kingdom)

    2017-06-15

    Highlights: • Repeated ice adhesion and removal occurs on nanocoatings. • Icephobicity of nanocoatings reduces with each test cycle. • Adhesion strength linked to contact angle hysteresis in Gaussian fit. • Icephobicity not linked to hydrophobicity. - Abstract: The accretion of ice can cause damage in applications ranging from power lines and shipping decks, to wind turbines and rail infrastructure. In particular on aircraft, it can change aerodynamic characteristics, greatly affecting the flight safety. Commercial aircraft are therefore required to be equipped with de-icing devices, such as heating mats over the wings. The application of icephobic coatings near the leading edge of a wing can in theory reduce the high power requirements of heating mats, which melt ice that forms there. Such coatings are effective in preventing the accretion of runback ice, formed from airborne supercooled droplets, or the water that the heating mats generate as it is sheared back over the wing's upper surface. However, the durability and the practicality of applying them over a large wing surface have been prohibitive factors in deploying this technology so far. Here, we evaluated the ice adhesion strength of four non-conductive coatings and seven thermally conductive coatings by shearing ice samples from coated plates by spinning them in a centrifuge device. The durability of the coating performance was also assessed by repeating the tests, each time regrowing ice samples on the previously-used coatings. Contact angle parameters of each coating were tested for each test to determine influence on ice adhesion strength. The results indicate that contact angle hysteresis is a crucial parameter in determining icephobicity of a coating and hydrophobicity is not necessarily linked to icephobicity.

  11. Experimental results of the SMART ECC injection performance with reduced scale of test facility

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Il; Cho, Seok; Ko, Yung Joo; Shin, Yong Cheol; Kwon, Tae Soon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2011-05-15

    SMART pressurized water reactor type is different from the existing integral NSSS commercial pressurized water reactor system which is equipped with the main features. In addition, RCS piping is removed and the feature of the SBLOCA is a major design break accident. SWAT (SMART ECC Water Asymmetric Two-phase choking test facility) test facility is to simulate the 2 inch SBLOCA of the SMART using with reduced scale. The Test was performed to produce experimental data for the validation of the TASS/SMR-S thermal hydraulic analysis code, and to investigate the related thermal hydraulic phenomena in the down-comer region during the 2 inch SBLOCA of the safety inject line. The particular phenomena for the observation are ECC bypass and multi-dimensional flow characteristics to verify the effectiveness and performance of the safety injection system. In this paper, the corresponding steady state test conditions, including initial and boundary conditions along with major measuring parameters, and related experimental results were described

  12. Thoracic splenosis. Know it-avoid unnecessary investigations, interventions, and thoracotomy

    International Nuclear Information System (INIS)

    Khan, A.M.; Manzoor, K.; Malik, Z.; Yasim, A.; Shim, C.

    2011-01-01

    Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a 99m Tc-sulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy. (author)

  13. Inhibition of TRPM8 channels reduces pain in the cold pressor test in humans.

    Science.gov (United States)

    Winchester, Wendy J; Gore, Katrina; Glatt, Sophie; Petit, Wendy; Gardiner, Jennifer C; Conlon, Kelly; Postlethwaite, Michael; Saintot, Pierre-Philippe; Roberts, Sonia; Gosset, James R; Matsuura, Tomomi; Andrews, Mark D; Glossop, Paul A; Palmer, Michael J; Clear, Nicola; Collins, Susie; Beaumont, Kevin; Reynolds, David S

    2014-11-01

    The transient receptor potential (subfamily M, member 8; TRPM8) is a nonselective cation channel localized in primary sensory neurons, and is a candidate for cold thermosensing, mediation of cold pain, and bladder overactivity. Studies with TRPM8 knockout mice and selective TRPM8 channel blockers demonstrate a lack of cold sensitivity and reduced cold pain in various rodent models. Furthermore, TRPM8 blockers significantly lower body temperature. We have identified a moderately potent (IC50 = 103 nM), selective TRPM8 antagonist, PF-05105679 [(R)-3-[(1-(4-fluorophenyl)ethyl)(quinolin-3-ylcarbonyl)amino]methylbenzoic acid]. It demonstrated activity in vivo in the guinea pig bladder ice water and menthol challenge tests with an IC50 of 200 nM and reduced core body temperature in the rat (at concentrations >1219 nM). PF-05105679 was suitable for acute administration to humans and was evaluated for effects on core body temperature and experimentally induced cold pain, using the cold pressor test. Unbound plasma concentrations greater than the IC50 were achieved with 600- and 900-mg doses. The compound displayed a significant inhibition of pain in the cold pressor test, with efficacy equivalent to oxycodone (20 mg) at 1.5 hours postdose. No effect on core body temperature was observed. An unexpected adverse event (hot feeling) was reported, predominantly periorally, in 23 and 36% of volunteers (600- and 900-mg dose, respectively), which in two volunteers was nontolerable. In conclusion, this study supports a role for TRPM8 in acute cold pain signaling at doses that do not cause hypothermia. Copyright © 2014 by The American Society for Pharmacology and Experimental Therapeutics.

  14. DOJ News Release: West Palm Beach Sellers of Unnecessary Septic Tank Products Plead Guilty to Wire Fraud

    Science.gov (United States)

    Moore, Nouerand and Lincoln, in concert with other employees of FBK Products, LLC., knowingly participated in a scheme to fraudulently market and sell an unnecessary and unneeded septic treatment product to residents of various states across the country.

  15. Electrochemical Testing of Gas Tungsten Arc Welded and Reduced Pressure Electron Beam Welded Alloy 22

    International Nuclear Information System (INIS)

    Day, S D; Wong, F G; Gordon, S R; Wong, L L; Rebak, R B

    2006-01-01

    Alloy 22 (N06022) is the material selected for the fabrication of the outer shell of the nuclear waste containers for the Yucca Mountain high-level nuclear waste repository site. A key technical issue in the waste package program has been the integrity of the container weld joints. The currently selected welding process for fabricating and sealing the containers is the traditional gas tungsten arc welding (GTAW) or TIG method. An appealing faster alternative technique is reduced pressure electron beam (RPEB) welding. It was of interest to compare the corrosion properties of specimens prepared using both types of welding techniques. Standard electrochemical tests were carried on GTAW and RPEB welds as well as on base metal (non-welded) to determine their relative corrosion behavior in simulated concentrated water (SCW) at 90 C (alkaline), 1 M HCl at 60 C (acidic) and 1 M NaCl at 90 C (neutral) solutions. Results show that for all practical purposes, the three tested materials had the same electrochemical behavior in the three tested electrolytes

  16. Electrochemical Testing of Gas Tungsten ARC Welded and Reduced Pressure Electron Beam Welded Alloy 22

    International Nuclear Information System (INIS)

    S. Daniel Day; Frank M.G. Wong; Steven R. Gordon; Lana L. Wong; Raul B. Rebak

    2006-01-01

    Alloy 22 (N06022) is the material selected for the fabrication of the outer shell of the nuclear waste containers for the Yucca Mountain high-level nuclear waste repository site. A key technical issue in the waste package program has been the integrity of the container weld joints. The currently selected welding process for fabricating and sealing the containers is the traditional gas tungsten arc welding (GTAW) or TIC method. An appealing faster alternative technique is reduced pressure electron beam (RPEB) welding. It was of interest to compare the corrosion properties of specimens prepared using both types of welding techniques. Standard electrochemical tests were carried on GTAW and RPEB welds as well as on base metal (non-welded) to determine their relative corrosion behavior in simulated concentrated water (SCW) at 90 C (alkaline), 1 M HCI at 60 C (acidic) and 1 M NaCl at 90 C (neutral) solutions. Results show that for all practical purposes, the three tested materials had the same electrochemical behavior in the three tested electrolytes

  17. Does the addition of saline infusion sonohysterography to transvaginal ultrasonography prevent unnecessary hysteroscopy in premenopausal women with abnormal uterine bleeding?

    Science.gov (United States)

    Short, John; Sharp, Benjamin; Elliot, Nikki; McEwing, Rachael; McGeoch, Graham; Shand, Brett; Holland, Kieran

    2016-08-01

    This observational case series in 65 premenopausal women with abnormal uterine bleeding evaluated whether transvaginal ultrasound followed by saline infusion sonohysterography (SIS) prevented unnecessary hysteroscopy. Although SIS indicated that hysteroscopy was unnecessary in eight women, this benefit was offset by the invasive nature of the scan, the number of endometrial abnormalities falsely detected by SIS and the cost of the additional investigation. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  18. Earthquake forecasting test for Kanto district to reduce vulnerability of urban mega earthquake disasters

    Science.gov (United States)

    Yokoi, S.; Tsuruoka, H.; Nanjo, K.; Hirata, N.

    2012-12-01

    Collaboratory for the Study of Earthquake Predictability (CSEP) is a global project on earthquake predictability research. The final goal of this project is to search for the intrinsic predictability of the earthquake rupture process through forecast testing experiments. The Earthquake Research Institute, the University of Tokyo joined CSEP and started the Japanese testing center called as CSEP-Japan. This testing center provides an open access to researchers contributing earthquake forecast models applied to Japan. Now more than 100 earthquake forecast models were submitted on the prospective experiment. The models are separated into 4 testing classes (1 day, 3 months, 1 year and 3 years) and 3 testing regions covering an area of Japan including sea area, Japanese mainland and Kanto district. We evaluate the performance of the models in the official suite of tests defined by CSEP. The total number of experiments was implemented for approximately 300 rounds. These results provide new knowledge concerning statistical forecasting models. We started a study for constructing a 3-dimensional earthquake forecasting model for Kanto district in Japan based on CSEP experiments under the Special Project for Reducing Vulnerability for Urban Mega Earthquake Disasters. Because seismicity of the area ranges from shallower part to a depth of 80 km due to subducting Philippine Sea plate and Pacific plate, we need to study effect of depth distribution. We will develop models for forecasting based on the results of 2-D modeling. We defined the 3D - forecasting area in the Kanto region with test classes of 1 day, 3 months, 1 year and 3 years, and magnitudes from 4.0 to 9.0 as in CSEP-Japan. In the first step of the study, we will install RI10K model (Nanjo, 2011) and the HISTETAS models (Ogata, 2011) to know if those models have good performance as in the 3 months 2-D CSEP-Japan experiments in the Kanto region before the 2011 Tohoku event (Yokoi et al., in preparation). We use CSEP

  19. TestMeEast: a campaign to increase HIV testing in hospitals and to reduce late diagnosis.

    Science.gov (United States)

    Bath, R; O'Connell, R; Lascar, M; Ferrand, R; Strachan, S; Matin, N; Bassnet, I; Orkin, C

    2016-01-01

    Late diagnosis occurs in almost half of those diagnosed in the UK (HIV Prevention England, 2013. Retrieved June 22, 2014, from HIV Prevention England: http://www.hivpreventionengland.org.uk/Campaigns-Current/National-HIV-Testing-Week ). Testing occurs mainly in sexual health and antenatal clinics despite recommendations to test more broadly [Ellis, S., & Curtis, H. (2012). HIV diagnoses and missed opportunities. Results of the British HIV association (BHIVA) National Audit 2010. Clinical Medicine, 12(5), 430-434]. We report the findings of an HIV-testing week campaign to offer testing to those who have blood tests as part of routine care within outpatient clinics and emergency departments of six London hospitals. The campaign target was to test 500 patients a day during the 2013 National HIV Testing Week (NHTW). Clinic staff and medical students were trained to offer routine HIV testing. Linkage to care was arranged for those who tested HIV-positive. During NHTW we tested 2402 of the planned 2500 test target. 2402/4317 (55.6% 95% CI 54.1-57.1%) of those who had routine blood tests were tested for HIV. There were eight HIV-positive tests; three were new diagnoses (all linked to care). The campaign hashtag #TestMeEast achieved a total Twitter "reach" of 238, 860 and the campaign had widespread news coverage. Our campaign showed that staff and students could be trained and mobilised to do thousands of routine HIV tests during a campaign.

  20. Development of Reduced Activation Ferritic-Martensitic Steels and fabrication technologies for Indian test blanket module

    Energy Technology Data Exchange (ETDEWEB)

    Raj, Baldev [Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102 (India); Jayakumar, T., E-mail: tjk@igcar.gov.in [Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102 (India)

    2011-10-01

    For the development of Reduced Activation Ferritic-Martensitic Steel (RAFMS), for the Indian Test Blanket Module for ITER, a 3-phase programme has been adopted. The first phase consists of melting and detailed characterization of a laboratory scale heat conforming to Eurofer 97 composition, to demonstrate the capability of the Indian industry for producing fusion grade steel. In the second phase which is currently in progress, the chemical composition will be optimized with respect to tungsten and tantalum for better combination of mechanical properties. Characterization of the optimized commercial scale India-specific RAFM steel will be carried out in the third phase. The first phase of the programme has been successfully completed and the tensile, impact and creep properties are comparable with Eurofer 97. Laser and electron beam welding parameters have been optimized and welding consumables were developed for Narrow Gap - Gas Tungsten Arc welding and for laser-hybrid welding.

  1. Technical issues of reduced activation ferritic/martensitic steels for fabrication of ITER test blanket modules

    International Nuclear Information System (INIS)

    Tanigawa, H.; Hirose, T.; Shiba, K.; Kasada, R.; Wakai, E.; Serizawa, H.; Kawahito, Y.; Jitsukawa, S.; Kimura, A.; Kohno, Y.; Kohyama, A.; Katayama, S.; Mori, H.; Nishimoto, K.; Klueh, R.L.; Sokolov, M.A.; Stoller, R.E.; Zinkle, S.J.

    2008-01-01

    Reduced activation ferritic/martensitic steels (RAFMs) are recognized as the primary candidate structural materials for fusion blanket systems. The RAFM F82H was developed in Japan with emphasis on high-temperature properties and weldability. Extensive irradiation studies have conducted on F82H, and it has the most extensive available database of irradiated and unirradiated properties of all RAFMs. The objective of this paper is to review the R and D status of F82H and to identify the key technical issues for the fabrication of an ITER test blanket module (TBM) suggested from the recent research achievements in Japan. This work clarified that the primary issues with F82H involve welding techniques and the mechanical properties of weld joints. This is the result of the distinctive nature of the joint caused by the phase transformation that occurs in the weld joint during cooling, and its impact on the design of a TBM will be discussed

  2. The RERTR [Reduced Enrichment Research and Test Reactor] Program: Progress and plans

    International Nuclear Information System (INIS)

    Travelli, A.

    1987-01-01

    The progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program is described. After a brief summary of the results which the RERTR Program, in collaboration with its many international partners, had achieved by the end of 1986, the activities, results, and new developments which occurred in 1987 are reviewed. Irradiation of the second miniplate series, concentrating on U 3 Si 2 -Al and U 3 Si-Al fuels, was completed and postirradiation examinations were performed on many of its miniplates. The whole-core ORR demonstration with U 3 Si 2 -Al fuel at 4.8 g U/cm 3 was completed at the end of March with excellent results and with 29 elements estimated to have reached at least 40% average burnup. Good progress was made in the area of LEU usage for the production of fission 99 Mo, and in the coordination of safety evaluations related to LEU conversions of US university reactors. Planned activities include testing and demonstrating advanced fuels intended to allow use of reduced enrichment uranium in very-high-performance reactors. Two candidate fuels are U 3 Si-Al with 19.75% enrichment and U 3 Si 2 -Al with 45% enrichment. Demonstration of these fuels will include irradiation of full-size elements and, possibly, a full-core demonstration. Achievement of the final program goals is still projected for 1990. This progress could not have been possible without the close international cooperation which has existed from the beginning, and which is essential to the ultimate success of the RERTR Program

  3. Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults.

    Science.gov (United States)

    Milward, Joanna; Deluca, Paolo; Drummond, Colin; Watson, Rod; Dunne, Jacklyn; Kimergård, Andreas

    2017-08-08

    Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As "Digital Natives," young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. The first theme, "Functionality" referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, "Design" described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, "Content" described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization. ©Joanna Milward, Paolo Deluca, Colin Drummond, Rod Watson, Jacklyn Dunne, Andreas Kimerg

  4. Proceedings of the 1990 International Meeting on Reduced Enrichment for Research and Test Reactors

    Energy Technology Data Exchange (ETDEWEB)

    1993-07-01

    The global effort to reduce, and possibly, eliminate the international traffic in highly-enriched uranium caused by its use in research reactors requires extensive cooperation and free exchange of information among all participants. To foster this free exchange of information, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the thirteenth of a series which began in 1978. The common effort brought together, past, a large number of specialists from many countries. On hundred twenty-three participants from 26 countries, including scientists, reactor operators, and personnel from commercial fuel suppliers, research centers, and government organizations, convened in Newport, Rhode Island to discuss their results, their activities, and their plans relative to converting research reactors to low-enriched fuels. As more and more reactors convert to the use of low-enriched uranium, the emphasis of our effort has begun to shift from research and development to tasks more directly related to implementation of the new fuels and technologies that have been developed, and to refinements of those fuels and technologies. It is appropriate, for this reason, that the emphasis of this meeting was placed on safety and on conversion experiences. This individual papers in this report have been cataloged separately.

  5. Proceedings of the 1990 International Meeting on Reduced Enrichment for Research and Test Reactors

    International Nuclear Information System (INIS)

    1993-07-01

    The global effort to reduce, and possibly, eliminate the international traffic in highly-enriched uranium caused by its use in research reactors requires extensive cooperation and free exchange of information among all participants. To foster this free exchange of information, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the thirteenth of a series which began in 1978. The common effort brought together, past, a large number of specialists from many countries. On hundred twenty-three participants from 26 countries, including scientists, reactor operators, and personnel from commercial fuel suppliers, research centers, and government organizations, convened in Newport, Rhode Island to discuss their results, their activities, and their plans relative to converting research reactors to low-enriched fuels. As more and more reactors convert to the use of low-enriched uranium, the emphasis of our effort has begun to shift from research and development to tasks more directly related to implementation of the new fuels and technologies that have been developed, and to refinements of those fuels and technologies. It is appropriate, for this reason, that the emphasis of this meeting was placed on safety and on conversion experiences. This individual papers in this report have been cataloged separately

  6. Exposure to aged crumb rubber reduces survival time during a stress test in earthworms (Eisenia fetida).

    Science.gov (United States)

    Pochron, Sharon; Nikakis, Jacqueline; Illuzzi, Kyra; Baatz, Andrea; Demirciyan, Loriana; Dhillon, Amritjot; Gaylor, Thomas; Manganaro, Alexa; Maritato, Nicholas; Moawad, Michael; Singh, Rajwinder; Tucker, Clara; Vaughan, Daniel

    2018-04-01

    Solid waste management struggles with the sustainable disposal of used tires. One solution involves shredding used tires into crumb rubber and using the material as infill for artificial turf. However, crumb rubber contains hydrocarbons, organic compounds, and heavy metals, and it travels into the environment. Earthworms living in soil contaminated with virgin crumb rubber gained 14% less body weight than did earthworms living in uncontaminated soil, but the impact of aged crumb rubber on the earthworms is unknown. Since many athletic fields contain aged crumb rubber, we compared the body weight, survivorship, and longevity in heat and light stress for earthworms living in clean topsoil to those living in topsoil contaminated with aged crumb rubber. We also characterized levels of metals, nutrients, and micronutrients of both soil treatments and compared those to published values for soil contaminated with virgin crumb rubber. Consistent with earlier research, we found that contaminated soil did not inhibit microbial respiration rates. Aged crumb rubber, like new crumb rubber, had high levels of zinc. However, while exposure to aged crumb rubber did not reduce earthworm body weight as did exposure to new crumb rubber, exposure to aged crumb rubber reduced earthworm survival time during a stress test by a statistically significant 38 min (16.2%) relative to the survival time for worms that had lived in clean soil. Aged crumb rubber and new crumb rubber appear to pose similar toxic risks to earthworms. This study suggests an environmental cost associated with the current tire-recycling solution.

  7. Testing Mediators of Reduced Drinking for Veterans in Alcohol Care Management.

    Science.gov (United States)

    Moskal, Dezarie; Maisto, Stephen A; Possemato, Kyle; Lynch, Kevin G; Oslin, David W

    2018-03-26

    Alcohol Care Management (ACM) is a manualized treatment provided by behavioral health providers working in a primary care team aimed at increasing patients' treatment engagement and decreasing their alcohol use. Research has shown that ACM is effective in reducing alcohol consumption; however, the mechanisms of ACM are unknown. Therefore, the purpose of this study is to examine the mechanisms of change in ACM in the context of a randomized clinical trial evaluating the effectiveness of ACM. This study performed secondary data analysis of existing data from a larger study that involved a sample of U.S. veterans (N = 163) who met criteria for current alcohol dependence. Upon enrollment into the study, participants were randomized to receive either ACM or standard care. ACM was delivered in-person or by telephone within the primary care clinic and focused on the use of oral naltrexone and manualized psychosocial support. According to theory, we hypothesized several ACM treatment components that would mediate alcohol consumption outcomes: engagement in addiction treatment, reduced craving, and increased readiness to change. Parallel mediation models were performed by the PROCESS macro Model 4 in SPSS to test study hypotheses. The institutional review boards at each of the participating facilities approved all study procedures before data collection. As hypothesized, results showed that treatment engagement mediated the relation between treatment and both measures of alcohol consumption outcomes, the percentage of alcohol abstinent days, and the percentage of heavy drinking days. Neither craving nor readiness to change mediated the treatment effect on either alcohol consumption outcome. Findings suggest that ACM may be effective in changing drinking patterns partially due to an increase in treatment engagement. Future research may benefit from evaluating the specific factors that underlie increased treatment engagement. The current study provides evidence that alcohol

  8. Incubation of ethanol reinstatement depends on test conditions and how ethanol consumption is reduced

    Science.gov (United States)

    Ginsburg, Brett C.; Lamb, R. J.

    2015-01-01

    In reinstatement studies (a common preclinical procedure for studying relapse), incubation occurs (longer abstinence periods result in more responding). This finding is discordant with the clinical literature. Identifying determinants of incubation could aid in interpreting reinstatement and identifying processes involved in relapse. Reinstated responding was examined in rats trained to respond for ethanol and food under a multiple concurrent schedule (Component 1: ethanol FR5, food FR150; Component 2: ethanol FR5, food FR5–alternating across the 30-min session). Ethanol consumption was then reduced for 1 or 16 sessions either by suspending training (rats remained in home cage) or by providing alternative reinforcement (only Component 2 stimuli and contingencies were presented throughout the session). In the next session, stimuli associated with Component 1 were presented and responses recorded but ethanol and food were never delivered. Two test conditions were studied: fixed-ratio completion either produced ethanol- or food-associated stimuli (signaled) or had no programmed consequence (unsignaled). Incubation of ethanol responding was observed only after suspended training during signaled test sessions. Incubation of food responding was also observed after suspended training. These results are most consistent with incubation resulting from a degradation of feedback functions limiting extinction responding, rather than an increased motivation. PMID:25595114

  9. Design of Hydraulic Bushing and Vehicle Testing for Reducing the Judder Vibration

    Directory of Open Access Journals (Sweden)

    Kim Youngman

    2018-01-01

    Full Text Available Generally, judder vibration is a low-frequency vibration phenomenon caused by a braking force imbalance that occurs when a vehicle is lightly decelerated within a range of 0.1 to 0.2g at a speed of 120 to 60 km/h. This comes from the change in the brake disk thickness (DTV, which is mainly caused by the side run-out (SRO and thermal deformation. The adoption of hydro-bushing in the low arm G bushings of the vehicle front suspension has been done in order to provide great damping in a particular frequency range (<20Hz in order to prevent this judder vibration from being transmitted to the body. The hydro bushing was formulated using a lumped parameter model. The fluid passage between the two chambers was modelled as a nonlinear element such as an orifice, and its important parameters (resistance, compliance were measured using a simplified experimental setup. The main design parameters are the ratio of the cross-sectional area of the chamber to the fluid passage, the length of the fluid passage, etc., and their optimal design is such that the loss angle is greater than 45 ° in the target frequency range of 10 to 20 Hz. The hydro bushing designed for reducing the judder vibration was prepared for the actual vehicle application test and applied to the actual vehicle test. In this study, the proposed hydro bushing was applied to the G bushing of the low arm of the front suspension system of the vehicle. The loss angle of the manufactured hydro bushing was measured using acceleration signals before and after passing through the bushing. The actual vehicle test was performed on the noise dynamometer for the performance analysis of the judder vibration reduction.

  10. The U.S. reduced enrichment research and test reactor (RERTR) program

    International Nuclear Information System (INIS)

    Travelli, A.

    1993-01-01

    Research and test reactors are widely deployed to study the irradiation behavior of materials of interest in nuclear engineering, to produce radioisotopes for medicine, industry, and agriculture, and as a basic research and teaching tool. In order to maximize neutron flux per unit power and/or to minimize capital costs and fuel cycle costs, most of these reactors were de- signed to utilize uranium with very high enrichment (in the 70% to 95% range). Research reactor fuels with such high uranium enrichment cause a potential risk of nuclear weapons proliferation. Over 140 research and test reactors of significant power (between 10 kW and 250 MW) are in operation with very highly enriched uranium in more than 35 countries, with total power in excess of 1,700 MW. The overall annual fuel requirement of these reactors corresponds to approximately 1,200 kg of 235 U. This highly strategic material is normally exported from the United States, converted to metal form, shipped to a fuel fabricator, and then shipped to the reactor site in finished fuel element form. At the reactor site the fuel is first stored, then irradiated, stored again, and eventually shipped back to the United States for reprocessing. The whole cycle takes approximately four years to complete, bringing the total required fuel inventory to approximately 5,000 kg of 235 U. The resulting international trade in highly-enriched uranium may involve several countries in the process of refueling a single reactor and creates a considerable concern that the highly-enriched uranium may be diverted for non-peaceful purposes while in fabrication, transport, or storage, particularly when it is in the unirradiated form. The proliferation resistance of nuclear fuels used in research and test reactors can be considerably improved by reducing their uranium enrichment to a value less than 20%, but significantly greater than natural to avoid excessive plutonium production

  11. Health hazard of the Tokai mura nuclear accident. Unnecessary fear and improper health checks should be eliminated

    International Nuclear Information System (INIS)

    Takebe, Hiraku

    2000-01-01

    Three workers were heavily exposed to radiations in the Tokai mura nuclear accident, and one of them died due to the acute effects of radiations. Doses for the heavily exposed persons were estimated to be 2.5, 10 and 18 Sv, according to the Science and Technology Agency. Workers who tried to stop the chain reaction by breaking the water pipe were estimated to have been exposed up to 120 mSv. Possible doses for other workers and residents in the neighborhoods were estimated to be less than 10 mSv, with a few workers with slightly higher film badge records. After the accident, many reports in mass-media warned that the exposed persons may develop cancers and leukemias in future and follow-up healthcare should be needed. Judging from our knowledge of the extensive epidemiological survey of the atomic bomb survivors in Hiroshima and Nagasaki, these reports are very misleading. There would be absolutely no or extremely small possibility of developing any health hazard among the workers and the residents except for the three unfortunate heavily exposed workers. If so-called follow-up health checks would involve x-ray diagnosis for cancers, the radiation doses by the diagnosis would exceed the exposure by the accident. Also, the test for the DNA damage applied to some workers and residents is not reliable at all, and could cause unnecessary fear among the persons who were mistakingly said to be of high-risk. (author)

  12. Liver AMP-Activated Protein Kinase Is Unnecessary for Gluconeogenesis but Protects Energy State during Nutrient Deprivation.

    Directory of Open Access Journals (Sweden)

    Clinton M Hasenour

    Full Text Available AMPK is an energy sensor that protects cellular energy state by attenuating anabolic and promoting catabolic processes. AMPK signaling is purported to regulate hepatic gluconeogenesis and substrate oxidation; coordination of these processes is vital during nutrient deprivation or pathogenic during overnutrition. Here we directly test hepatic AMPK function in regulating metabolic fluxes that converge to produce glucose and energy in vivo. Flux analysis was applied in mice with a liver-specific deletion of AMPK (L-KO or floxed control littermates to assess rates of hepatic glucose producing and citric acid cycle (CAC fluxes. Fluxes were assessed in short and long term fasted mice; the latter condition is a nutrient stressor that increases liver AMP/ATP. The flux circuit connecting anaplerosis with gluconeogenesis from the CAC was unaffected by hepatic AMPK deletion in short and long term fasting. Nevertheless, depletion of hepatic ATP was exacerbated in L-KO mice, corresponding to a relative elevation in citrate synthase flux and accumulation of branched-chain amino acid-related metabolites. L-KO mice also had a physiological reduction in flux from glycogen to G6P. These results demonstrate AMPK is unnecessary for maintaining gluconeogenic flux from the CAC yet is critical for stabilizing liver energy state during nutrient deprivation.

  13. Reducing Retroactive Interference through the Use of Different Encoding Techniques: An Exploration of Pre-Test/Post-Test Analyses

    Science.gov (United States)

    Cumming, John M.; De Miranda, Michael A.

    2012-01-01

    Retroactive interference (RI) in list learning occurs when the learning of a second list of words interferes with the recall of the first learned list. Having the lists be thematically different can reduce retroactive interference within list learning; however, this study demonstrates how RI can be reduced when the lists contain similar words.…

  14. The RERTR [Reduced Enrichment Research and Test Reactor] program: A progress report

    International Nuclear Information System (INIS)

    Travelli, A.

    1986-11-01

    The progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program is described. After a brief summary of the results which the RERTR Program, in collaboration with its many international partners, had achieved by the end of 1985, the activities, results, and new developments which occurred in 1986 are reviewed. The second miniplate series, concentrating on U 3 Si 2 -Al and U 3 Si-Al fuels, was expanded and its irradiation continued. Postirradiation examinations of several of these miniplates and of six previously irradiated U 3 Si 2 -Al full-size elements were completed with excellent results. The whole-core ORR demonstration with U 3 Si 2 -Al fuel at 4.8 g U/cm 3 is well under way and due for completion before the end of 1987. DOE removed an important barrier to conversions by announcing that the new LEU fuels will be accepted for reprocessing. New DOE prices for enrichment and reprocessing services were calculated to have minimal effect on HEU reactors, and to reduce by about 8 to 10% the total fuel cycle costs of LEU reactors. New program activities include preliminary feasibility studies of LEU use in DOE reactors, evaluation of the feasibility to use LEU targets for the production of fission-product 99 Mo, and responsibility for coordinating safety evaluations related to LEU conversions of US university reactors, as required by NRC. Achievement of the final program goals is projected for 1990. This progress could not have been achieved without close international cooperation, whose continuation and intensification are essential to the achievement of the ultimate goals of the RERTR Program

  15. Randomized test of an implementation intention-based tool to reduce stress-induced eating.

    Science.gov (United States)

    O'Connor, Daryl B; Armitage, Christopher J; Ferguson, Eamonn

    2015-06-01

    Stress may indirectly contribute to disease (e.g. cardiovascular disease, cancer) by producing deleterious changes to diet. The purpose of this study was to test the effectiveness of a stress management support (SMS) tool to reduce stress-related unhealthy snacking and to promote stress-related healthy snacking. Participants were randomized to complete a SMS tool with instruction to link stressful situations with healthy snack alternatives (experimental) or a SMS tool without a linking instruction (control). On-line daily reports of stressors and snacking were completed for 7 days. Daily stressors were associated with unhealthy snack consumption in the control condition but not in the experimental condition. Participants highly motivated towards healthy eating consumed a greater number of healthy snacks in the experimental condition on stressful days compared to participants in the experimental condition with low and mean levels of motivation. This tool is an effective, theory driven, intervention that helps to protect against stress-induced high-calorie snack consumption.

  16. A premature demise for RERTR [Reduced Enrichment for Research and Test Reactors programme]?

    International Nuclear Information System (INIS)

    Rydell, R.J.

    1990-01-01

    A common commitment from France, Belgium, Germany and the US to eliminate highly enriched uranium from their research reactors is needed to help guard against this material falling into the wrong hands. In the US, an essential part of this commitment would be rekindling the weakened Reduced Enrichment for Research and Test Reactors programme (RERTR). This is an American initiative to develop low-enrichment uranium fuel for research reactors that have previously required weapons-usable material. Underway since 1978 at Argonne National Laboratory, RERTR has achieved some impressive results: the development of higher density, low enriched fuels that are suitable for use at over 90% of the world's research reactors; a net reduction of US exports of highly enriched uranium (HEU) from the annual 700kg levels in the late 1970s to a 1990 level of just over 100kg; the encouragement of international scientific co-operation aimed at developing new fuels and facilitating the conversion of existing reactors to these fuels. However, in recent years, the US commitment to RERTR has been declining -budgets have fallen and advanced fuel development work has terminated. (author)

  17. Reducing health impacts of biomass burning for cooking. The need for cookstove performance testing

    Energy Technology Data Exchange (ETDEWEB)

    Abeliotis, K. [Department of Home Economics and Ecology, Harokopio University, Athens (Greece); Pakula, C. [Institute of Agricultural Engineering, Section Household and Appliance Technology, Rheinische Friedrich-Wilhelms University, Bonn (Germany)

    2013-08-15

    Biomass is a renewable energy source that is routinely used for cooking in the developing world, especially in rural areas. The World Health Organization estimates that about 2.5 billion people globally rely on biomass, such as wood, agricultural waste and animal dung to meet their energy needs for cooking utilising traditional low-efficiency cookstoves. However, certain human health risks are associated with the inhalation of off-gases resulting from the indoor use of biomass for cooking, especially for women and children who spend more of their time at home. On the other hand, use of energy-efficient cookstoves is considered to reduce those risks. Thus, qualitative and quantitative measurements of cookstove performance are necessary in order to make different stoves and different cooking processes comparable. The aim of this paper is the presentation of the current situation regarding biomass use for cooking with emphasis placed on the developing world, the brief of the adverse health impacts of biomass burning based on the review of literature, the presentation of the merits of improved efficiency cookstoves and to highlight the need for stove performance tests. The demand of different types of biomass is not likely to change in the near future in the developing world since biomass is readily available and cheap. Thus, the efforts to improve household air quality must concentrate on improving cookstoves efficiency and ventilation of the flue gases outdoors. Programmes for the improvement of the cookstoves efficiency in the developing world should be part of the development agenda.

  18. Proceedings of the international meeting on development, fabrication and application of reduced enrichment fuels for research and test reactors

    International Nuclear Information System (INIS)

    1983-08-01

    Separate abstracts were prepared for each of the papers presented in the following areas: (1) Reduced Enrichment Fuels for Research and Test Reactors (RERTR) Program Status; (2) Fuel Development; (3) Fuel Demonstrations; (4) General Topics; and (5) Specific Reactor Applications

  19. Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test.

    Science.gov (United States)

    Pisani, Anthony R; Wyman, Peter A; Gurditta, Kunali; Schmeelk-Cone, Karen; Anderson, Carolyn L; Judd, Emily

    2018-05-31

    Suicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach. We field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention. We field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students' own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the

  20. A better state-of-mind: deep breathing reduces state anxiety and enhances test performance through regulating test cognitions in children.

    Science.gov (United States)

    Khng, Kiat Hui

    2017-11-01

    A pre-test/post-test, intervention-versus-control experimental design was used to examine the effects, mechanisms and moderators of deep breathing on state anxiety and test performance in 122 Primary 5 students. Taking deep breaths before a timed math test significantly reduced self-reported feelings of anxiety and improved test performance. There was a statistical trend towards greater effectiveness in reducing state anxiety for boys compared to girls, and in enhancing test performance for students with higher autonomic reactivity in test-like situations. The latter moderation was significant when comparing high-versus-low autonomic reactivity groups. Mediation analyses suggest that deep breathing reduces state anxiety in test-like situations, creating a better state-of-mind by enhancing the regulation of adaptive-maladaptive thoughts during the test, allowing for better performance. The quick and simple technique can be easily learnt and effectively applied by most children to immediately alleviate some of the adverse effects of test anxiety on psychological well-being and academic performance.

  1. Proceedings of the 1978 international meeting on reduced enrichment for research and test reactors

    Energy Technology Data Exchange (ETDEWEB)

    Travelli, A [Argonne National Laboratory, Argonne, IL (United States)

    1993-08-01

    November 9-10, 1978, marked the first of what has become an annual event - the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The RERTR Program had been started only three months earlier, and the meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and while it established the basis for all later meetings, it was unique in several respects. It was a time of feeling each other out, and of sharing new ideas, concerns, and hopes. In the absence of an established precedent, a number of participants came with written papers while others made only verbal presentations. Informality added spice and special importance to the discussions at the end of each presentation and, especially, to the panel discussion at the end of the meeting. An important achievement was a consensus on near-, medium-, and long-term density goals for the various fuels. This consensus resulted in a list written on the blackboard at the end of the panel discussion, and reproduced on page 216, which outlined the goals of each fabricator. Luckily, both presentations and discussions were recorded on audio tape. These recordings were transcribed and used to complete the informal presentations and to append the discussions at the end of each presentation. Considerable effort was expended in clearing the transcribed papers and key discussions with the participants. A few issues could not be resolved quickly, and in the frantic rush of those early years, these proceedings were set aside. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort, we have recently dusted off the manuscript and finished our editing job.

  2. Proceedings of the 1978 international meeting on reduced enrichment for research and test reactors

    International Nuclear Information System (INIS)

    Travelli, A.

    1993-08-01

    November 9-10, 1978, marked the first of what has become an annual event - the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The RERTR Program had been started only three months earlier, and the meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and while it established the basis for all later meetings, it was unique in several respects. It was a time of feeling each other out, and of sharing new ideas, concerns, and hopes. In the absence of an established precedent, a number of participants came with written papers while others made only verbal presentations. Informality added spice and special importance to the discussions at the end of each presentation and, especially, to the panel discussion at the end of the meeting. An important achievement was a consensus on near-, medium-, and long-term density goals for the various fuels. This consensus resulted in a list written on the blackboard at the end of the panel discussion, and reproduced on page 216, which outlined the goals of each fabricator. Luckily, both presentations and discussions were recorded on audio tape. These recordings were transcribed and used to complete the informal presentations and to append the discussions at the end of each presentation. Considerable effort was expended in clearing the transcribed papers and key discussions with the participants. A few issues could not be resolved quickly, and in the frantic rush of those early years, these proceedings were set aside. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort, we have recently dusted off the manuscript and finished our editing job

  3. A case of autoimmune cholangitis misdiagnosed for cholangiocarcinoma: How to avoid unnecessary surgical intervention?

    Directory of Open Access Journals (Sweden)

    Ignjatović Igor I.

    2015-01-01

    Full Text Available Introduction. Autoimmune cholangitis or immunoglobulin G4-associated cholangitis (IAC has been recently regarded as a new clinical and histopathological entity and is a part of a complex autoimmune disorder - IgG4-related systemic disease (ISD. ISD is an autoimmune disease with multi-organic involvement, characterized with IgG4-positive plasmocytic infiltration of various tissues and organs with a consequent sclerosis, which responds well to steroid therapy. Most commonly affected organs are the pancreas (autoimmune pancreatitis, [AIP] and the common bile duct (IAC. IAC and cholangiocarcinoma (CCA share many clinical, laboratory and imaging findings. Case Outline. We present a case of a 60-year-old male with a biliary stricture of a common bile duct, which was clinically considered as a bile duct carcinoma and treated surgically. Definite histopathological findings and immunohistochemistry revealed profound chronic inflammation, showing lymphoplasmacytic IgG-positive infiltration of a resected part of a common bile duct, highly suggestive for the diagnosis of IAC. In addition, postoperative IgG4 serum levels were also increased. Conclusion. It is of primary clinical importance to make a difference between IAC and CCA, in order to avoid unnecessary surgical intervention. Therefore, IAC should be considered in differential diagnosis in similar cases.

  4. Decision analysis for the cost effectiveness of Sestamibi Scintimammography in minimizing unnecessary biopsies

    International Nuclear Information System (INIS)

    Allen, M.W.; Hendi, P.; Schwimmer, J.; Gambhir, S.S.; Bassett, L.

    2000-01-01

    The purpose of this study was to assess if breast cancer screening using sestamibi scintimammography (SSMM) in conjunction with mammography (MM) is cost effective in avoiding biopsies in healthy patients. Quantitative decision tree sensitivity analysis was used to compare the conventional MM alone strategy (strategy A) with two decision strategies for screening with SSMM; SSMM after an indeterminate mammogram (strategy B) or SSMM after both a positive and an indeterminate mammogram (strategy C). Cost effectiveness was measured by calculating the expected cost per patient and the average life expectancy per patient for baseline values as well as over a range of values for all of the variables of each strategy. Based on Medicare reimbursement values, strategies B and C showed a cost savings of $9 and $20 per patient respectively as compared to strategy A. This translates into respective savings of $189 and $420 million per year assuming 21 million females undergo screening each year. Strategies B and C did however have a loss of mean life expectancy of 0.000178 and 0.000222 years respectively as compared to strategy A due to interval progression of breast cancer in a small number of women. Strategies B and C significantly lowered the number of biopsies performed on healthy patients in the screening population by 750,063 and 1,557,915 biopsies respectively as compared to strategy A. These results quantitatively verify the potential utility of using SSMM in avoiding unnecessary biopsies

  5. Integrated Vibration and Acceleration Testing to Reduce Payload Mass, Cost and Mission Risk, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to develop a capability to provide integrated acceleration, vibration, and shock testing using a state-of-the-art centrifuge, allowing for the test of...

  6. Use of predefined biochemical admission profiles does not reduce the number of tests or total cost

    DEFF Research Database (Denmark)

    Pareek, Manan; Haidl, Felix; Folkestad, Lars

    2014-01-01

    The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost.......The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost....

  7. Randomised controlled trial of routine individual feedback to improve rationality and reduce numbers of test requests.

    Science.gov (United States)

    Winkens, R A; Pop, P; Bugter-Maessen, A M; Grol, R P; Kester, A D; Beusmans, G H; Knottnerus, J A

    1995-02-25

    Feedback can be described as a way to provide information on doctors' performance to enable changes in future behaviour. Feedback is used with the aim of changing test-ordering behaviour. It can lead to reductions in test usage and cost savings. It is not sufficiently clear, however, whether feedback leads to more appropriate test use. Since 1985, the Diagnostic Coordinating Center Maastricht has been giving feedback on diagnostic tests as a routine health care activity to all family doctors in its region. Both quantity and quality of requests are discussed. In a randomised, controlled trial over 2.5 years, discussion of tests not included previously was added to the existing routine feedback. One group of family doctors (n = 39) received feedback on test-group A (electrocardiography, endoscopy, cervical smears, and allergy tests), the other (n = 40) on test-group B (radiographic and ultrasonographic tests). Thus, each group of doctors acted as a control group for the other. Changes in volume and rationality of requests were analysed. The number of requests decreased during the trial (p = 0.036). Request numbers decreased particularly for test-group A (p = 0.04). The proportion of requests that were non-rational decreased more in the intervention than in the control groups (p = 0.009). Rationality improved predominantly for test-group B (p = 0.043). Thus, routine feedback can change the quantity and quality of requests.

  8. Reducing animal experimentation in foot-and-mouth disease vaccine potency tests.

    Science.gov (United States)

    Reeve, Richard; Cox, Sarah; Smitsaart, Eliana; Beascoechea, Claudia Perez; Haas, Bernd; Maradei, Eduardo; Haydon, Daniel T; Barnett, Paul

    2011-07-26

    The World Organisation for Animal Health (OIE) Terrestrial Manual and the European Pharmacopoeia (EP) still prescribe live challenge experiments for foot-and-mouth disease virus (FMDV) immunogenicity and vaccine potency tests. However, the EP allows for other validated tests for the latter, and specifically in vitro tests if a "satisfactory pass level" has been determined; serological replacements are also currently in use in South America. Much research has therefore focused on validating both ex vivo and in vitro tests to replace live challenge. However, insufficient attention has been given to the sensitivity and specificity of the "gold standard"in vivo test being replaced, despite this information being critical to determining what should be required of its replacement. This paper aims to redress this imbalance by examining the current live challenge tests and their associated statistics and determining the confidence that we can have in them, thereby setting a standard for candidate replacements. It determines that the statistics associated with the current EP PD(50) test are inappropriate given our domain knowledge, but that the OIE test statistics are satisfactory. However, it has also identified a new set of live animal challenge test regimes that provide similar sensitivity and specificity to all of the currently used OIE tests using fewer animals (16 including controls), and can also provide further savings in live animal experiments in exchange for small reductions in sensitivity and specificity. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Reduce, Reuse, Recycle: The Longitudinal Value of Local Cut Scores Using State Test Data

    Science.gov (United States)

    Nelson, Peter M.; Van Norman, Ethan R.; VanDerHeyden, Amanda

    2017-01-01

    We used existing reading (n = 1,498) and math (n = 2,260) data to evaluate state test scores for screening middle school students. In Phase 1, state test data were used to create a research-derived cut score that was optimal for predicting state test performance the following year. In Phase 2, those cut scores were applied with future cohorts.…

  10. Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations

    Energy Technology Data Exchange (ETDEWEB)

    Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2017-03-15

    Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)

  11. Internalized homophobia and reduced HIV testing among men who have sex with men in China.

    Science.gov (United States)

    Pyun, Thomas; Santos, Glenn-Milo; Arreola, Sonya; Do, Tri; Hebert, Pato; Beck, Jack; Makofane, Keletso; Wilson, Patrick A; Ayala, George

    2014-03-01

    Although previous research has examined barriers and facilitators of HIV testing among men who have sex with men (MSM) in China, few studies have focused on social factors, including homophobia and internalized homophobia. This study utilized data from a global online survey to determine correlates of HIV testing as part of a subanalysis focused on Chinese MSM. Controlling for age, HIV knowledge, number of sexual partners, and other covariates, ever having tested for HIV was significantly correlated with lower internalized homophobia. This study suggests that stigma associated with sexual orientation may serve as a barrier to participation in HIV testing and other health-promoting behaviors.

  12. Reducing Resistance

    DEFF Research Database (Denmark)

    Lindell, Johanna

    care may influence decisions on antibiotic use. Based on video-and audio recordings of physician-patient consultations it is investigated how treatment recommendations are presented, can be changed, are forecast and explained, and finally, how they seemingly meet resistance and how this resistance......Antibiotic resistance is a growing public health problem both nationally and internationally, and efficient strategies are needed to reduce unnecessary use. This dissertation presents four research studies, which examine how communication between general practitioners and patients in Danish primary...... is responded to.The first study in the dissertation suggests that treatment recommendations on antibiotics are often done in a way that encourages patient acceptance. In extension of this, the second study of the dissertation examines a case, where acceptance of such a recommendation is changed into a shared...

  13. Reduced Capacity in a Dichotic Memory Test for Adult Patients with ADHD

    Science.gov (United States)

    Dige, Niels; Maahr, Eija; Backenroth-Ohsako, Gunnel

    2010-01-01

    Objective: To evaluate whether a dichotic memory test would reveal deficits in short-term working-memory recall and long-term memory recall in a group of adult patients with ADHD. Methods: A dichotic memory test with ipsilateral backward speech distraction in an adult ADHD group (n = 69) and a control group (n = 66) is used to compare performance…

  14. Home-based voluntary HIV counselling and testing found highly acceptable and to reduce inequalities

    Directory of Open Access Journals (Sweden)

    Michelo Charles

    2010-06-01

    Full Text Available Abstract Background Low uptake of voluntary HIV counselling and testing (VCT in sub-Saharan Africa is raising acceptability concerns which might be associated with ways by which it is offered. We investigated the acceptability of home-based delivery of counselling and HIV testing in urban and rural populations in Zambia where VCT has been offered mostly from local clinics. Methods A population-based HIV survey was conducted in selected communities in 2003 (n = 5035. All participants stating willingness to be HIV tested were offered VCT at home and all counselling was conducted in the participants' homes. In the urban area post-test counselling and giving of results were done the following day whereas in rural areas this could take 1-3 weeks. Results Of those who indicated willingness to be HIV tested, 76.1% (95%CI 74.9-77.2 were counselled and received the test result. Overall, there was an increase in the proportion ever HIV tested from 18% before provision of home-based VCT to 38% after. The highest increase was in rural areas; among young rural men aged 15-24 years up from 14% to 42% vs. for urban men from 17% to 37%. Test rates by educational attainment changed from being positively associated to be evenly distributed after home-based VCT. Conclusions A high uptake was achieved by delivering HIV counselling and testing at home. The highest uptakes were seen in rural areas, in young people and groups with low educational attainment, resulting in substantial reductions in existing inequalities in accessing VCT services.

  15. Low-Cost, Class D Testing of Spacecraft Photovoltaic Systems Can Reduce Risk

    Science.gov (United States)

    Forgione, Joshua B.; Kojima, Gilbert K.; Hanel, Robert; Mallinson, Mark V.

    2014-01-01

    The end-to-end verification of a spacecraft photovoltaic power generation system requires light! Specifically, the standard practice for doing so is the Large Area Pulsed Solar Simulation (LAPSS). A LAPSS test can characterize a photovoltaic system's efficiency via its response to rapidly applied impulses of simulated sunlight. However, a Class D program on a constrained budget and schedule may not have the resources to ship an entire satellite for a LAPSS test alone. Such was the case with the Lunar Atmospheric and Dust Environment Explorer (LADEE) program, which was also averse to the risk of hardware damage during shipment. When the Electrical Power System (EPS) team was denied a spacecraft-level LAPSS test, the lack of an end-to-end power generation test elevated to a project-level technical risk. The team pulled together very limited resources to not only eliminate the risk, but build a process to monitor the health of the system through mission operations. We discuss a process for performing a low-cost, end-to-end test of the LADEE photovoltaic system. The approach combines system-level functional test, panel-level performance results, and periodic inspection (and repair) up until launch. Following launch, mission operations tools are utilized to assess system performance based on a scant amount of data. The process starts in manufacturing at the subcontractor. The panel manufacturer provides functional test and LAPSS data on each individual panel. We apply an initial assumption that the per-panel performance is sufficient to meet the power generation requirements. The manufacturer's data is also carried as the performance allocation for each panel during EPS system modeling and initial mission operations. During integration and test, a high-power, professional theater lamp system provides simulated sunlight to each panel on the spacecraft, thereby permitting a true end-to-end system test. A passing test results in a step response to nearly full-rated current

  16. REDUCING GONAD IRRADIATION IN PEDIATRIC DIAGNOSIS

    Science.gov (United States)

    Bishop, Harry A.; Webber, Milo; O'Loughlin, Bernard J.

    1959-01-01

    The greatest danger of carcinogenesis and of genetic damage through diagnostic radiologic procedures is in children, whose smaller bodies are more vulnerable and who have a longer life span in which this damage can be realized. Film badges placed on the gonad area during radiologic studies indicated widely varying degrees of gonad irradiation from similar procedures. These results emphasize the importance of technique in protecting children from unnecessary exposure. Such exposure can be reduced by greater beam filtration, use of higher tube potentials, careful beam collimation and centering, closer coning and shielding of the gonads. A new film tested reduced exposure time by 50 per cent. Further reduction was obtained by high-speed screens. A most important measure is avoidance of unnecessary, repetitious and undiagnostic studies. Fluoroscopy should be avoided if possible. If not, the operator must dark-adapt his eyes, use the smallest possible current, the narrowest beam, and the shortest exposure time. Image intensification promotes these aims. Modern equipment, properly shielded, assures against unsuspected exposure. PMID:13618739

  17. EPA Releases Draft Policy to Reduce Animal Testing for Skin Sensitization

    Science.gov (United States)

    The document, Draft Interim Science Policy: Use of Alternative Approaches for Skin Sensitization as a Replacement for Laboratory Animal Testing, describes the science behind the non-animal alternatives that can now be used to identify skin sensitization.

  18. STRATEGIES TO REDUCE OR REPLACE THE USE OF ANIMALS IN THE ENDOCRINE SCREENING AND TESTING PROGRAM.

    Science.gov (United States)

    Abstract: The US Environmental Protection Agency (EPA) is developing a screening and testing program for endocrine disrupting chemicals (EDCs) to detect alterations of hypothalamic-pituitary-gonadal (HPG) function, estrogen, androgen and thyroid hormone synthesis and androgen (AR...

  19. Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities.

    Science.gov (United States)

    Wachelka, D; Katz, R C

    1999-09-01

    Test anxiety seems like a benign problem to some people, but it can be potentially serious when it leads to high levels of distress and academic failure in otherwise capable students. Because test anxiety is common in older students with learning disabilities (LD), it is surprising that little research has been done on ways to reduce the distress these students experience in test situations. In this study, we used a randomized pretest-posttest control group design to examine the effectiveness of a cognitive-behavioral treatment for reducing test anxiety and improving academic self-esteem in a cohort (N = 27) of high school and college students with learning disabilities (LD). All of the students participated voluntarily. They were enrolled in classes for students with learning problems. Before the study began, they complained of test anxiety and showed an elevated score on the Test Anxiety Inventory (TAI). Eleven students (85%) completed the 8-week long treatment, which consisted of progressive muscle relaxation, guided imagery, self-instruction training, as well as training in study and test-taking skills. Results showed significant improvement in the treated group which was not evident in an untreated control group (N = 16). Compared to the control group, the treated group showed significant reductions in test anxiety on the TAI, as well as improvement in study skills and academic self-esteem as measured by the Survey of Study Habits and Attitudes, and the school scale of the Coopersmith Self-Esteem Inventory. These results extend the generality of similar studies on reducing test anxiety and improving academic self-esteem in younger students. They also suggest that relief from test anxiety can be expected fairly quickly when cognitive-behavioral methods are used. Additional implications and methodological limitations of the study are discussed.

  20. Potential impact of the MR spectroscopic cancer blood test on reducing the need for lung biopsy

    International Nuclear Information System (INIS)

    Simon, M.; Fossel, E.T.

    1989-01-01

    Lung biopsies are generally performed to identify or rule out malignancy. A clinical presumption of lung malignancy without biopsy proof may result in unjustified surgery. The authors sought to test the value of the MR cancer blood test (CBT) recently described. They obtained prebiopsy blood samples (2 mL) from 65 patients undergoing lung biopsy for radiologically identified lesions. The CBT was performed blinded, and the result was then compared with the pathologic diagnosis obtained from biopsy. Results are presented

  1. Testing whether reduced cognitive performance in burnout can be reversed by a motivational intervention

    NARCIS (Netherlands)

    Dam, A. van; Keijsers, G.P.J.; Eling, P.A.T.M.; Becker, E.S.

    2011-01-01

    It has been suggested that the motivation to spend effort is decreased in burnout patients, resulting in reduced cognitive performance. A question that remains is whether this decreased motivation can be reversed by motivational interventions. We investigated this by examining the effect of a

  2. Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods.

    Science.gov (United States)

    Raab, Stephen S; Andrew-Jaja, Carey; Condel, Jennifer L; Dabbs, David J

    2006-01-01

    The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%. The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.

  3. Hypnotherapy and Test Anxiety: Two Cognitive-Behavioral Constructs. The Effects of Hypnosis in Reducing Test Anxiety and Improving Academic Achievement in College Students.

    Science.gov (United States)

    Sapp, Marty

    A two-group randomized multivariate analysis of covariance (MANCOVA) was used to investigate the effects of cognitive-behavioral hypnosis in reducing test anxiety and improving academic performance in comparison to a Hawthorne control group. Subjects were enrolled in a rigorous introductory psychology course which covered an entire text in one…

  4. From guidelines to hospital practice: reducing inappropriate ordering of thyroid hormone and antibody tests.

    Science.gov (United States)

    Toubert, M E; Chevret, S; Cassinat, B; Schlageter, M H; Beressi, J P; Rain, J D

    2000-06-01

    Because of major technical improvements and conscious care about cost effectiveness, limiting the inadequate use of thyroid biological tests appears to be a major issue. To (i) estimate the ordering prevalence of each thyroid test, (ii) assess the prevalence of relevant thyroid tests, and (iii) evaluate the impact of expressing justification for tests during a 2-month intervention period on these prevalences. During a prospective 2-month survey (June-July 1997), all the request forms were divided into four groups of prescription: (1) investigation of thyroid function, (2) taking drugs affecting the thyroid, (3) monitoring of nodule and cancer, and (4) investigation of thyroid autoimmunity. Their appropriateness was thus determined according to consensus in our hospital and previously published recommendations. Results were compared with those of retrospective similar 2-month periods in 1996 and 1998. Combinations of thyroid function tests and thyroid antibodies were analyzed during the 1996, 1997 and 1998 periods. The overall estimated rate of appropriate ordering between 1996 and 1997 increased from 42.5% to 72.4% (P<10(-4)), with a significant improvement in each group of main diagnosis referral, except in group 3 where suitability was always over 85%. However, in group 4, appropriateness remained low (36%). Combinations of thyroid tests revealed an increase in single TSH order forms and single autoantibodies to thyroperoxidase (TPOAb) ones, while TSH+free thyroxine+free tri-iodothyronine and TPOAb+ autoantibodies to thyroglobulin ones decreased significantly. Interestingly, all these changes were maintained 1 year later (June-July 1998) even though physicians were not aware of this new study. Persistent change in medical practice was thus assessed.

  5. Reducing Test Anxiety among 12th Grade Students: Iraqi Kurdistan Region/Soran City as an Example

    Science.gov (United States)

    Faqe, Chiayee Khorshid; Moheddin, Kurdistan Rafiq; Kakamad, Karwan Kakabra

    2016-01-01

    This study aims at reducing test anxiety among twelfth grade students at Soran city high schools. Throughout the study both quantitative and qualitative methods used to collect data. The participants were 450 twelfth grade students in five schools at Soran City-Kurdistan region of Iraq. Non-random purposive sampling because the students needed…

  6. Proceedings of the international meeting on reduced enrichment for research and test reactors

    International Nuclear Information System (INIS)

    Tsuchihashi, Keichiro

    1984-05-01

    The purpose of the Meeting was to exchange and discuss the most up-to-date information on the progress of various programs related to research and test reactor core conversion from high enriched uranium to lower enriched uranium. The papers presented during the Meeting were divided into 9 sessions and one round able discussion which concluded the Meeting. The Sessions were: Program, Fuel Development, Fuel Fabrication, Irradiation testing, Safety Analysis, Special Reactor Conversion, Reactor Design, Critical Experiments, and Reprocessing and Spent Fuel Storage. Thus, topics of this Meeting were of a very wide range that was expected to result in information exchange valuable for all the participants in the RERTR program

  7. Proceedings of the international meeting on reduced enrichment for research and test reactors

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchihashi, Keichiro [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    1984-05-01

    The purpose of the Meeting was to exchange and discuss the most up-to-date information on the progress of various programs related to research and test reactor core conversion from high enriched uranium to lower enriched uranium. The papers presented during the Meeting were divided into 9 sessions and one round able discussion which concluded the Meeting. The Sessions were: Program, Fuel Development, Fuel Fabrication, Irradiation testing, Safety Analysis, Special Reactor Conversion, Reactor Design, Critical Experiments, and Reprocessing and Spent Fuel Storage. Thus, topics of this Meeting were of a very wide range that was expected to result in information exchange valuable for all the participants in the RERTR program.

  8. Behavioural testing based breeding policy reduces the prevalence of fear and aggression related behaviour in Rottweilers

    NARCIS (Netherlands)

    Borg, van der Joanne A.M.; Graat, Lisette; Beerda, Bonne

    2017-01-01

    Behavioural testing allows to exclude dogs that are fearful and aggressive from the breeding population, but relatively little is known about the effectiveness of such strategies in practice. From 2001 till 2009 parent purebred Dutch Rottweilers had to pass the Socially Acceptable Behaviour

  9. Proceedings of the 1984 international meeting on Reduced Enrichment for Research and Test Reactors. Base technology

    International Nuclear Information System (INIS)

    1985-07-01

    More than 40 papers were presented at this RERTR Meeting during the following sessions: Status of RERTR programs and licensing procedures; LEU fuel element development; fuel fabrication and testing; economics; mixed reactor cores; and applications, i.e. neutronics and thermal hydraulics design of upgraded reactors, with new LEU fuel, fuel cycle studies, feasibility and safety analyses

  10. A reduced transcriptome approach to assess environmental toxicants using zebrafish embryo tests

    Science.gov (United States)

    This paper reports on the pilot testing of a new bioassay platform that monitors expression of 1600 genes in zebrafish embryos exposed to either single chemicals or complex water samples. The method provides a more cost effective, high throughput means to broadly evaluate the pot...

  11. Proceedings of the 1984 international meeting on Reduced Enrichment for Research and Test Reactors. Base technology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1985-07-01

    More than 40 papers were presented at this RERTR Meeting during the following sessions: Status of RERTR programs and licensing procedures; LEU fuel element development; fuel fabrication and testing; economics; mixed reactor cores; and applications, i.e. neutronics and thermal hydraulics design of upgraded reactors, with new LEU fuel, fuel cycle studies, feasibility and safety analyses.

  12. Opening address at the international meeting on reduced enrichment for research and test reactors

    International Nuclear Information System (INIS)

    Kazuo Sato

    1984-01-01

    The purpose of the Meeting was to exchange and discuss the most up-to-date information on the progress of variuos programs related to research and test reactor core conversion from high enriched uranium to lower enriched uranium. More detailed status of the RERTR program in Japan, as the host country is covered in this presentation

  13. Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

    Science.gov (United States)

    Jacobs, Jac J W M; Jacobs, Jan P A M; van Sonderen, Eric; van der Molen, Thys; Sanderman, Robbert

    2015-05-06

    Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

  14. The effectiveness of psychoeducation and systematic desensitization to reduce test anxiety among first-year pharmacy students.

    Science.gov (United States)

    Rajiah, Kingston; Saravanan, Coumaravelou

    2014-11-15

    To analyze the effect of psychological intervention on reducing performance anxiety and the consequences of the intervention on first-year pharmacy students. In this experimental study, 236 first-year undergraduate pharmacy students from a private university in Malaysia were approached between weeks 5 and 7 of their first semester to participate in the study. The completed responses for the Westside Test Anxiety Scale (WTAS), the Kessler Perceived Distress Scale (PDS), and the Academic Motivation Scale (AMS) were received from 225 students. Out of 225 students, 42 exhibited moderate to high test anxiety according to the WTAS (score ranging from 30 to 39) and were randomly placed into either an experiment group (n=21) or a waiting list control group (n=21). The prevalence of test anxiety among pharmacy students in this study was lower compared to other university students in previous studies. The present study's anxiety management of psychoeducation and systematic education for test anxiety reduced lack of motivation and psychological distress and improved grade point average (GPA). Psychological intervention helped significantly reduce scores of test anxiety, psychological distress, and lack of motivation, and it helped improve students' GPA.

  15. Reducing tilt-to-length coupling for the LISA test mass interferometer

    Science.gov (United States)

    Tröbs, M.; Schuster, S.; Lieser, M.; Zwetz, M.; Chwalla, M.; Danzmann, K.; Fernández Barránco, G.; Fitzsimons, E. D.; Gerberding, O.; Heinzel, G.; Killow, C. J.; Perreur-Lloyd, M.; Robertson, D. I.; Schwarze, T. S.; Wanner, G.; Ward, H.

    2018-05-01

    Objects sensed by laser interferometers are usually not stable in position or orientation. This angular instability can lead to a coupling of angular tilt to apparent longitudinal displacement—tilt-to-length coupling (TTL). In LISA this is a potential noise source for both the test mass interferometer and the long-arm interferometer. We have experimentally investigated TTL coupling in a setup representative for the LISA test mass interferometer and used this system to characterise two different imaging systems (a two-lens design and a four-lens design) both designed to minimise TTL coupling. We show that both imaging systems meet the LISA requirement of  ±25 μm rad‑1 for interfering beams with relative angles of up to  ±300 μrad. Furthermore, we found a dependency of the TTL coupling on beam properties such as the waist size and location, which we characterised both theoretically and experimentally.

  16. Design and Test of Semi-Active Vibration-Reducing System for Lathe

    Directory of Open Access Journals (Sweden)

    Hongsheng Hu

    2014-09-01

    Full Text Available In this paper, its theory design, analysis and test system of semi-active vibration controlling system used for precision machine have been done. Firstly, lathe bed and spindle entity were modeled by using UG software; Then modes of the machine bed and the key components of spindle were obtained by using ANSYS software; Finally, harmonic response analysis of lathe spindle under complex load was acquired, which provided a basis of MR damper’s structure optimization design for a certain type of precision machine. In order to prove its effectives, a prototype semi-active vibration controlling lathe with MR damper was developed. Tests have been done, and comparison results between passive vibration isolation equipment and semi-active vibration controlling equipment proved its good performances of MR damper.

  17. Production and Test of 352 MHZ Niobum-Sputtered Reduced-$\\beta$ Cavities

    CERN Document Server

    Benvenuti, Cristoforo; Calatroni, Sergio; Chiaveri, Enrico; Tückmantel, Joachim

    1997-01-01

    Three types of 352 MHz single-cell cavities foreseen for different particle speeds (v/c=0.8, 0.625 and 0.48) have been designed and built with the niobium sputtered on copper technique. We report on the results of the cold tests at 4.5 and 2.5 K and the actual status of the data analysis.

  18. Nurturing the Continuum of HIV Testing, Treatment and Prevention Matrix Cascade in Reducing HIV Transmission.

    Science.gov (United States)

    Yah, Clarence S

    2017-11-01

    Despite the shift in antiretroviral therapy (ARVs) eligibility cascade from CD4 ≤ 200 to CD4 ≤ 350 to CD4 ≤ 500 mm 3 , HIV related morbidity and mortality continue to escalate annually, as do HIV infections. The new paradigm of treatment for all HIV positives individual irrespective of CD4 count may significantly reduce HIV and related illnesses. The author assumes that all HIV infected partners should be eligible for HIV treatment and care, irrespective of CD4 count. A second assumption is that high risk HIV negative partners have free access to continuum of HIV pre-exposure prophylaxis (PrEP), post exposure prophylaxis (PEP) and other prevention packages. A literature review search was used to extract evidence-based ARVs-HIV treatment and prevention interventions among HIV positives and high risk partners respectively. Only articles published in English and indexed in journal nuclei were used for the study. The information was used to nurture understanding of HIV treatment and prevention approaches as well as HIV incidence multiplier effect among HIV serodiscordant partners. The imputed HIV incident reference was assumed at 1.2 per 100 person-years (2). This was based on the imputation that retention in care, adherence and other predetermined factors are functions of an effective health care delivery system. The model showed a reduced HIV transmission from 1.2 per 100 person-years to 1.032 per 100 person-years in 6 months. The average threshold period of HIV suppressed partners on ARVs to an undetectable level. The combined multiplier protective-effect probability of transmitting HIV from HIV positive partners on ARVs-suppressed viremic load to HIV negative partners on PrEP/PEP-prevention was detected at 86. The model showed a significant reduction in HIV incidence. Placing serodiscordant sexual partners in HIV treatment and prevention plays a significant role in reducing and controlling HIV infection. Therefore, the policy of enrolling all HIV positives

  19. Testing climate-smart irrigation strategies to reduce methane emissions from rice fields

    Science.gov (United States)

    Runkle, B.; Suvocarev, K.; Reba, M. L.

    2017-12-01

    Approximately 11% of the global 308 Tg CH4 anthropogenic emissions are currently attributed to rice cultivation. In this study, the impact of water conservation practices on rice field CH4 emissions was evaluated in Arkansas, the leading state in US rice cultivation. While conserving water, the Alternate Wetting and Drying (AWD) irrigation practice can also reduce CH4 emissions through the deliberate, periodic introduction of aerobic conditions. Seasonal CH4emissions from a pair of adjacent, production-sized rice fields were estimated and compared during the 2015 to 2017 growing seasons using the eddy covariance method on each field. The fields were alternately treated with continuous flood (CF) and AWD irrigation. In 2015, the seasonal cumulative carbon losses by CH4 emission were 30.3 ± 6.3 and 141.9 ± 8.6 kg CH4-C ha-1 for the AWD and CF treatments, respectively. Data from 2016 and 2017 will be analyzed and shown within this presentation; an initial view demonstrates consistent findings to 2015. When accounting for differences in field conditions and soils, the AWD practice is attributable to a 36-51% reduction in seasonal emissions. The substantial decrease in CH4 emissions by AWD supports previous chamber-based research and offers strong evidence for the efficacy of AWD in reducing CH4 emissions in Arkansas rice production. The AWD practice has enabled the sale of credits for carbon offsets trading and this new market could encourage CH4 emissions reductions on a national scale. These eddy covariance towers are being placed into a regional perspective including crop and forest land in the three states comprising the Mississippi Delta: Arkansas, Mississippi, and Louisiana.

  20. On the Reduced Testing of a Primitive Element in ${\\\\mathbb Z}_n^\\\\times$

    OpenAIRE

    Suzuki, Hideo; スズキ, ヒデオ; Hideo, Suzuki

    2015-01-01

    The primitive roots in ${\\mathbb Z}_n^\\times$ are defined and exist iff $n = 2, 4, p^{\\alpha}, 2p^{\\alpha}$. Knuth gave the definition of the primitive roots in ${\\mathbb Z}_{p^\\alpha}^\\times$, and showed the necessary and sufficient condition for testing a primitive root in ${\\mathbb Z}_{p^\\alpha}^\\times$. In this paper we define the primitive elements in ${\\mathbb Z}_n^\\times$, which is a generalization of primitive roots, as elements that take the maximum multiplicative order.And we give t...

  1. Results and Lessons Learned from Performance Testing of Humans in Spacesuits in Simulated Reduced Gravity

    Science.gov (United States)

    Chappell, Steven P.; Norcross, Jason R.; Gernhardt, Michael L.

    2009-01-01

    NASA's Constellation Program has plans to return to the Moon within the next 10 years. Although reaching the Moon during the Apollo Program was a remarkable human engineering achievement, fewer than 20 extravehicular activities (EVAs) were performed. Current projections indicate that the next lunar exploration program will require thousands of EVAs, which will require spacesuits that are better optimized for human performance. Limited mobility and dexterity, and the position of the center of gravity (CG) are a few of many features of the Apollo suit that required significant crew compensation to accomplish the objectives. Development of a new EVA suit system will ideally result in performance close to or better than that in shirtsleeves at 1 G, i.e., in "a suit that is a pleasure to work in, one that you would want to go out and explore in on your day off." Unlike the Shuttle program, in which only a fraction of the crew perform EVA, the Constellation program will require that all crewmembers be able to perform EVA. As a result, suits must be built to accommodate and optimize performance for a larger range of crew anthropometry, strength, and endurance. To address these concerns, NASA has begun a series of tests to better understand the factors affecting human performance and how to utilize various lunar gravity simulation environments available for testing.

  2. Building on a solid foundation: SAR and QSAR as a fundamental strategy to reduce animal testing.

    Science.gov (United States)

    Sullivan, K M; Manuppello, J R; Willett, C E

    2014-01-01

    The development of more efficient, ethical, and effective means of assessing the effects of chemicals on human health and the environment was a lifetime goal of Gilman Veith. His work has provided the foundation for the use of chemical structure for informing toxicological assessment by regulatory agencies the world over. Veith's scientific work influenced the early development of the SAR models in use today at the US Environmental Protection Agency. He was the driving force behind the Organisation for Economic Co-operation and Development QSAR Toolbox. Veith was one of a few early pioneers whose vision led to the linkage of chemical structure and biological activity as a means of predicting adverse apical outcomes (known as a mode of action, or an adverse outcome pathway approach), and he understood at an early stage the power that could be harnessed when combining computational and mechanistic biological approaches as a means of avoiding animal testing. Through the International QSAR Foundation he organized like-minded experts to develop non-animal methods and frameworks for the assessment of chemical hazard and risk for the benefit of public and environmental health. Avoiding animal testing was Gil's passion, and his work helped to initiate the paradigm shift in toxicology that is now rendering this feasible.

  3. [Testing reliability and validity of reduced substitutes for leadership scales(rd-SLS)].

    Science.gov (United States)

    Kim, Jeong-Hee

    2005-10-01

    This paper was conducted to test the reliability and validity of rd-SLS, developed by Podsakoff, et al. (1993) which measured 'substitutes for leadership'. The subjects were 345 nurses in 5 general hospitals. Cronbach's and the Guttman split-half coefficient were used to test the reliability of rd-SLS. Factor analysis, and the correlations of the rv-SLS and SLS with rd-SLS were used for convergent and discriminant validity. Cronbach's data was 0.76 and the Guttman split-half coefficient was 0.52. Twelve factors evolved by factor analysis, which explained 70.4% of the total variance. This result was similar to previous study results. However, 'Indifference toward organizational rewards'-related items were classified two factors. It was not clear t hat the rd-SLS consisted of 13 concepts(factors). The correlations of the rv-SLS and SLS with the rd-SLS were 0.93 and 0.87 respectively. The rd-SLS showed a moderate degree of validity and reliability. Thus, it is recommended to use the rd-SLS in general nursing organizations for screening for leadership substitutes. In addition, it is necessary to clarify the concept of organizational rewards. In a further study, the factor structure of the rd-SLS may be considered.

  4. Impact of Knowledge Resources Linked to an Electronic Health Record on Frequency of Unnecessary Tests and Treatments

    Science.gov (United States)

    Goodman, Kenneth; Grad, Roland; Pluye, Pierre; Nowacki, Amy; Hickner, John

    2012-01-01

    Introduction: Electronic knowledge resources have the potential to rapidly provide answers to clinicians' questions. We sought to determine clinicians' reasons for searching these resources, the rate of finding relevant information, and the perceived clinical impact of the information they retrieved. Methods: We asked general internists, family…

  5. Fabrication and testing of a device capable of reducing the incidence of ventricular shunt promoted metastasis.

    Science.gov (United States)

    Halperin, E C; Samulski, T; Oakes, W J; Friedman, H S

    1996-01-01

    Some malignant brain tumors shed cells into the cerebrospinal fluid (CSF). These tumors may implant throughout the neuroaxis via the CSF. With the placement of a ventriculoperitoneal (VP) or ventriculoatrial (VA) shunt, tumor cells free-floating in the CSF may be carried through the shunt to the remainder of the body. Mechanical filtration devices to prevent this are not reliable. We report the development of a new device capable of reducing the incidence of shunt promoted metastasis. The device exposes the draining CSF, as it passes through a baffle system, to a localized high-intensity radiation field adequately shielded from surrounding normal tissue. The prototype consists of geometrically fixed iodine-125 (125I) sources. The device accommodates the maximum CSF flow rate of 500 ml/24 hours. Radiation exposure to clonogenic cells occurs as they transit through the baffle system. Since the volume of the prototype device is 14 ml, a tumor cell floating through the device will be exposed to radiation for 40 minutes. Utilizing the human medulloblastoma cell line D425 MED, a limiting dilution clonogenic assay was performed. Suspensions of tumor cells in liquid medium were pumped through the device at the maximum anticipated CSF production rate of 0.35 ml/min. After the cells, with their tissue culture medium, were received from the device, a series of nine 5-fold dilutions were prepared from the suspensions which initially contained 10(6) tumor cell/ml. Plates were then incubated and growth was demonstrated by visual scoring of colonies of more than 20 cells. Limiting dilution data analysis was performed. Radiation surveys of the fully loaded (approximately 1.8 Ci) 125I prototype were conducted. A well calibrator was used to measure the activity of the fully loaded device. When the device was loaded with 125I seeds providing a dose of 364-479 cGy the probability of clonogen survival was 0.033. Radiation exposure levels at the exterior surface of the shielded device

  6. The development and testing of reduced enrichment fuels for Canadian research reactors

    International Nuclear Information System (INIS)

    Wood, J.C.; Foo, M.T.; Berthiaume, L.C.

    1983-01-01

    Fuel rods of uranium silicide dispersed in aluminum and clad in aluminum have been developed and tested in the laboratory and in-reactor. The properties of the dispersion fuel materials proved satisfactory with regard to thermal conductivity, aqueous corrosion resistance, strength and ductility, and thermal stability below 473 K. A vacancy condensation model is proposed to account for the thermally-induced swelling that occurs above 473 K by virtue of the chemical reactions that occur between the dispersed silicide fuel particles and the aluminum matrix. The in-reactor fuel core swelling was less than % after irradiation at high powers 76-131 kW/m) to a high terminal burnup (79.2 at% of U-235 atoms). (author)

  7. Engineering Macaca fascicularis cytochrome P450 2C20 to reduce animal testing for new drugs.

    Science.gov (United States)

    Rua, Francesco; Sadeghi, Sheila J; Castrignanò, Silvia; Di Nardo, Giovanna; Gilardi, Gianfranco

    2012-12-01

    In order to develop in vitro methods as an alternative to P450 animal testing in the drug discovery process, two main requisites are necessary: 1) gathering of data on animal homologues of the human P450 enzymes, currently very limited, and 2) bypassing the requirement for both the P450 reductase and the expensive cofactor NADPH. In this work, P450 2C20 from Macaca fascicularis, homologue of the human P450 2C8 has been taken as a model system to develop such an alternative in vitro method by two different approaches. In the first approach called "molecular Lego", a soluble self-sufficient chimera was generated by fusing the P450 2C20 domain with the reductase domain of cytochrome P450 BM3 from Bacillus megaterium (P450 2C20/BMR). In the second approach, the need for the redox partner and also NADPH were both obviated by the direct immobilization of the P450 2C20 on glassy carbon and gold electrodes. Both systems were then compared to those obtained from the reconstituted P450 2C20 monooxygenase in presence of the human P450 reductase and NADPH using paclitaxel and amodiaquine, two typical drug substrates of the human P450 2C8. The K(M) values calculated for the 2C20 and 2C20/BMR in solution and for 2C20 immobilized on electrodes modified with gold nanoparticles were 1.9 ± 0.2, 5.9 ± 2.3, 3.0 ± 0.5 μM for paclitaxel and 1.2 ± 0.2, 1.6±0.2 and 1.4 ± 0.2 μM for amodiaquine, respectively. The data obtained not only show that the engineering of M. fascicularis did not affect its catalytic properties but also are consistent with K(M) values measured for the microsomal human P450 2C8 and therefore show the feasibility of developing alternative in vitro animal tests. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Daily online testing in large classes: boosting college performance while reducing achievement gaps.

    Directory of Open Access Journals (Sweden)

    James W Pennebaker

    Full Text Available An in-class computer-based system, that included daily online testing, was introduced to two large university classes. We examined subsequent improvements in academic performance and reductions in the achievement gaps between lower- and upper-middle class students in academic performance. Students (N = 901 brought laptop computers to classes and took daily quizzes that provided immediate and personalized feedback. Student performance was compared with the same data for traditional classes taught previously by the same instructors (N = 935. Exam performance was approximately half a letter grade above previous semesters, based on comparisons of identical questions asked from earlier years. Students in the experimental classes performed better in other classes, both in the semester they took the course and in subsequent semester classes. The new system resulted in a 50% reduction in the achievement gap as measured by grades among students of different social classes. These findings suggest that frequent consequential quizzing should be used routinely in large lecture courses to improve performance in class and in other concurrent and subsequent courses.

  9. Pre-exposure to food temptation reduces subsequent consumption: A test of the procedure with a South-African sample.

    Science.gov (United States)

    Duh, Helen Inseng; Grubliauskiene, Aiste; Dewitte, Siegfried

    2016-01-01

    It has been suggested that the consumption of unhealthy Westernized diet in a context of poverty and resultant food insecurity may have contributed to South-Africa's status of the third fattest country in the World. Considering that a number of South-Africans are reported to have experienced, or are still experiencing food insecurity, procedures which have been shown to reduce the consumption of unhealthy food in higher income countries may be ineffective in South-Africa. We thus tested the robustness of the so called pre-exposure procedure in South-Africa. We also tested the moderating role of childhood poverty in the pre-exposure procedure. With the pre-exposure procedure, a respondent is exposed to a tempting unhealthy food (e.g. candy) in a context that is designed such that eating the food interferes with a task goal. The typical result is that this procedure spills over and reduces consumption of similar tempting food later on. An experimental study conducted in a South-African laboratory showed that the pre-exposure effect is robust even with a sample, where food insecurity prevails. Childhood poverty did not moderate the effect. This study proves that behavioral procedures aimed at reducing the consumption of unhealthy food would be valuable in less rich non-Western countries. Further testing of the robustness of the pre-exposure effect is however recommended in other poorer food insecure countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Welcome address to the 26th international meeting on Reduced Enrichment for Research and Test Reactors

    International Nuclear Information System (INIS)

    Sokolov, Y.

    2005-01-01

    While the IAEA has been a vigorous supporter of the RERTR programme since its inception. RERTR and the related fresh and spent fuel return efforts have gained new momentum with the launching of the Global Threat Reduction Initiative (GTRI) by U.S. Energy Secretary Abraham here in Vienna on May 25, 2004. All of the activities to be be discussed are included within the framework of the GTRI. The international programmes to qualify high density, LEU, dispersion fuels based on U-Mo alloys have run into unexpected technical difficulties that will delay qualification. A number of the presentations address the problems that have been encountered. At the same time, it is encouraging that the international resolve to reduce and eventually eliminate HEU in international commerce appears to have strengthened. In the past year, fresh HEU at research reactors in different countries have been returned to the country of origin. In all these examples, the return of the fresh fuel was accompanied by plans for conversion of existing reactors or design of new reactors to use LEU, as well as for the repatriation of spent research reactor fuel. The IAEA, particularly the Department of Technical Cooperation and my Department of Nuclear Energy has played an important role in implementing these fresh fuel return activities. In addition, several of the reactor conversion projects will be carried out under the auspices of IAEA technical cooperation projects and with important involvement of the Department of Nuclear Energy. The IAEA has also supported the repatriation of spent fuel to the country of original enrichment. The U.S. spent fuel acceptance programme has been operating for more than eight years, and was originally scheduled to terminate in 2006. Important announcements concerning the extension of the U.S. programme are expected. At the same time, the IAEA has been working hard with the U.S. and Russia to initiate the Russian research reactor spent fuel return programme. We are

  11. Investigation of Stress Indices and Directional Loading of Eccentric Reducers

    International Nuclear Information System (INIS)

    Carter, R.; Wais, E.A.; Rodabaugh, E.C.

    2003-01-01

    OAK- B135 Engineering for fatigue is an essential concern in piping systems. Addressing this concern, the ASME Section III and ANSI B31.1 Codes provide stress indices and stress intensification factors (SIFs) to be used in the design and evaluation of Class 1, 2 and 3 systems. In recent research cosponsored by EPRI and the U.S. DOE, new test data have been developed for comparison with the ASME stress indices and SIFs. This report presents the results of fatigue tests on eccentric reducers, taking into account the directionality of the loading. As detailed in the report, the results can help to improve the evaluation of reducers and can help to reduce unnecessary conservatism in piping system design

  12. Repeated rat-forced swim test: reducing the number of animals to evaluate gradual effects of antidepressants.

    Science.gov (United States)

    Mezadri, T J; Batista, G M; Portes, A C; Marino-Neto, J; Lino-de-Oliveira, C

    2011-02-15

    The forced swim test (FST) is a pre-clinical test to short and long term treatment with antidepressant drugs (ADT), which requires between-subject designs. Herein a modified protocol of the FST using within-subject design (repeated rat-FST) was evaluated. Male Wistar rats were submitted to 15 min of swimming (Day 1: pretest) followed by three subsequent 5 min-swimming tests one week apart (Day 2: test, Day 7: retest 1, Day 14: retest 2). To determine the temporal and factorial characteristics of the variables scored in the repeated rat-FST, the protocol was carried out in untreated animals (E1). To validate the method, daily injections of Fluoxetine (FLX, 2.5mg/kg, i.p.) or saline were given over a 2-week period (E2). Tests and retests have been videotaped for further register of the latency, frequency and duration of behaviors. Over retesting the latency to immobility decreased whereas duration of immobility tended to increase. Factorial analysis revealed that the test, the retest 1 as well as the retest 2 have variables suitable to detection of antidepressant-like effects of ADT. Compared to saline, FLX chronically administrated reduced duration of immobility whereas increased duration of swimming in retest 2. The data suggest that repeated rat-FST detected the gradual increase in the efficacy of low doses of FLX over time. Therefore, repeated rat-FST seemed suitable to detect short and long term effects of selective serotonin reuptake inhibitors, or other ADT, thus reducing the number of animals used in the screenings of this type of compounds. © 2010 Elsevier B.V. All rights reserved.

  13. The Effect of Rapid Antigen Detection Test on Antibiotic Prescription Decision of Clinicians and Reducing Antibiotic Costs in Children with Acute Pharyngitis.

    Science.gov (United States)

    Kose, Engin; Sirin Kose, Seda; Akca, Deniz; Yildiz, Kerem; Elmas, Cengizhan; Baris, Mustafa; Anil, Murat

    2016-08-01

    We aimed to investigate the effect of rapid antigen detection test (RADT) in the diagnosis of streptococcal pharyngitis, its impact on antibiotic prescription decision of pediatricians and influence on reduction of antibiotic treatment costs in children with pharyngitis. The study group consisted of 223 patients who were diagnosed with pharyngitis by pediatricians. The sensitivity and specificity of RADT were 92.1% (95% Cl: 78.6-98.3%) and 97.3% (95% Cl: 93.8-99.1%), respectively. In the first assessment, before performing RADT, pediatricians decided to prescribe antibiotics for 178 (79.8%) patients with pharyngitis. After learning RADT results, pediatricians finally decided to prescribe antibiotics for 83 (37.2%) patients with pharyngitis, and antibiotic prescription decreased by 42.6%. Antibiotic costs in non-Group A streptococcus pharyngitis, Group A streptococcus pharyngitis and all subjects groups decreased by 80.8%, 48%, and 76.4%, respectively. Performing RADT in children with pharyngitis has an important impact on treatment decision of clinicians, reduction of unnecessary antibiotic prescriptions and antibiotic costs. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Trial Manufacture and Evaluation of a Hologram with an unnecessary development process at 1.55 μm

    OpenAIRE

    大島, 茂

    2016-01-01

    A holographic optical element (HOE) for optical fiber coupling has been investigated. The hologram with an unnecessary development process has been manufactured at wavelength of 1.55μm. Diimonium organic dye was used for photosensitive material. Because diimonium organic dye did not stick to a plate glass, acrylic resin was used for binder resin. The thin film of the organic dye was exposed by improved equipment for high power light irradiation at wavelength of 1.55μm. The thin film became th...

  15. A Systematic Review of Behavioral Interventions to Reduce Condomless Sex and Increase HIV Testing for Latino MSM.

    Science.gov (United States)

    Pérez, Ashley; Santamaria, E Karina; Operario, Don

    2017-12-15

    Latino men who have sex with men (MSM) in the United States are disproportionately affected by HIV, and there have been calls to improve availability of culturally sensitive HIV prevention programs for this population. This article provides a systematic review of intervention programs to reduce condomless sex and/or increase HIV testing among Latino MSM. We searched four electronic databases using a systematic review protocol, screened 1777 unique records, and identified ten interventions analyzing data from 2871 Latino MSM. Four studies reported reductions in condomless anal intercourse, and one reported reductions in number of sexual partners. All studies incorporated surface structure cultural features such as bilingual study recruitment, but the incorporation of deep structure cultural features, such as machismo and sexual silence, was lacking. There is a need for rigorously designed interventions that incorporate deep structure cultural features in order to reduce HIV among Latino MSM.

  16. Amygdala Lesions Reduce Anxiety-like Behavior in a Human Benzodiazepine-Sensitive Approach-Avoidance Conflict Test.

    Science.gov (United States)

    Korn, Christoph W; Vunder, Johanna; Miró, Júlia; Fuentemilla, Lluís; Hurlemann, Rene; Bach, Dominik R

    2017-10-01

    Rodent approach-avoidance conflict tests are common preclinical models of human anxiety disorder. Their translational validity mainly rests on the observation that anxiolytic drugs reduce rodent anxiety-like behavior. Here, we capitalized on a recently developed approach-avoidance conflict computer game to investigate the impact of benzodiazepines and of amygdala lesions on putative human anxiety-like behavior. In successive epochs of this game, participants collect monetary tokens on a spatial grid while under threat of virtual predation. In a preregistered, randomized, double-blind, placebo-controlled trial, we tested the effect of a single dose (1 mg) of lorazepam (n = 59). We then compared 2 patients with bilateral amygdala lesions due to Urbach-Wiethe syndrome with age- and gender-matched control participants (n = 17). Based on a previous report, the primary outcome measure was the effect of intra-epoch time (i.e., an adaptation to increasing potential loss) on presence in the safe quadrant of the spatial grid. We hypothesized reduced loss adaptation in this measure under lorazepam and in patients with amygdala lesions. Lorazepam and amygdala lesions reduced loss adaptation in the primary outcome measure. We found similar results in several secondary outcome measures. The relative reduction of anxiety-like behavior in patients with amygdala lesions was qualitatively and quantitatively indistinguishable from an impact of anterior hippocampus lesions found in a previous report. Our results establish the translational validity of human approach-avoidance conflict tests in terms of anxiolytic drug action. We identified the amygdala, in addition to the hippocampus, as a critical structure in human anxiety-like behavior. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  17. Use of remifentanil to reduce propofol injection pain and the required propofol dose in upper digestive tract endoscopy diagnostic tests.

    Science.gov (United States)

    Uliana, Gustavo Nadal; Tambara, Elizabeth Milla; Baretta, Giorgio Alfredo Pedroso

    2015-01-01

    The introduction of propofol (2,6-diisopropylphenol) as a sedative agent has transformed the area of sedation for endoscopic procedures. However, a major drawback of sedation with the use of propofol is its high incidence of injection pain. The most widely used technique in reducing propofol injection pain is through the association of other drugs. The aim of this study was to evaluate the effect of remifentanil-propofol combination on the incidence of propofol injection pain and its influence on the total dose of propofol required for sedation in upper digestive tract endoscopy (UDE) diagnostic tests. One hundred and five patients undergoing upper digestive tract endoscopy were evaluated and randomly divided into 3 groups of 35 patients each. The Control Group received propofol alone; Study-group 1 received remifentanil at a fixed dose of 0.2mg/kg combined with propofol; Study-group 2 received remifentanil at a fixed dose of 0.3mg/kg combined with propofol. The incidence of propofol injection pain and the total dose of propofol required for the test were evaluated. The sample was very similar regarding age, weight, height, sex, and physical status. Statistical analysis was performed according to the nature of the evaluated data. Student's t-test was used to compare the mean of age, weight, height (cm), and dose (mg/kg) variables between groups. The χ(2) test was used to compare sex, physical status, and propofol injection pain between groups. The significance level was αpain and total dose of propofol (mg/kg) used. However, there were no statistical differences between the two study groups for these parameters. We conclude that the use of remifentanil at doses of 0.2mg/kg and 0.3mg/kg was effective for reducing both the propofol injection pain and the total dose of propofol used. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  18. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    International Nuclear Information System (INIS)

    Golding, Lauren P.; Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn; Gyr, Bettina M.; Gardner, Alison

    2015-01-01

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  19. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    Energy Technology Data Exchange (ETDEWEB)

    Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)

    2015-08-15

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  20. Análogos das prostaglandinas diminuem a sensibilidade do teste provocativo da ibopamina no glaucoma Prostaglandin analogues reduce the ibopamine provocative test specificity in glaucoma

    Directory of Open Access Journals (Sweden)

    Leopoldo Magacho

    2006-04-01

    auxiliary test in glaucoma diagnosis. Despite the small sample size, concurrent use of prostaglandin analogues apparently reduces the test's sensitivity.

  1. Evaluating a Hospitalist-Based Intervention to Decrease Unnecessary Antimicrobial Use in Patients With Asymptomatic Bacteriuria.

    Science.gov (United States)

    Hartley, Sarah E; Kuhn, Latoya; Valley, Staci; Washer, Laraine L; Gandhi, Tejal; Meddings, Jennifer; Robida, Michelle; Sabnis, Salas; Chenoweth, Carol; Malani, Anurag N; Saint, Sanjay; Flanders, Scott A

    2016-09-01

    OBJECTIVE Inappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention. DESIGN Prospective, interventional trial. SETTING Two community hospitals and a tertiary-care academic center. PATIENTS Adult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection. INTERVENTIONS An educational intervention using a pocket card was implemented at all sites followed by a pharmacist-based intervention at the academic center. Medical records of the first 50 eligible patients at each site were reviewed at baseline and after each intervention for signs and symptoms of UTI, microbiological results, antimicrobials used, and duration of treatment for positive urine cultures. Diagnosis of ASB was determined through adjudication by 2 hospitalists and 2 infectious diseases physicians. RESULTS Treatment rates of ASB decreased (23.5%; P=.001) after the educational intervention. Reductions in treatment rates for ASB differed by site and were greatest in patients without classic signs and symptoms of UTI (34.1%; Ppharmacist-based intervention was most effective at reducing ASB treatment rates in catheterized patients. CONCLUSIONS A hospitalist-focused educational intervention significantly reduced ASB treatment rates. The impact varied across sites and by patient characteristics, suggesting that a tailored approach may be useful. Infect Control Hosp Epidemiol 2016;37:1044-1051.

  2. Inconvenient and Unnecessary? Regulations in the U.S. Taxi Industry

    Directory of Open Access Journals (Sweden)

    Johnson Colton

    2017-12-01

    Full Text Available A Certificate of Public Convenience and Necessity (CPCN is a common requirement for a new business owner in services such as utilities, communications, healthcare, and transportation. However, studies have called into question the effectiveness and purpose of these laws when applied in certain industries. This study chronicles the development of and justifications provided for the enactment of CPCN laws. It then empirically tests the effectiveness of these laws in the taxi industry. This paper finds no evidence that the CPCN laws in the taxi industry are meeting their objectives. Some evidence suggests that CPCN laws achieve the opposite of their intention.

  3. Thrombophilia and assisted reproduction technology-any detrimental impact or unnecessary overuse?

    Science.gov (United States)

    Ata, Baris; Urman, Bulent

    2016-10-01

    The aim of this study is to provide an overview of the studies investigating a possible association between thrombophilia and assisted reproductive technology (ART) outcome. This is a literature review. Congenital thrombophilias (CoT) are reported to be associated with pregnancy loss. However, the association between CoT and early pregnancy loss is weak and does not necessarily support causation. CoT are more likely to be associated with late fetal loss. Even though data pooled from case-control and cohort studies suggest an increased risk of ART failure in women with CoTs, there seems no association when the analysis is confined to better quality cohort studies. The evidence supporting anticoagulation to improve ART outcome in CoT carriers is weak. Likewise, studies on antiphospholipid antibodies (APAs) and ART outcome suffer from multiple methodological limitations and a detrimental impact of APA positivity is controversial. Empirical administration of heparin or low molecular weight heparin to women with recurrent ART failures is supported by weak evidence. Importantly, thrombophilias are likely to increase thrombotic complications after ovarian stimulation for ART. Current evidence does not support routinely testing for or treatment of thrombophilia in the setting of ART nor in couples with implantation failure. A careful personal and family history should be obtained and a risk assessment for thrombotic complications should be made in every woman undergoing ovarian stimulation. If positive, testing for thrombophilia is warranted.

  4. Testing a two-scale focused conservation strategy for reducing phosphorus and sediment loads from agricultural watersheds

    Science.gov (United States)

    Carvin, Rebecca; Good, Laura W.; Fitzpatrick, Faith A.; Diehl, Curt; Songer, Katherine; Meyer, Kimberly J.; Panuska, John C.; Richter, Steve; Whalley, Kyle

    2018-01-01

    This study tested a focused strategy for reducing phosphorus (P) and sediment loads in agricultural streams. The strategy involved selecting small watersheds identified as likely to respond relatively quickly, and then focusing conservation practices on high-contributing fields within those watersheds. Two 5,000 ha (12,360 ac) watersheds in the Driftless Area of south central Wisconsin, previously ranked in the top 6% of similarly sized Wisconsin watersheds for expected responsiveness to conservation efforts to reduce high P and sediment loads, were chosen for the study. The stream outlets from both watersheds were monitored from October of 2006 through September of 2016 for streamflow and concentrations of sediment, total P, and, beginning in October of 2009, total dissolved P. Fields and pastures having the highest potential P delivery to the streams in each watershed were identified using the Wisconsin P Index (Good et al. 2012). After three years of baseline monitoring (2006 to 2009), farmers implemented both field- and farm-based conservation practices in one watershed (treatment) as a means to reduce sediment and P inputs to the stream from the highest contributing areas, whereas there were no out-of-the-ordinary conservation efforts in the second watershed (control). Implementation occurred primarily in 2011 and 2012. In the four years following implementation of conservation practices (2013 through 2016), there was a statistically significant reduction in storm-event suspended sediment loads in the treatment watershed compared to the control watershed when the ground was not frozen (p = 0.047). While there was an apparent reduction in year-round suspended sediment event loads, it was not statistically significant at the 95% confidence level (p = 0.15). Total P loads were significantly reduced for runoff events (p < 0.01) with a median reduction of 50%. Total P and total dissolved P concentrations for low-flow conditions were also significantly reduced (p

  5. A Flexible Computational Framework Using R and Map-Reduce for Permutation Tests of Massive Genetic Analysis of Complex Traits.

    Science.gov (United States)

    Mahjani, Behrang; Toor, Salman; Nettelblad, Carl; Holmgren, Sverker

    2017-01-01

    In quantitative trait locus (QTL) mapping significance of putative QTL is often determined using permutation testing. The computational needs to calculate the significance level are immense, 10 4 up to 10 8 or even more permutations can be needed. We have previously introduced the PruneDIRECT algorithm for multiple QTL scan with epistatic interactions. This algorithm has specific strengths for permutation testing. Here, we present a flexible, parallel computing framework for identifying multiple interacting QTL using the PruneDIRECT algorithm which uses the map-reduce model as implemented in Hadoop. The framework is implemented in R, a widely used software tool among geneticists. This enables users to rearrange algorithmic steps to adapt genetic models, search algorithms, and parallelization steps to their needs in a flexible way. Our work underlines the maturity of accessing distributed parallel computing for computationally demanding bioinformatics applications through building workflows within existing scientific environments. We investigate the PruneDIRECT algorithm, comparing its performance to exhaustive search and DIRECT algorithm using our framework on a public cloud resource. We find that PruneDIRECT is vastly superior for permutation testing, and perform 2 ×10 5 permutations for a 2D QTL problem in 15 hours, using 100 cloud processes. We show that our framework scales out almost linearly for a 3D QTL search.

  6. Validity of the reduced-sample insulin modified frequently-sampled intravenous glucose tolerance test using the nonlinear regression approach.

    Science.gov (United States)

    Sumner, Anne E; Luercio, Marcella F; Frempong, Barbara A; Ricks, Madia; Sen, Sabyasachi; Kushner, Harvey; Tulloch-Reid, Marshall K

    2009-02-01

    The disposition index, the product of the insulin sensitivity index (S(I)) and the acute insulin response to glucose, is linked in African Americans to chromosome 11q. This link was determined with S(I) calculated with the nonlinear regression approach to the minimal model and data from the reduced-sample insulin-modified frequently-sampled intravenous glucose tolerance test (Reduced-Sample-IM-FSIGT). However, the application of the nonlinear regression approach to calculate S(I) using data from the Reduced-Sample-IM-FSIGT has been challenged as being not only inaccurate but also having a high failure rate in insulin-resistant subjects. Our goal was to determine the accuracy and failure rate of the Reduced-Sample-IM-FSIGT using the nonlinear regression approach to the minimal model. With S(I) from the Full-Sample-IM-FSIGT considered the standard and using the nonlinear regression approach to the minimal model, we compared the agreement between S(I) from the Full- and Reduced-Sample-IM-FSIGT protocols. One hundred African Americans (body mass index, 31.3 +/- 7.6 kg/m(2) [mean +/- SD]; range, 19.0-56.9 kg/m(2)) had FSIGTs. Glucose (0.3 g/kg) was given at baseline. Insulin was infused from 20 to 25 minutes (total insulin dose, 0.02 U/kg). For the Full-Sample-IM-FSIGT, S(I) was calculated based on the glucose and insulin samples taken at -1, 1, 2, 3, 4, 5, 6, 7, 8,10, 12, 14, 16, 19, 22, 23, 24, 25, 27, 30, 40, 50, 60, 70, 80, 90, 100, 120, 150, and 180 minutes. For the Reduced-Sample-FSIGT, S(I) was calculated based on the time points that appear in bold. Agreement was determined by Spearman correlation, concordance, and the Bland-Altman method. In addition, for both protocols, the population was divided into tertiles of S(I). Insulin resistance was defined by the lowest tertile of S(I) from the Full-Sample-IM-FSIGT. The distribution of subjects across tertiles was compared by rank order and kappa statistic. We found that the rate of failure of resolution of S(I) by

  7. Comparison of pacing algorithms to avoid unnecessary ventricular pacing in patients with sick sinus node syndrome: a single-centre, observational, parallel study.

    Science.gov (United States)

    Poghosyan, Hermine R; Jamalyan, Smbat V

    2012-10-01

    Reduction of unnecessary ventricular pacing (uVP) is an essential component in the treatment strategy in any pacing population in general. The aim of this study was to evaluate the efficacy of different algorithms to reduce uVP in an adult population with sick sinus syndrome (SSS) treated outside of clinical trials. Evaluation of the relationship between different types of pacing algorithms and clinical outcomes is also provided. This was a single-centre, observational, parallel study, based on retrospective analysis of the Arrhythmology Cardiology Center of Armenia electronic clinical database. This study evaluated atrial pacing percentage (AP%), ventricular pacing percentage (VP%), and the incidence of atrial high rate episodes in 56 patients with SSS using three different pacing strategies: managed VP, search atrioventricular (AV), and fixed long AV. We did not find statistically significant differences in the amount of VP between the groups. Although the atrial high rate percentage (AHR%) tended to be higher in the fixed long AV group, this difference was not statistically significant. Mean VP% and AP% were similar in all three groups. In our study, all three programmed strategies produced the same mean AP% and VP%, and were equally efficient in uVP reduction. There was no relationship between chosen algorithms and the incidence of pacemaker syndrome, hospitalizations, or change in New York Heart Association class. The percentage of AHR was not associated with pacing strategy or co-morbidities but showed borderline correlation with left atrial size.

  8. A cane reduces loss of balance in patients with peripheral neuropathy: results from a challenging unipedal balance test.

    Science.gov (United States)

    Ashton-Miller, J A; Yeh, M W; Richardson, J K; Galloway, T

    1996-05-01

    To test the hypothesis that use of a cane in the nondominant hand during challenging balance tasks would significantly decrease loss of balance in patients with peripheral neuropathy while transferring from bipedal to unipedal stance on an unsteady surface. Nonrandomized control study. Tertiary-care institution. Eight consecutive patients with peripheral neuropathy (PN) and eight age- and gender-matched controls (C) with a mean (SD) age of 65 (8.2) years. Subjects were asked to transfer their weight onto their right foot, despite a rapid +/- 2 degrees or +/- 4 degrees frontal plane tilt of the support surface at 70% of weight transfer, and balance unipedally for at least 3 seconds. The efficacy of their weight transfer was evaluated over 112 consecutive randomized and blocked trials by calculating loss of balance as failure rates (%FR) with and without visual feedback, and with and without use of a cane in the nondominant (left) hand. Results were analyzed using a 2 x 2 x 2 x 2 x 2 repeated-measures analysis of variance (rm-ANOVA) and post hoc t tests. The rm-ANOVA showed that the FR of the PN subjects (47.6% [18.1%]) was significantly higher than C (29.2% [15.2%], p = .036). Removing visual feedback, simulating the dark of night, increased the FR fourfold (p = .000). Use of a cane in the contralateral nondominant hand significantly reduced the FR (p = .000), particularly in the PN group (cane x disease interaction: p = .055). Post hoc t tests showed that with or without visual feedback, the cane reduced the FR of the PN group fourfold and enabled them to perform more reliably than matched controls not using a cane (p = .011). An inversion perturbation resulted in a higher FR than an eversion perturbation (p = .007). The PN group employed larger mean peak cane forces (21.9% BW) than C (13.6% BW) in restoring their balance (p = .000). Use of a cane by PN patients significantly reduced their risk of losing balance on unstable surfaces, especially under low

  9. Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?

    Science.gov (United States)

    Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca

    2016-04-01

    Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (Pcosts were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.

  10. A calculus of unnecessary echoes: application of management principles to health care.

    Science.gov (United States)

    Waldman, J D; McCullough, G

    2002-01-01

    We studied the clinical utility of echocardiography in children and applied principles of business management to draw conclusions that are applicable to health care in general. A significant number (13% in this series) of expensive medical diagnostic tests could be avoided without harm to patients. Cost reduction in medicine is possible in many situations without compromising quality of care. Care pathways (i.e., practice guidelines or clinical algorithms) provide one useful modality. However, for the safety of patients, all cost reduction methods must start with practicing physicians (or involve them at conceptualization) and an escape clause must be available to the treating physician for the atypical patient. The analytic approach used--concurrent assessment of percentage cost, charge, and payor--is applicable to all components of the health care value chain. The use of "percentage of charges" as an indicator of collection effectiveness is unrealistic and should be changed to "percentage potential reimbursement" because health care is effectively a fixed-reimbursement industry rather than a system subject to standard microeconomic (supply and demand) forces. The current reimbursement structure provides conflicting incentives both to health care institutions and to providers, creating an insurmountable barrier to any effective incentive system. Colloquy between practicing physicians and experts in operations management will stimulate cost reduction and can optimize the delivery of health care.

  11. Tried and tested automation system helps to reduce air pollution. Ausgereifte Automatisierung hilft beim Reduzieren schaedlicher Emissionen

    Energy Technology Data Exchange (ETDEWEB)

    Haack, R. (Still Otto GmbH, Bochum (Germany, F.R.)); Schreiter, K.D. (Siemens AG, Erlangen (Germany, F.R.). Bereich Anlagentechnik)

    An important step in the coking process is the cooling of the red hot coke. This is mainly done by dowsing with water. The result is the emission of pollutant gases and the waste of heat energy. Disadvantages of this kind can be reduced by the use of a coke drying and cooling plant. This requires, however, because of its complex technology, a tried and tested automation system. A homogeneous solution to the problems faced by the automation system is found in the SIMATIC S5-150U automation unit which was delivered with the coke drying and cooling plant for Pohang (Korea) from the firm Still Otto GmbH in Bochum. This is the largest of its kind. (orig.).

  12. A comparison of laws preventing unnecessary canine cosmetic surgery in Italy and in the Czech Republic

    Directory of Open Access Journals (Sweden)

    Valeria Quartarone

    2012-01-01

    Full Text Available Many invasive procedures, including surgery (ear cropping, tail docking, and debarking in the dog, are performed on dogs for purely cosmetic reasons or convenience. These procedures, also known as “cosmetic surgery”, fall into a variety of categories from the questionably unethical to the undoubtedly criminal, because they are mostly carried out solely to alter a dog’s physical appearance. Although in several European countries these procedures are banned, except when performed by a veterinarian for medical reasons, veterinarians are often requested to perform them for various reasons. Though controversial, canine cosmetic surgery continues to be performed, reaching epidemic proportions. The authors summarize legislation, individual positions and veterinary attitudes regarding cosmetic surgery in Italy and the Czech Republic. Additionally, they explain the ways in which the law is being used in the two countries to prevent these unnecessary procedures, and how current and future anti-cruelty laws can stop unethical use of cosmetic surgery.

  13. Acceptance- and imagery-based strategies can reduce chocolate cravings: A test of the elaborated-intrusion theory of desire.

    Science.gov (United States)

    Schumacher, Sophie; Kemps, Eva; Tiggemann, Marika

    2017-06-01

    The elaborated-intrusion theory of desire proposes that craving is a two-stage process whereby initial intrusions about a desired target are subsequently elaborated with mental imagery. The present study tested whether the craving reduction strategies of cognitive defusion and guided imagery could differentially target the intrusion and elaboration stages, respectively, and thus differentially impact the craving process. Participants were randomly assigned to a cognitive defusion, a guided imagery or a mind-wandering control condition. Pre- and post-intervention chocolate-related thoughts, intrusiveness of thoughts, vividness of imagery, craving intensity, and chocolate consumption were compared. Experiment 1 recruited a general sample of young women (n = 94), whereas Experiment 2 recruited a sample of chocolate cravers who wanted to reduce their chocolate consumption (n = 97). Across both experiments, cognitive defusion lowered intrusiveness of thoughts, vividness of imagery and craving intensity. Guided imagery reduced chocolate-related thoughts, intrusiveness, vividness and craving intensity for chocolate cravers (Experiment 2), but not for the general sample (Experiment 1). There were no group differences in chocolate consumption in either experiment. Results add to existing evidence supporting the elaborated-intrusion theory of desire in the food domain, and suggest that acceptance- and imagery-based techniques have potential for use in combatting problematic cravings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Nonlinear numerical analysis and experimental testing for an electrothermal SU-8 microgripper with reduced out-of-plane displacement

    Science.gov (United States)

    Voicu, Rodica-Cristina; Zandi, Muaiyd Al; Müller, Raluca; Wang, Changhai

    2017-11-01

    This paper reports the results of numerical nonlinear electro-thermo-mechanical analysis and experimental testing of a polymeric microgripper designed using electrothermal actuators. The simulation work was carried out using a finite element method (FEM) and a commercial software (Coventorware 2014). The biocompatible SU-8 polymer was used as structural material for the fabrication of the microgripper. The metallic micro-heater was encapsulated in the polymeric actuation structures of the microgripper to reduce the undesirable out-of-plane displacement of the microgripper tips, and to electrically isolate the micro-heater, and to reduce the mechanical stress as well as to improve the thermal efficiency. The electro- thermo-mechanical analysis of the actuator considers the nonlinear temperature-dependent properties of the SU-8 polymer and the gold thin film layers used for the micro-heater fabrication. An optical characterisation of the microgripper based on an image tracking approach shows the thermal response and the good repeatability. The average deflection is ~11 µm for an actuation current of ~17 mA. The experimentally obtained tip deflection and the heater temperature at different currents are both shown to be in good agreement with the nonlinear electro-thermo-mechanical simulation results. Finally, we demonstrate the capability of the microgripper by capture and manipulation of cotton fibres.

  15. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Directory of Open Access Journals (Sweden)

    Peiman Eini

    2012-04-01

    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  16. Suppressing Unwanted Autobiographical Memories Reduces Their Automatic Influences: Evidence From Electrophysiology and an Implicit Autobiographical Memory Test.

    Science.gov (United States)

    Hu, Xiaoqing; Bergström, Zara M; Bodenhausen, Galen V; Rosenfeld, J Peter

    2015-07-01

    The present study investigated the extent to which people can suppress unwanted autobiographical memories in a memory-detection context involving a mock crime. Participants encoded sensorimotor-rich memories by enacting a lab-based crime (stealing a ring) and received instructions to suppress memory of the crime in order to evade guilt detection in a brain-wave-based concealed-information test. Aftereffects of suppression on automatic memory processes were measured in an autobiographical Implicit Association Test. Results showed that suppression attenuated brain-wave activity (the P300) associated with crime-relevant memory retrieval, which rendered waveforms from innocent and guilty participants indistinguishable. However, the two groups could nevertheless be discriminated via the late-posterior-negative slow wave, which may reflect the need to monitor response conflict arising between voluntary suppression and automatic recognition processes. Finally, extending recent findings that suppression can impair implicit memory processes, we provide novel evidence that suppression reduces automatic cognitive biases often associated with actual autobiographical memories. © The Author(s) 2015.

  17. Impact of Heterogeneity in Sexual Behavior on Effectiveness in Reducing HIV Transmission with Test-and-Treat Strategy.

    Directory of Open Access Journals (Sweden)

    Ganna Rozhnova

    2016-08-01

    Full Text Available The WHO's early-release guideline for antiretroviral treatment (ART of HIV infection based on a recent trial conducted in 34 countries recommends starting treatment immediately upon an HIV diagnosis. Therefore, the test-and-treat strategy may become more widely used in an effort to scale up HIV treatment and curb further transmission. Here we examine behavioural determinants of HIV transmission and how heterogeneity in sexual behaviour influences the outcomes of this strategy. Using a deterministic model, we perform a systematic investigation into the effects of various mixing patterns in a population of men who have sex with men (MSM, stratified by partner change rates, on the elimination threshold and endemic HIV prevalence. We find that both the level of overdispersion in the distribution of the number of sexual partners and mixing between population subgroups have a large influence on endemic prevalence before introduction of ART and on possible long term effectiveness of ART. Increasing heterogeneity in risk behavior may lead to lower endemic prevalence levels, but requires higher coverage levels of ART for elimination. Elimination is only feasible for populations with a rather low degree of assortativeness of mixing and requires treatment coverage of almost 80% if rates of testing and treatment uptake by all population subgroups are equal. In this case, for fully assortative mixing and 80% coverage endemic prevalence is reduced by 57%. In the presence of heterogeneity in ART uptake, elimination is easier to achieve when the subpopulation with highest risk behavior is tested and treated more often than the rest of the population, and vice versa when it is less. The developed framework can be used to extract information on behavioral heterogeneity from existing data which is otherwise hard to determine from population surveys.

  18. Reduction of the unnecessary dose from the over-range area with a spiral dynamic z-collimator: comparison of beam pitch and detector coverage with 128-detector row CT.

    Science.gov (United States)

    Shirasaka, Takashi; Funama, Yoshinori; Hayashi, Mutsukazu; Awamoto, Shinichi; Kondo, Masatoshi; Nakamura, Yasuhiko; Hatakenaka, Masamitsu; Honda, Hiroshi

    2012-01-01

    Our purpose in this study was to assess the radiation dose reduction and the actual exposed scan length of over-range areas using a spiral dynamic z-collimator at different beam pitches and detector coverage. Using glass rod dosimeters, we measured the unilateral over-range scan dose between the beginning of the planned scan range and the beginning of the actual exposed scan range. Scanning was performed at detector coverage of 80.0 and 40.0 mm, with and without the spiral dynamic z-collimator. The dose-saving ratio was calculated as the ratio of the unnecessary over-range dose, with and without the spiral dynamic z-collimator. In 80.0 mm detector coverage without the spiral dynamic z-collimator, the actual exposed scan length for the over-range area was 108, 120, and 126 mm, corresponding to a beam pitch of 0.60, 0.80, and 0.99, respectively. With the spiral dynamic z-collimator, the actual exposed scan length for the over-range area was 48, 66, and 84 mm with a beam pitch of 0.60, 0.80, and 0.99, respectively. The dose-saving ratios with and without the spiral dynamic z-collimator for a beam pitch of 0.60, 0.80, and 0.99 were 35.07, 24.76, and 13.51%, respectively. With 40.0 mm detector coverage, the dose-saving ratios with and without the spiral dynamic z-collimator had the highest value of 27.23% with a low beam pitch of 0.60. The spiral dynamic z-collimator is important for a reduction in the unnecessary over-range dose and makes it possible to reduce the unnecessary dose by means of a lower beam pitch.

  19. A pilot test of a motivational interviewing social network intervention to reduce substance use among housing first residents.

    Science.gov (United States)

    Kennedy, David P; Osilla, Karen Chan; Hunter, Sarah B; Golinelli, Daniela; Maksabedian Hernandez, Ervant; Tucker, Joan S

    2018-03-01

    This article presents findings of a pilot test of a Motivational Interviewing social network intervention (MI-SNI) to enhance motivation to reduce high risk alcohol and other drug (AOD) use among formerly homeless individuals transitioning to housing. Delivered in-person by a facilitator trained in MI, this four-session computer-assisted intervention provides personalized social network visualization feedback to help participants understand the people in their network who trigger their alcohol and other drug (AOD) use and those who support abstinence. If ready, participants are encouraged to make changes to their social network to help reduce their own high-risk behavior. Participants were 41 individuals (33 male, 7 female, 1 other; 23 African-American, 5 non-Latino White, 6 Latino, 7 other, mean age 48) who were transitioning from homelessness to permanent supportive housing. They were randomly assigned to either the MI-SNI condition or usual care. Readiness to change AOD use, AOD abstinence self-efficacy, and AOD use were assessed at baseline and shortly after the final intervention session for the MI-SNI arm and around 3-months after baseline for the control arm. Acceptability of the intervention was also evaluated. MI-SNI participants reported increased readiness to change AOD use compared to control participants. We also conducted a subsample analysis for participants at one housing program and found a significant intervention effect on readiness to change AOD use, AOD abstinence self-efficacy, and alcohol use compared to control participants. Participants rated the intervention as highly acceptable. We conclude that a brief computer-assisted Motivational Interviewing social network intervention has potential to efficaciously impact readiness to change AOD use, AOD abstinence self-efficacy, and AOD use among formerly homeless individuals transitioning to permanent supportive housing, and warrants future study in larger clinical trials. Copyright © 2017

  20. Leishmaniasis direct agglutination test: using pictorials as training materials to reduce inter-reader variability and improve accuracy.

    Directory of Open Access Journals (Sweden)

    Emily R Adams

    Full Text Available BACKGROUND: The Direct Agglutination Test (DAT has a high diagnostic accuracy and remains, in some geographical areas, part of the diagnostic algorithm for Visceral Leishmaniasis (VL. However, subjective interpretation of results introduces potential for inter-reader variation. We report an assessment of inter-laboratory agreement and propose a pictorial-based approach to standardize reading of the DAT. METHODOLOGY: In preparation for a comparative evaluation of immunochromatographic diagnostics for VL, a proficiency panel of 15 well-characterized sera, DAT-antigen from a single batch and common protocol was sent to nine laboratories in Latin-America, East-Africa and Asia. Agreement (i.e., equal titre or within 1 titer with the reading by the reference laboratory was computed. Due to significant inter-laboratory disagreement on-site refresher training was provided to all technicians performing DAT. Photos of training plates were made, and end-titres agreed upon by experienced users of DAT within the Visceral-Leishmaniasis Laboratory-Network (VL-LN. RESULTS: Pre-training, concordance in DAT results with reference laboratories was only 50%, although agreement on negative sera was high (94%. After refresher training concordance increased to 84%; agreement on negative controls increased to 98%. Variance in readings significantly decreased after training from 3.3 titres to an average of 1.0 titre (two-sample Wilcoxon rank-sum (Mann-Whitney test (z = -3,624 and p = 0.0003. CONCLUSION: The most probable explanation for disagreement was subjective endpoint reading. Using pictorials as training materials may be a useful tool to reduce disparity in results and promote more standardized reading of DAT, without compromising diagnostic sensitivity.

  1. Female mucopolysaccharidosis IIIA mice exhibit hyperactivity and a reduced sense of danger in the open field test.

    Directory of Open Access Journals (Sweden)

    Alex Langford-Smith

    Full Text Available Reliable behavioural tests in animal models of neurodegenerative diseases allow us to study the natural history of disease and evaluate the efficacy of novel therapies. Mucopolysaccharidosis IIIA (MPS IIIA or Sanfilippo A, is a severe, neurodegenerative lysosomal storage disorder caused by a deficiency in the heparan sulphate catabolising enzyme, sulfamidase. Undegraded heparan sulphate accumulates, resulting in lysosomal enlargement and cellular dysfunction. Patients suffer a progressive loss of motor and cognitive function with severe behavioural manifestations and premature death. There is currently no treatment. A spontaneously occurring mouse model of the disease has been described, that has approximately 3% of normal enzyme activity levels. Behavioural phenotyping of the MPS IIIA mouse has been previously reported, but the results are conflicting and variable, even after full backcrossing to the C57BL/6 background. Therefore we have independently backcrossed the MPS IIIA model onto the C57BL/6J background and evaluated the behaviour of male and female MPS IIIA mice at 4, 6 and 8 months of age using the open field test, elevated plus maze, inverted screen and horizontal bar crossing at the same circadian time point. Using a 60 minute open field, we have demonstrated that female MPS IIIA mice are hyperactive, have a longer path length, display rapid exploratory behaviour and spend less time immobile than WT mice. Female MPS IIIA mice also display a reduced sense of danger and spend more time in the centre of the open field. There were no significant differences found between male WT and MPS IIIA mice and no differences in neuromuscular strength were seen with either sex. The altered natural history of behaviour that we observe in the MPS IIIA mouse will allow more accurate evaluation of novel therapeutics for MPS IIIA and potentially other neurodegenerative disorders.

  2. Female mucopolysaccharidosis IIIA mice exhibit hyperactivity and a reduced sense of danger in the open field test.

    Science.gov (United States)

    Langford-Smith, Alex; Langford-Smith, Kia J; Jones, Simon A; Wynn, Robert F; Wraith, J E; Wilkinson, Fiona L; Bigger, Brian W

    2011-01-01

    Reliable behavioural tests in animal models of neurodegenerative diseases allow us to study the natural history of disease and evaluate the efficacy of novel therapies. Mucopolysaccharidosis IIIA (MPS IIIA or Sanfilippo A), is a severe, neurodegenerative lysosomal storage disorder caused by a deficiency in the heparan sulphate catabolising enzyme, sulfamidase. Undegraded heparan sulphate accumulates, resulting in lysosomal enlargement and cellular dysfunction. Patients suffer a progressive loss of motor and cognitive function with severe behavioural manifestations and premature death. There is currently no treatment. A spontaneously occurring mouse model of the disease has been described, that has approximately 3% of normal enzyme activity levels. Behavioural phenotyping of the MPS IIIA mouse has been previously reported, but the results are conflicting and variable, even after full backcrossing to the C57BL/6 background. Therefore we have independently backcrossed the MPS IIIA model onto the C57BL/6J background and evaluated the behaviour of male and female MPS IIIA mice at 4, 6 and 8 months of age using the open field test, elevated plus maze, inverted screen and horizontal bar crossing at the same circadian time point. Using a 60 minute open field, we have demonstrated that female MPS IIIA mice are hyperactive, have a longer path length, display rapid exploratory behaviour and spend less time immobile than WT mice. Female MPS IIIA mice also display a reduced sense of danger and spend more time in the centre of the open field. There were no significant differences found between male WT and MPS IIIA mice and no differences in neuromuscular strength were seen with either sex. The altered natural history of behaviour that we observe in the MPS IIIA mouse will allow more accurate evaluation of novel therapeutics for MPS IIIA and potentially other neurodegenerative disorders.

  3. Order of Administration of Math and Verbal Tests: An Ecological Intervention to Reduce Stereotype Threat on Girls' Math Performance

    Science.gov (United States)

    Smeding, Annique; Dumas, Florence; Loose, Florence; Régner, Isabelle

    2013-01-01

    In 2 field experiments, we relied on the very features of real testing situations--where both math and verbal tests are administered--to examine whether order of test administration can, by itself, create vs. alleviate stereotype threat (ST) effects on girls' math performance. We predicted that taking the math test before the verbal test would be…

  4. IMPLEMENTING HEAT SEALED BAG RELIEF and HYDROGEN and METANE TESTING TO REDUCE THE NEED TO REPACK HANFORD TRANSURANIC (TRU) WASTE

    International Nuclear Information System (INIS)

    MCDONALD, K.M.

    2005-01-01

    The Department of Energy's site at Hanford has a significant quantity of drums containing heat-sealed bags that required repackaging under previous revisions of the TRUPACT-II Authorized Methods for Payload Control (TRAMPAC) before being shipped to the Waste Isolation Pilot Plant (WIPP). Since glovebox repackaging is the most rate-limiting and resource-intensive step for accelerating Hanford waste certification, a cooperative effort between Hanford's TRU Program and the WIPP site significantly reduced the number of drums requiring repackaging. More specifically, recent changes to the TRAMPAC (Revision 19C), allow relief for heat-sealed bags having more than 390 square inches of surface area. This relief is based on data provided by Hanford on typical Hanford heat-sealed bags, but can be applied to other sites generating transuranic waste that have waste packaged in heat-sealed bags. The paper provides data on the number of drums affected, the attendant cost savings, and the time saved. Hanford also has a significant quantity of high-gram drums with multiple layers of confinement including heat-scaled bags. These higher-gram drums are unlikely to meet the decay-heat limits required for analytical category certification under the TRAMPAC. The combination of high-gram drums and accelerated reprocessing/shipping make it even more difficult to meet the decay-heat limits because of necessary aging requirements associated with matrix depletion. Hydrogen/methane sampling of headspace gases can be used to certify waste that does not meet decay-heat limits of the more restrictive analytical category using the test category. The number of drums that can be qualified using the test category is maximized by assuring that the detection limit for hydrogen and methane is as low as possible. Sites desiring to ship higher-gram drums must understand the advantages of using hydrogen/methane sampling and shipping under the test category. Headspace gas sampling, as specified by the WIPP

  5. Can parental monitoring and peer management reduce the selection or influence of delinquent peers? Testing the question using a dynamic social network approach.

    NARCIS (Netherlands)

    Tilton-Weaver, L.C.; Burk, W.J.; Kerr, M.; Stattin, H.

    2013-01-01

    We tested whether parents can reduce affiliation with delinquent peers through 3 forms of peer management: soliciting information, monitoring rules, and communicating disapproval of peers. We examined whether peer management interrupted 2 peer processes: selection and influence of delinquent peers.

  6. Development of filler wires for welding of reduced activation ferritic martenstic steel for India's test blanket module of ITER

    International Nuclear Information System (INIS)

    Srinivasan, G.; Arivazhagan, B.; Albert, S.K.; Bhaduri, A.K.

    2011-01-01

    Highlights: → Weld microstructure produced by RAFMS filler wires are free from delta ferrite. → Cooling rates of by weld thermal cycles influences the presence of delta ferrite. → Weld parameters modified with higher pre heat temperature and high heat input. → PWHT optimized based on correlation of hardness between base and weld metals. → Optimised mechanical properties achieved by proper tempering of the martensite. - Abstract: Indigenous development of reduced activation ferritic martensitic steel (RAFMS) has become mandatory to India to participate in the International Thermo-nuclear Experimental Reactor (ITER) programme. Optimisation of RAFMS is in an advanced stage for the fabrication of test blanket module (TBM) components. Simultaneously, development of RAFMS filler wires has been undertaken since there is no commercial filler wires are available for fabrication of components using RAFMS. Purpose of this study is to develop filler wires that can be directly used for both tungsten inert gas welding (TIG) and narrow gap tungsten inert gas welding (NG-TIG), which reduces the deposited weld metal volume and heat affected zone (HAZ) width. Further, the filler wires would also be used for hybrid laser welding for thick section joints. In view of meeting all the requirements, a detailed specification was prepared for the development of filler wires for welding of RAFM steel. Meanwhile, autogenous welding trials have been carried out on 2.5 mm thick plates of the RAFM steel using TIG process at various heat inputs with a preheat temperature of 250 deg. C followed by various post weld heat treatments (PWHT). The microstructure of the weld metal in most of the cases showed the presence of some delta-ferrite. Filler wires as per specifications have also been developed with minor variations on the chemistry against the specified values. Welding parameters and PWHT parameters were optimised to qualify the filler wires without the presence of delta-ferrite in

  7. Development of filler wires for welding of reduced activation ferritic martensitic steel for India's test blanket module of ITER

    International Nuclear Information System (INIS)

    Srinivasan, G.; Arivazhagan, B.; Albert, S.K.; Bhaduri, A.K.

    2010-01-01

    Indigenous development of reduced activation ferritic-martensitic (RAFM) steel has become necessary for India as a participant in the International Thermo-nuclear Experimental Reactor (ITER) programme. Optimisation of RAFM steel is in an advanced stage for the fabrication of test blanket module (TBM) components. Simultaneously, development of RAFM steel filler wires has been undertaken since there is no commercial filler wires are available for fabrication of components using RAFM steel. The purpose of this study is to develop filler wires that can be directly used for both gas tungsten arc welding (GTAW) and for narrow-gap gas tungsten arc welding (NG-GTAW) that reduces the deposited weld metal volume and heat affected zone (HAZ) width. Further, the filler wires would also be used for hybrid laser-MIG welding for thick section joints. In view of meeting all the requirements, a detailed specification was prepared for the development of filler wires for welding of RAFM steel. Meanwhile, welding trials have been carried out on 2.5 mm thick plates of the RAFM steel using GTAW process at various heat inputs with a preheat temperature of 250 C followed by various post weld heat treatments (PWHT). The microstructure of the weld metal in most of the cases showed the presence of some amount of delta-ferrite. Filler wires as per specifications have also been developed with minor variations on the chemistry against the specified values. Welding parameters and PWHT parameters were optimized to qualify the filler wires without the presence of delta-ferrite in the weld metal and with optimized mechanical properties. Results showed that the weld metals are free from delta-ferrite. Tensile properties at ambient temperature and at 500 C are well above the specified values, and are much higher than the base metal values. Ductile Brittle Transition Temperature (DBTT) has been evaluated as -81 C based on the 68 J criteria. The present study highlights the basis and methodology

  8. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

    Science.gov (United States)

    Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara

    2016-01-01

    The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

  9. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

    Directory of Open Access Journals (Sweden)

    Mathieu Boulin

    Full Text Available The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.An economic (decision-tree analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services and Canadian public health payer perspectives were adopted.Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

  10. Prevention of unnecessary pregnancy terminations by counselling women on drug, chemical, and radiation exposure during the first trimester

    International Nuclear Information System (INIS)

    Koren, G.; Pastuszak, A.

    1990-01-01

    As part of a new approach to counselling pregnant women concerned about antenatal exposure to drugs, chemicals, or radiation, we measured their tendency to terminate their pregnancy by using a visual analogue scale (VAS). Analysis of 78 cases where women had less than 50% tendency to continue pregnancy before they were advised by us reveals that 61 decided to continue their pregnancy after the consultation (57 normal, healthy infants, four miscarriages) and 17 terminated. Women who continued their pregnancy significantly changed their tendency after we discussed relevant information with them (from 34.3 +/- 2.5% to 84.5 +/- 3.3%, P less than 0.00001), whereas most of those who eventually terminated pregnancy did not change their tendency to continue pregnancy beyond the 50% mark (from 24.8 +/- 5.4% to 45.1 +/- 9.8%) (P greater than 0.1). Only two of the women who terminated their pregnancy were exposed to teratogenic drugs; however, in most other cases, other obvious reasons, unrelated to the exposure in question, were identified by the women as leading reasons for termination. An appropriate intervention in early pregnancy can prevent unnecessary pregnancy terminations by correcting misinformation and thereby decreasing the unrealistically high perception of risk by women exposed to nonteratogens

  11. Web-Based Intervention to Reduce Substance Abuse and Depressive Symptoms in Mexico: Development and Usability Test.

    Science.gov (United States)

    Tiburcio, Marcela; Lara, Ma Asunción; Aguilar Abrego, Araceli; Fernández, Morise; Martínez Vélez, Nora; Sánchez, Alejandro

    2016-09-29

    The development of Web-based interventions for substance abuse in Latin America is a new field of interest with great potential for expansion to other Spanish-speaking countries. This paper describes a project aimed to develop and evaluate the usability of the Web-based Help Program for Drug Abuse and Depression (Programa de Ayuda para Abuso de Drogas y Depresión, PAADD, in Spanish) and also to construct a systematic frame of reference for the development of future Web-based programs. The PAADD aims to reduce substance use and depressive symptoms with cognitive behavioral techniques translated into Web applications, aided by the participation of a counselor to provide support and guidance. This Web-based intervention includes 4 steps: (1) My Starting Point, (2) Where Do I Want to Be? (3) Strategies for Change, and (4) Maintaining Change. The development of the program was an interactive multistage process. The first stage defined the core structure and contents, which were validated in stage 2 by a group of 8 experts in addiction treatment. Programming of the applications took place in stage 3, taking into account 3 types of end users: administrators, counselors, and substance users. Stage 4 consisted of functionality testing. In stage 5, a total of 9 health professionals and 20 drug users currently in treatment voluntarily interacted with the program in a usability test, providing feedback about adjustments needed to improve users' experience. The main finding of stage 2 was the consensus of the health professionals about the cognitive behavioral strategies and techniques included in PAADD being appropriate for changing substance use behaviors. In stage 5, the health professionals found the functionalities easy to learn; their suggestions were related to the page layout, inclusion of confirmation messages at the end of activities, avoiding "read more" links, and providing feedback about every activity. On the other hand, the users said the information presented

  12. Clinical application of 'Justification' and 'Optimization' principle of ALARA in pediatric CT imaging: "How many children can be protected from unnecessary radiation?".

    Science.gov (United States)

    Sodhi, Kushaljit S; Krishna, Satheesh; Saxena, Akshay K; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y

    2015-09-01

    Practice of ALARA (as low as reasonably achievable) principle in the developed world is currently well established. However, there is striking lack of published data regarding such experience in the developing countries. Therefore, the goal of this study is to prospectively evaluate CT request forms to assess how many children could be protected from harmful radiation exposure if 'Justification' and 'Optimization' principles of ALARA are applied before obtaining CT imaging in a developing country. This can save children from potential radiation risks including development of brain cancer and leukemia. Consecutive CT request forms over a six month study period (May 16, 2013 to November 15, 2013) in a tertiary pediatric children's hospital in India were prospectively reviewed by two pediatric radiologists before obtaining CT imaging. First, 'Justification' of CT was evaluated and then 'Optimization' was applied for evaluation of appropriateness of the requested CT studies. The number (and percentage) of CT studies avoided by applying 'Justification' and 'Optimization' principle of ALARA were calculated. The difference in number of declined and optimized CT requests between CT requests from inpatient and outpatient departments was compared using Chi-Square test. A total of 1302 consecutive CT request forms were received during the study period. Some of the request forms (n=86; 6.61%) had requests for more than one (multiple) anatomical regions, hence, a total of 1392 different anatomical CT requests were received. Based on evaluation of the CT request forms for 'Justification' and 'Optimization' principle of ALARA by pediatric radiology reviewers, 111 individual anatomic part CT requests from 105 pediatric patients were avoided. Therefore, 8.06% (105 out of 1302 pediatric patients) were protected from unnecessary or additional radiation exposure.The rates of declined or optimized CT requests from inpatient department was significantly higher than that from outpatient

  13. Testing the effectiveness of pine needlecast in reducing post-fire soil erosion using complementary experimental approaches

    Science.gov (United States)

    Bento, C. P. M.; Shakesby, R. A.; Walsh, R. P. D.; Ferreira, C. S. S.; Ferreira, A. J. D.; Urbanek, E.

    2012-04-01

    Mediterranean wildfire activity has increased markedly in recent decades, leading to enhanced runoff and erosion. Limiting post-fire on-site soil degradation and off-site flooding and sedimentation, however, often has a low priority because of the high costs of materials and labour needed to implement many recognised techniques (e.g. seeding, hydromulching, installing logs along the contour). However, in pine plantations, the crowns may only be scorched so that after fire the needlecast can form a comparatively dense ground cover. Its post-fire erosion-limiting effectiveness is virtually unknown in the Mediterranean context, despite potentially protecting soil with minimal effort (requiring only a delay to existing salvage logging procedures at most). As part of the DESIRE research programme, this paper presents results from two complementary approaches testing the erosion-limiting effectiveness of needlecast. (1) Near Moinhos, central Portugal, two 8m2 erosion plots were established immediately post-fire in September 2009 on a steep (30°) slope representative of an adjacent burnt Pinus pinaster plantation. Soil erosion was monitored during a 3-month pre-treatment phase. Needles were then applied to one plot at a density (37.7% cover) measured on a post-fire pine plantation. Soil losses from treated and untreated plots were then monitored until April 2011. By taking the percentage increase or decrease in erosion between the two monitoring phases for the untreated control plot as the 'expected' pattern, the erosion-limiting effectiveness of needles applied to the treated plot could then be determined. (2) Six adjacent rectangular 1.23m2 lysimeters were filled with gravel and sand, and capped by 10 cm of topsoil taken from a long unburnt Pinus pinaster plantation. They were set at 15° and left open to natural rainfall. This angle was considered the steepest possible from logistical and soil stability points of view. All lysimeters underwent a phase under bare soil

  14. MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio; Pinker-Domenig, Katja; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna (AKH), General Hospital Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Wien (Austria); Rudas, Margaretha [Medical University of Vienna (AKH), Clinical Institute of Pathology, Wien (Austria)

    2014-06-15

    To assess if the application of diffusion-weighted imaging (DWI) obviates unnecessary MR-guided biopsies in suspicious breast lesions visible only on contrast-enhanced MRI (CE-MRI). This institutional review board (IRB)-approved, retrospective, single-centre study included 101 patients (mean age, 49.5; SD 13.9 years) who underwent additional DWI at 1.5 T prior to MRI-guided biopsy of 104 lesions classified as suspicious for malignancy and visible on CE-MRI only. An experienced radiologist, blinded to histopathologic and follow-up results, measured apparent diffusion coefficient (ADC) values obtained from DWI. Diagnostic accuracy was investigated using receiver operating characteristics (ROC) analysis. Histopathology revealed 20 malignant and 84 benign lesions. Lesions were masses in 61 (15 malignant, 24.6 %) and non-masses in 43 cases (five malignant, 11.6 %). Mean ADC values were 1.53 ± 0.38 x 10{sup -3} mm{sup 2}/s in benign lesions and 1.06 ± 0.27 x 10{sup -3} mm{sup 2}/s in malignant lesions. ROC analysis revealed exclusively benign lesions if ADC values were greater than 1.58 x 10{sup -3} mm{sup 2}/s. As a consequence, 29 false-positive biopsies (34.5 %) could have been avoided without any false-negative findings. Both in mass and in non-mass lesions, rule-in and rule-out criteria were identified using flexible ADC thresholds based on ROC analysis. Additional application of DWI in breast lesions visible only on MRI can avoid false-positive, MR-guided biopsies. Thus, DWI should be an integral part of breast MRI protocols. (orig.)

  15. A research program to reduce interior noise in general aviation airplanes. Design of an acoustic panel test facility

    Science.gov (United States)

    Roskam, J.; Muirhead, V. U.; Smith, H. W.; Henderson, T. D.

    1977-01-01

    The design, construction, and costs of a test facility for determining the sound transmission loss characteristics of various panels and panel treatments are described. The pressurization system and electronic equipment used in experimental testing are discussed as well as the reliability of the facility and the data gathered. Tests results are compared to pertinent acoustical theories for panel behavior and minor anomalies in the data are examined. A method for predicting panel behavior in the stiffness region is also presented.

  16. Reducing Overutilization of Testing for Clostridium difficile Infection in a Pediatric Hospital System: A Quality Improvement Initiative.

    Science.gov (United States)

    Klatte, J Michael; Selvarangan, Rangaraj; Jackson, Mary Anne; Myers, Angela L

    2016-01-01

    Study objectives included addressing overuse of Clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing. A multifaceted initiative was developed, and components included multiple provider education methods, computerized order entry modifications, and automatic declination from laboratory on testing stool specimens of nondiarrheal consistency and from children ≤12 months old. A run chart, demonstrating numbers of nondiarrheal plus infant stool specimens submitted over time, was developed to analyze the initiative's impact on clinicians' test-ordering practices. A p-chart was generated to evaluate the percentage of these submitted specimens tested biweekly over a 12-month period. Cost savings for patients and the laboratory were assessed at the study period's conclusion. Run chart analysis revealed an initial shift after the interventions, suggesting a temporary decrease in testing submission; however, no sustained differences in numbers of specimens submitted biweekly were observed over time. On the p-chart, the mean percentage of specimens tested before the intervention was 100%. After the intervention, the average percentage of specimens tested dropped to 53.8%. Resultant laboratory cost savings totaled nearly $3600, and patient savings on testing charges were ∼$32 000. Automatic laboratory declination of nondiarrheal stools submitted for CDI testing resulted in a sustained decrease in the number of specimens tested, resulting in significant laboratory and patient cost savings. Despite multiple educational efforts, no sustained changes in physician ordering practices were observed. Copyright © 2016 by the American Academy of Pediatrics.

  17. Using Reduced Inoculum Densities of Mycobacterium tuberculosis in MGIT Pyrazinamide Susceptibility Testing to Prevent False-Resistant Results and Improve Accuracy: A Multicenter Evaluation

    Directory of Open Access Journals (Sweden)

    Glenn P. Morlock

    2017-01-01

    Full Text Available The primary platform used for pyrazinamide (PZA susceptibility testing of Mycobacterium tuberculosis is the MGIT culture system (Becton Dickinson. Since false-resistant results have been associated with the use of this system, we conducted a multicenter evaluation to determine the effect of using a reduced cell density inoculum on the rate of false resistance. Two reduced inoculum densities were compared with that prescribed by the manufacturer (designated as “BD” method. The reduced inoculum methods (designated as “A” and “C” were identical to the manufacturer’s protocol in all aspects with the exception of the cell density of the inoculum. Twenty genetically and phenotypically characterized M. tuberculosis isolates were tested in duplicate by ten independent laboratories using the three inoculum methods. False-resistant results declined from 21.1% using the standard “BD” method to 5.7% using the intermediate (“A” inoculum and further declined to 2.8% using the most dilute (“C” inoculum method. The percentages of the resistant results that were false-resistant declined from 55.2% for the “BD” test to 28.8% and 16.0% for the “A” and “C” tests, respectively. These results represent compelling evidence that the occurrence of false-resistant MGIT PZA susceptibility test results can be mitigated through the use of reduced inoculum densities.

  18. Large-scale testing of women in Copenhagen has not reduced the prevalence of Chlamydia trachomatis infections

    DEFF Research Database (Denmark)

    Westh, Henrik Torkil; Kolmos, H J

    2003-01-01

    OBJECTIVE: To examine the impact of a stable, large-scale enzyme immunoassay (EIA) Chlamydia trachomatis testing situation in Copenhagen, and to estimate the impact of introducing a genomic-based assay with higher sensitivity and specificity. METHODS: Over a five-year study period, 25 305-28 505...... and negative predictive values of the Chlamydia test result, new screening strategies for both men and women in younger age groups will be necessary if chlamydial infections are to be curtailed....

  19. Testing a simple control law to reduce broadband frequency harmonic vibrations using semi-active tuned mass dampers

    International Nuclear Information System (INIS)

    Moutinho, Carlos

    2015-01-01

    This paper is focused on the control problems related to semi-active tuned mass dampers (TMDs) used to reduce harmonic vibrations, specially involving civil structures. A simplified version of the phase control law is derived and its effectiveness is investigated and evaluated. The objective is to improve the functioning of control systems of this type by simplifying the measurement process and reducing the number of variables involved, making the control system more feasible and reliable. Because the control law is of ON/OFF type, combined with appropriate trigger conditions, the activity of the actuation system may be significantly reduced, which may be of few seconds a day in many practical cases, increasing the durability of the device and reducing its maintenance. Moreover, due to the ability of the control system to command the motion of the inertial mass, the semi-active TMD is relatively insensitive to its initial tuning, resulting in the capability of self-tuning and in the possibility of controlling several vibration modes of a structure over a significant broadband frequency. (paper)

  20. Testing the effectiveness of certainty scales, cheap talk, and dissonance-minimization in reducing hypothetical bias in contingent valuation studies

    Science.gov (United States)

    Mark Morrison; Thomas C. Brown

    2009-01-01

    Stated preference methods such as contingent valuation and choice modeling are subject to various biases that may lead to differences between actual and hypothetical willingness to pay. Cheap talk, follow-up certainty scales, and dissonance minimization are three techniques for reducing this hypothetical bias. Cheap talk and certainty scales have received considerable...

  1. Testing Probation Outcomes in an Evidence-Based Practice Setting: Reduced Caseload Size and Intensive Supervision Effectiveness

    Science.gov (United States)

    Jalbert, Sarah Kuck; Rhodes, William; Flygare, Christopher; Kane, Michael

    2010-01-01

    Probation and parole professionals argue that supervision outcomes would improve if caseloads were reduced below commonly achieved standards. Criminal justice researchers are skeptical because random assignment and strong observation studies have failed to show that criminal recidivism falls with reductions in caseload sizes. One explanation is…

  2. Implementation challenges for designing integrated in vitro testing strategies (ITS) aiming at reducing and replacing animal experimentation.

    Science.gov (United States)

    De Wever, Bart; Fuchs, Horst W; Gaca, Marianna; Krul, Cyrille; Mikulowski, Stan; Poth, Albrecht; Roggen, Erwin L; Vilà, Maya R

    2012-04-01

    At the IVTIP (in vitro testing industrial platform) meeting of November 26th 2009 entitled 'Toxicology in the 21st century ('21C')--working our way towards a visionary reality' all delegates endorsed the emerging concept of the '21C' vision as the way forward to enable a thorough, reliable and systematic approach to future toxicity testing without the use of animals. One of the emerging concepts focused on integrating a defined number of tests modelling in vivo-relevant and well-characterised toxicity pathways representing mechanistic endpoints. At this meeting the importance of Integrated Testing Strategies (ITS) as tools towards reduction and eventually replacement of the animals currently used for hazard identification and risk assessment was recognised. A follow-up IVTIP Spring 2010 meeting entitled 'Integrated In Vitro Testing Strategies (ITS)--Implementation Challenges' was organised to address pending questions about ITS. This report is not a review of the ITS literature, but a summary of the discussions triggered by presented examples on how to develop and implement ITS. Contrasts between pharmaceutical and chemical industry, as well as a list of general but practical aspects to be considered while developing an ITS emerged from the discussions. In addition, current recommendations on the validation of ITS were discussed. In conclusion, the outcome of this workshop improved the understanding of the participants of some important factors that may impact the design of an ITS in function of its purpose (e.g., screening, or early decision making versus regulatory), the context in which they need to be applied (e.g., ICH guidelines, REACH) and the status and quality of the available tools. A set of recommendations of best practices was established and the importance of the applicability of the individual tests as well as the testing strategy itself was highlighted. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Point-of-care procalcitonin test to reduce antibiotic exposure in patients hospitalized with acute exacerbation of COPD

    DEFF Research Database (Denmark)

    Corti, Caspar; Fally, Markus; Fabricius-Bjerre, Andreas

    2016-01-01

    BACKGROUND: This study was conducted to investigate whether point-of-care (POC) procalcitonin (PCT) measurement can reduce redundant antibiotic treatment in patients hospitalized with acute exacerbation of COPD (AECOPD). METHODS: One-hundred and twenty adult patients admitted with AECOPD were...... in the PCT-arm vs 8.5 (IQR 1-11) days in the control arm (P=0.0169, Wilcoxon) for the intention-to-treat population. The proportion of patients using antibiotics for ≥5 days within the 28-day follow-up was 41.9% (PCT-arm) vs 67.2% (P=0.006, Fisher's exact) in the intention-to-treat population. For the per...... no apparent difference. CONCLUSION: Our study shows that the implementation of a POC PCT-guided algorithm can be used to substantially reduce antibiotic exposure in patients hospitalized with AECOPD, with no apparent harm....

  4. The emergence of the Activity Reduces Conflict Associated Strain (ARCAS) model: a test of a conditional mediation model of workplace conflict and employee strain

    NARCIS (Netherlands)

    Dijkstra, M.T.M.; Beersma, B.; Cornelissen, R.A.W.M.

    2012-01-01

    To test and extend the emerging Activity Reduces Conflict-Associated Strain (ARCAS) model, we predicted that the relationship between task conflict and employee strain would be weakened to the extent that people experience high organization-based self-esteem (OBSE). A survey among Dutch employees

  5. The emergence of the activity reduces conflict related strain (ARCAS) model: A test of a conditional mediation model of workplace conflict and employee strain

    NARCIS (Netherlands)

    Dijkstra, M.T.M.; Beersma, B.; Cornelissen, R. A. W. M.

    2012-01-01

    To test and extend the emerging Activity Reduces Conflict-Associated Strain (ARCAS) model, we predicted that the relationship between task conflict and employee strain would be weakened to the extent that people experience high organization-based self-esteem (OBSE). A survey among Dutch employees

  6. Willingness-to-pay function for two fuel treatments to reduce wildfire acreage burned: A scope test and comparison of white and hispanic households

    Science.gov (United States)

    John B. Loomis; Hung Le Trong; Armando González-Cabán

    2009-01-01

    We estimate a marginal benefit function for using prescribed burning and mechanical fuel reduction programs to reduce acres burned by wildfire in three states. Since each state had different acre reductions, a statistically significant coefficient on the reduction in acres burned is also a split sample scope test frequently used as an indicator of the internal validity...

  7. Can Parental Monitoring and Peer Management Reduce the Selection or Influence of Delinquent Peers? Testing the Question Using a Dynamic Social Network Approach

    Science.gov (United States)

    Tilton-Weaver, Lauree C.; Burk, William J.; Kerr, Margaret; Stattin, Håkan

    2013-01-01

    We tested whether parents can reduce affiliation with delinquent peers through 3 forms of peer management: soliciting information, monitoring rules, and communicating disapproval of peers. We examined whether peer management interrupted 2 peer processes: selection and influence of delinquent peers. Adolescents' feelings of being overcontrolled by…

  8. Three Treatments for Reducing the Worry and Emotionality Components of Test Anxiety with Undergraduate and Graduate College Students: Cognitive-Behavioral Hypnosis, Relaxation Therapy, and Supportive Counseling.

    Science.gov (United States)

    Sapp, Marty

    1996-01-01

    Examines the effects of 3 different types of therapy in reducing the worry and emotional components associated with test anxiety among undergraduate (n=45) and graduate (n=45) students. Relaxation therapy was more effective with graduate students, while undergraduates responded more to supportive counseling. (JPS)

  9. Using pathology-specific laboratory profiles in Clinical Pathology to reduce inappropriate test requesting: two completed audit cycles

    Science.gov (United States)

    2012-01-01

    Background Systematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles. Methods Observational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs’ request forms. Results Seven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001). Conclusions The first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the

  10. Evaluation of nitrous oxide as a substitute for sulfur hexafluoride to reduce global warming impacts of ANSI/HPS N13.1 gaseous uniformity testing

    Science.gov (United States)

    Yu, Xiao-Ying; Barnett, J. Matthew; Amidan, Brett G.; Recknagle, Kurtis P.; Flaherty, Julia E.; Antonio, Ernest J.; Glissmeyer, John A.

    2018-03-01

    The ANSI/HPS N13.1-2011 standard requires gaseous tracer uniformity testing for sampling associated with stacks used in radioactive air emissions. Sulfur hexafluoride (SF6), a greenhouse gas with a high global warming potential, has long been the gas tracer used in such testing. To reduce the impact of gas tracer tests on the environment, nitrous oxide (N2O) was evaluated as a potential replacement to SF6. The physical evaluation included the development of a test plan to record percent coefficient of variance and the percent maximum deviation between the two gases while considering variables such as fan configuration, injection position, and flow rate. Statistical power was calculated to determine how many sample sets were needed, and computational fluid dynamic modeling was utilized to estimate overall mixing in stacks. Results show there are no significant differences between the behaviors of the two gases, and SF6 modeling corroborated N2O test results. Although, in principle, all tracer gases should behave in an identical manner for measuring mixing within a stack, the series of physical tests guided by statistics was performed to demonstrate the equivalence of N2O testing to SF6 testing in the context of stack qualification tests. The results demonstrate that N2O is a viable choice leading to a four times reduction in global warming impacts for future similar compliance driven testing.

  11. Leishmaniasis Direct Agglutination Test: Using Pictorials as Training Materials to Reduce Inter-Reader Variability and Improve Accuracy

    NARCIS (Netherlands)

    Adams, Emily R.; Jacquet, Diane; Schoone, Gerard; Gidwani, Kamlesh; Boelaert, Marleen; Cunningham, Jane

    2012-01-01

    Background: The Direct Agglutination Test (DAT) has a high diagnostic accuracy and remains, in some geographical areas, part of the diagnostic algorithm for Visceral Leishmaniasis (VL). However, subjective interpretation of results introduces potential for inter-reader variation. We report an

  12. Does Distraction Reduce the Alcohol-Aggression Relation? A Cognitive and Behavioral Test of the Attention-Allocation Model

    Science.gov (United States)

    Gallagher, Kathryn E.; Parrott, Dominic J.

    2011-01-01

    Objective: This study provided the first direct test of the cognitive underpinnings of the attention-allocation model and attempted to replicate and extend past behavioral findings for this model as an explanation for alcohol-related aggression. Method: A diverse community sample (55% African American) of men (N = 159) between 21 and 35 years of…

  13. Implementation challenges for designing Integrated In Vitro Testing Strategies (ITS) aiming at reducing and replacing animal experimentation

    NARCIS (Netherlands)

    Wever, B.de; Fuchs, H.W.; Gaca, M.; Krul, C.A.M.; Mikulowski, S.; Poth, A.; Roggen, E.L.; Vilà, M.R.

    2012-01-01

    At the IVTIP (In Vitro Testing Industrial Platform) meeting of November 26th 2009 entitled 'Toxicology in the 21st century ('21C') - working our way towards a visionary reality' all delegates endorsed the emerging concept of the '21C' vision as the way forward to enable a thorough, reliable and

  14. Impact of Heterogeneity in Sexual Behavior on Effectiveness in Reducing HIV Transmission with Test-and-Treat Strategy

    NARCIS (Netherlands)

    Rozhnova, Ganna; Schim van der Loeff, Maarten F.; Heijne, Janneke C. M.; Kretzschmar, Mirjam E.

    2016-01-01

    The WHO's early-release guideline for antiretroviral treatment (ART) of HIV infection based on a recent trial conducted in 34 countries recommends starting treatment immediately upon an HIV diagnosis. Therefore, the test-and-treat strategy may become more widely used in an effort to scale up HIV

  15. Age-correction of test scores reduces the validity of mild cognitive impairment in predicting progression to dementia

    NARCIS (Netherlands)

    Hessler, Johannes; Tucha, Oliver; Förstl, Hans; Mönsch, Edelgard; Bickel, Horst

    2014-01-01

    Objectives: A phase of mild cognitive impairment (MCI) precedes most forms of neurodegenerative dementia. Many definitions of MCI recommend the use of test norms to diagnose cognitive impairment. It is, however, unclear whether the use of norms actually improves the detection of individuals at risk

  16. Are unnecessary follow-up procedures induced by computer-aided diagnosis (CAD) in mammography? Comparison of mammographic diagnosis with and without use of CAD

    International Nuclear Information System (INIS)

    Marx, Christiane; Malich, Ansgar; Facius, Mirjam; Grebenstein, Uta; Sauner, Dieter; Pfleiderer, Stefan O.R.; Kaiser, Werner A.

    2004-01-01

    Objective: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. Materials and methods: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers=group 1; 49 histologically proven benign lesions=group 2 and 100 screening cases (4 years-follow up=group 3). Mammograms were evaluated by a CAD system (Second Look [reg] , CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). Results: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. Conclusion: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid

  17. Pre-test analysis of a LBLOCA using the design data of the ATLAS facility, a reduced-height integral effect test loop for PWRs

    International Nuclear Information System (INIS)

    Hyun-Sik Park; Ki-Yong Choi; Dong-Jin Euh; Tae-Soon Kwon; Won-Pil Baek

    2005-01-01

    Full text of publication follows: The simulation capability of the KAERI integral effect test facility, ATLAS (Advanced Thermalhydraulic Test Loop for Accident Simulation), has been assessed for a large-break loss-of-coolant accident (LBLOCA) transient. The ATLAS facility is a 1/2 height-scaled, 1/144 area-scaled (1/288 in volume scale), and full-pressure test loop based on the design features of the APR1400, an evolutionary pressurized water reactor that has been developed by Korean industry. The APR1400 has four mechanically separated hydraulic trains for the emergency core cooling system (ECCS) with direct vessel injection (DVI). The APR1400 design features have brought about several new safety issues related to the LBLOCA including the steam-water interaction, ECC bypass, and boiling in the reactor vessel downcomer. The ATLAS facility will be used to investigate the multiple responses between the systems or between the components during various anticipated transients. The ATLAS facility has been designed according to a scaling method that is mainly based on the model suggested by Ishii and Kataoka. The ATLAS facility is being evaluated against the prototype plant APR1400 with the same control logics and accident scenarios using the best-estimated code, MARS. This paper briefly introduces the basic design features of the ATLAS facility and presents the results of pre-test analysis for a postulated LBLOCA of a cold leg. The LBLOCA analyses has been conducted to assess the validity of the applied scaling law and the similarity between the ATLAS facility and the APR1400. As the core simulator of the ATLAS facility has the 10% capability of the scaled full power, the blowdown phase can not be simulated, and the starting point of the accident scenario is around the end of blowdown. So it is an important problem to find the correct initial conditions. For the analyzed LBLOCA scenario, the ATLAS facility showed very similar thermal-hydraulic characteristics to the APR

  18. Human Sperm Bioassay for Reprotoxicity Testing in Embryo Culture Media: Some Practical Considerations in Reducing the Assay Time

    Directory of Open Access Journals (Sweden)

    Amjad Hossain

    2010-01-01

    Full Text Available Human sperm assay (HSA is a preferred in house quality control and proficiency test (PT practiced in fertility laboratories. HSA is performed over varying durations, apparently without following set criteria. To better understand the assay time required for reprotoxicity testing in embryo culture media, we compared American-Association-of-Bioanalysts-(AAB- administered HSA data to our own assay performed using PT samples obtained from AAB. Participating laboratories were required to culture sperm for 48 hours to determine media acceptability. Conclusions drawn from 48- and 24-hour observations were the same, suggesting that HSA could identify reprotoxic media in less time than required by AAB. Our assay revealed that changes in motility grade in adulterated media are significantly different from those in control media. Furthermore, grade changes can be identified earlier than differences in motility loss between samples. Analyzing motility and motility quality together provides a method for establishing an optimal time for HSA.

  19. Field Test Results of Using a Nacelle-Mounted Lidar for Improving Wind Energy Capture by Reducing Yaw Misalignment (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Fleming, P.; Scholbrock, A.; Wright, A.

    2014-11-01

    Presented at the Nordic Wind Power Conference on November 5, 2014. This presentation describes field-test campaigns performed at the National Wind Technology Center in which lidar technology was used to improve the yaw alignment of the Controls Advanced Research Turbine (CART) 2 and CART3 wind turbines. The campaigns demonstrated that whether by learning a correction function to the nacelle vane, or by controlling yaw directly with the lidar signal, a significant improvement in power capture was demonstrated.

  20. Female Mucopolysaccharidosis IIIA Mice Exhibit Hyperactivity and a Reduced Sense of Danger in the Open Field Test

    OpenAIRE

    Langford-Smith, Alex; Langford-Smith, Kia J.; Jones, Simon A.; Wynn, Robert F.; Wraith, J. E.; Wilkinson, Fiona L.; Bigger, Brian W.

    2011-01-01

    Reliable behavioural tests in animal models of neurodegenerative diseases allow us to study the natural history of disease and evaluate the efficacy of novel therapies. Mucopolysaccharidosis IIIA (MPS IIIA or Sanfilippo A), is a severe, neurodegenerative lysosomal storage disorder caused by a deficiency in the heparan sulphate catabolising enzyme, sulfamidase. Undegraded heparan sulphate accumulates, resulting in lysosomal enlargement and cellular dysfunction. Patients suffer a progressive lo...

  1. Who benefits from reduced reproduction in parasitized hosts? An experimental test using the Pasteuria ramosa-Daphnia magna system.

    Science.gov (United States)

    Mageroy, Jon H; Grepperud, Eldfrid J; Jensen, Knut Helge

    2011-12-01

    We investigated whether parasites or hosts benefit from reduced reproduction in infected hosts. When parasites castrate their hosts, the regain of host reproduction is necessary for castration to be a host adaptation. When infecting Daphnia magna with Pasteuria ramosa, in a lake water based medium, 49 2% of the castrated females regained reproduction. We investigated the relationship between castration level, and parasite and host fitness proxies to determine the adaptive value of host castration. Hosts which regained reproduction contained less spores and had a higher lifetime reproduction than permanently castrated hosts. We also found a negative correlation between parasite and host lifetime reproduction. For hosts which regained reproduction we found no optimal level of castration associated with lifetime reproduction. These results support the view that host castration only is adaptive to the parasite in this system. In addition, we suggest that permanent castration might not be the norm under natural conditions in this system. Finally, we argue that a reduction in host reproduction is more likely to evolve as a property favouring parasites rather than hosts. To our knowledge this is the only experimental study to investigate the adaptive value of reduced host reproduction when castrated hosts can regain reproduction.

  2. TESTING OF THE EFFICIENCY OF SOME ENZYMATIC MIXTURES, CONCERNING THE CONVERSION OF SEVERAL LIGNOCELLULOSIC BIOMASS’ SOURSES, TO REDUCING SUGARS

    Directory of Open Access Journals (Sweden)

    RADIANA TAMBA-BEREHOIU

    2008-05-01

    Full Text Available Three lignocelluloses substrates have been used, as following: Mischantus, Maize stalk and Wheat bran, in order to obtain fermentescible sugars, which will be transformed into bioethanol. The substrates were hydrolysed using commercial enzymes: MethaPlus (b-glucanase, xylanase, cellulase, Veron 191 (xylanase, Hep C (cellulase. The hydrolysis was performed at 550 C, for 20 h, at pH = 5,5. The best results were obtained by using MethaPlus enzyme. The efficiency of hydrolysis was 110.80 % for Miscanthus, 126.15 % for maize stalk and 118.76 % for wheat bran, reported to the control. The most enhanced quantities of reducing sugars were obtained in maize stalk, namely: 126.15 % using MethaPlus, 112.07 % using Veron 191 and 113.52 % using Hep C. The wheat bran was hydrolysed with enzymatic mixtures, for emphasizing the reducing sugars’ grow, coming from residual starch’s content (flour. In comparison to the control, the efficiency of hydrolysis was of: 181.004 % for MethaPlus-Veron M4 mixture, 168.83 % for MethaPlus-Veron 393 mixture, 205.86 % for MethaPlus-BG a-malt mixture and of 176.57 % for MethaPlus-Veron MX mixture. The enzymatic mixture which contains BG a-malt was the most productive, the hydrolysis efficiency being superior to all other variants.

  3. Manufacturing and test of a low cost polypropylene bag to reduce the radioactive gas released by a radiopharmaceutical production facility

    Energy Technology Data Exchange (ETDEWEB)

    Tavares, Jose Carlos Freitas; Lacerda, Marco Aurelio de Sousa, E-mail: jcft@cdtn.b, E-mail: masl@cdtn.b [Centro de Desenvolvimento da Tecnologia Nuclear (SEPRA/ CDTN/CNEN-MG) Belo Horizonte, MG (Brazil). Servico de Protecao Radiologica; Nascimento, Leonardo Tafas Constantino do; Silva, Juliana Batista da, E-mail: ltcn@cdtn.b, E-mail: silvajb@cdtn.b [Centro de Desenvolvimento da Tecnologia Nuclear (SECPRA/ CDTN/CNEN-MG) Belo Horizonte, MG (Brazil). Secao de Producao de Radiofarmacos

    2011-07-01

    The main objective of this work was to evaluate the efficiency of a plastic gas storage bag to reduce the radioactive gas released by the chimney of a radiopharmaceutical production facility during the 2-[{sup 18}F]fluoro-2- deoxy-D-glucose ({sup 18}FDG) synthesis. The studied facility was the Development Centre of Nuclear Technology (CDTN/CNEN) in Belo Horizonte, Brazil. The bag was manufactured utilizing foils of polypropylene of 360 x 550 x 0.16 mm and disposable components of the cassette of the synthesizer. Two synthesis of {sup 18}FDG were done using the same hot cell and synthesizer to evaluate the efficiency of the bag. The manufactured bag was put in the gas exit of the synthesizer and the activity reported by the online radiation monitoring system in the first synthesis. These results were compared to the activity released in a synthesis performed without the bag. We observed when the bag was used the amount released was about 0.2% in 270 minutes. The second synthesis was performed without the bag, about 7,1% of the input activity was released by the exhaust of the facility in the same time interval. The bag presented a very good efficiency in the reducing of the radioactive gas released by the chimney of the radiopharmaceutical production facility. (author)

  4. Manufacturing and test of a low cost polypropylene bag to reduce the radioactive gas released by a radiopharmaceutical production facility

    International Nuclear Information System (INIS)

    Tavares, Jose Carlos Freitas; Lacerda, Marco Aurelio de Sousa; Nascimento, Leonardo Tafas Constantino do; Silva, Juliana Batista da

    2011-01-01

    The main objective of this work was to evaluate the efficiency of a plastic gas storage bag to reduce the radioactive gas released by the chimney of a radiopharmaceutical production facility during the 2-[ 18 F]fluoro-2- deoxy-D-glucose ( 18 FDG) synthesis. The studied facility was the Development Centre of Nuclear Technology (CDTN/CNEN) in Belo Horizonte, Brazil. The bag was manufactured utilizing foils of polypropylene of 360 x 550 x 0.16 mm and disposable components of the cassette of the synthesizer. Two synthesis of 18 FDG were done using the same hot cell and synthesizer to evaluate the efficiency of the bag. The manufactured bag was put in the gas exit of the synthesizer and the activity reported by the online radiation monitoring system in the first synthesis. These results were compared to the activity released in a synthesis performed without the bag. We observed when the bag was used the amount released was about 0.2% in 270 minutes. The second synthesis was performed without the bag, about 7,1% of the input activity was released by the exhaust of the facility in the same time interval. The bag presented a very good efficiency in the reducing of the radioactive gas released by the chimney of the radiopharmaceutical production facility. (author)

  5. Agent based models for testing city evacuation strategies under a flood event as strategy to reduce flood risk

    Science.gov (United States)

    Medina, Neiler; Sanchez, Arlex; Nokolic, Igor; Vojinovic, Zoran

    2016-04-01

    This research explores the uses of Agent Based Models (ABM) and its potential to test large scale evacuation strategies in coastal cities at risk from flood events due to extreme hydro-meteorological events with the final purpose of disaster risk reduction by decreasing human's exposure to the hazard. The first part of the paper corresponds to the theory used to build the models such as: Complex adaptive systems (CAS) and the principles and uses of ABM in this field. The first section outlines the pros and cons of using AMB to test city evacuation strategies at medium and large scale. The second part of the paper focuses on the central theory used to build the ABM, specifically the psychological and behavioral model as well as the framework used in this research, specifically the PECS reference model is cover in this section. The last part of this section covers the main attributes or characteristics of human beings used to described the agents. The third part of the paper shows the methodology used to build and implement the ABM model using Repast-Symphony as an open source agent-based modelling and simulation platform. The preliminary results for the first implementation in a region of the island of Sint-Maarten a Dutch Caribbean island are presented and discussed in the fourth section of paper. The results obtained so far, are promising for a further development of the model and its implementation and testing in a full scale city

  6. Test

    DEFF Research Database (Denmark)

    Bendixen, Carsten

    2014-01-01

    Bidrag med en kortfattet, introducerende, perspektiverende og begrebsafklarende fremstilling af begrebet test i det pædagogiske univers.......Bidrag med en kortfattet, introducerende, perspektiverende og begrebsafklarende fremstilling af begrebet test i det pædagogiske univers....

  7. Test Research of Reducing Combed Yarn Neps%降低精梳纱棉结的试验研究

    Institute of Scientific and Technical Information of China (English)

    赵建伟

    2011-01-01

    Technology measures of reducing combed yarn neps were discussed.Causes of combed yarn neps formation and changing rules in spinning were analyzed.Cotton assorting and processing configurations in each process were modified and optimized.Basic management works were enhanced such as raw cotton selection, equipment clean, operation clean and temperature & humidity control.Finally neps of CJ 18.2 tex cheese and CJ 22.4 tex cheese could be kept below 31 per kilometer and 25 per kilometer.It is pointed out that processing in cotton assorting,carding and combing process should be set rationally,reducing neps is a system project,the key points should be focused, whole process control should be implemented and basic management should be strengthened, finally the better effect could be got.%探讨降低精梳纱棉结的技术措施.分析了精梳纱棉结的形成原因及纺纱过程中的变化规律,通过对配棉及各工序的工艺进行改进和优化配置,加强原棉、设备揩车和运转清洁工作及温湿度等各项基础管理工作,结果使CJ 18.2 tex、CJ 22.4 tex筒纱棉结长期保持在31个/km和25个/km以下.指出:减少精梳纱棉结是一项系统工程,仅仅依靠配棉、梳棉、精梳工序的作用是不够的,应突出重点实行纺纱全过程控制并切实加强基础性管理工作,才能收到较好效果.

  8. Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculuskeletal pain patients with high pain sensitivity

    DEFF Research Database (Denmark)

    Vægter, Henrik Bjarke; Handberg, Gitte; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: In chronic pain patients, impaired conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) have been reported. No studies have compared CPM and EIH in chronic musculoskeletal pain patients with high pain sensitivity (HPS) and low pain sensitivity (LPS). MATERIALS.......005). Pain tolerance increased after the cold pressor test and exercise in both groups (PCPM and EIH were partly impaired in chronic pain patients with high versus less pain sensitivity, suggesting that the CPM and EIH responses depend on the degree of pain sensitivity. This has clinical...

  9. Demand elasticity increase for reducing social welfare losses due to transfer capacity restriction: A test case on Italian cross-border imports

    International Nuclear Information System (INIS)

    Bruno, Sergio; De Benedictis, Michele; La Scala, Massimo; Wangensteen, Ivar

    2006-01-01

    The paper is aimed at showing how demand-side policies for increasing inner demand elasticity could help in reducing market inefficiencies generated by transfer limits on interconnections, with a special regard to energy imports dependent countries. In order to develop the studies in a realistic environment, a model for the Italian electricity market has been developed. Test results show effects of variations in demand elasticity on the national social surplus and congestion costs. It will be shown how an increase of demand elasticity can counterbalance the need of additional transfer capacity in reducing cross-border congestions. (author)

  10. Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction

    Science.gov (United States)

    Freeman, Daniel; Bradley, Jonathan; Antley, Angus; Bourke, Emilie; DeWeever, Natalie; Evans, Nicole; Černis, Emma; Sheaves, Bryony; Waite, Felicity; Dunn, Graham; Slater, Mel; Clark, David M.

    2016-01-01

    Background Persecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed. Use of virtual reality could facilitate new learning. Aims To test the hypothesis that enabling patients to test the threat predictions of persecutory delusions in virtual reality social environments with the dropping of safety-seeking behaviours (virtual reality cognitive therapy) would lead to greater delusion reduction than exposure alone (virtual reality exposure). Method Conviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions. Patients were then randomised to virtual reality cognitive therapy or virtual reality exposure, both with 30 min in graded virtual reality social environments. Delusion conviction and real-world distress were then reassessed. Results In comparison with exposure, virtual reality cognitive therapy led to large reductions in delusional conviction (reduction 22.0%, P = 0.024, Cohen's d = 1.3) and real-world distress (reduction 19.6%, P = 0.020, Cohen's d = 0.8). Conclusion Cognitive therapy using virtual reality could prove highly effective in treating delusions. PMID:27151071

  11. Reduced effectiveness of escitalopram in the forced swimming test is associated with increased serotonin clearance rate in food restricted rats

    Science.gov (United States)

    France, CP; Li, J-X; Owens, WA; Koek, W; Toney, GM; Daws, LC

    2012-01-01

    Efficacy of antidepressant drugs is often limited. One of the limiting factors may be diet. This study shows that the effect of escitalopram in the forced swimming test is diminished in rats by food restriction that decreased body weight by 8%. The primary target for escitalopram is the serotonin (5-HT) transporter. Using high-speed chronoamperometry to measure 5-HT clearance in vivo in rats fed the same food restricted diet, the rate of 5-HT clearance from extracellular fluid in brain was dramatically increased. Increased 5-HT transporter function under conditions of dietary restriction might contribute to the decreased effect of escitalopram. These results suggest that diet plays an integral role in determining efficacy of antidepressant drugs, and might well generalize to other psychoactive drugs that impinge upon the 5-HT transporter. PMID:19419596

  12. Impact of Laboratory Test Use Strategies in a Turkish Hospital.

    Directory of Open Access Journals (Sweden)

    Fatma Meriç Yılmaz

    Full Text Available Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH and calculate potential savings in costs.A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months.Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0% was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars.Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.

  13. Testing and modeling the influence of reclamation and control methods for reducing nonpoint mercury emissions associated with industrial open pit gold mines.

    Science.gov (United States)

    Miller, Matthieu B; Gustin, Mae S

    2013-06-01

    Industrial gold mining is a significant source of mercury (Hg) emission to the atmosphere. To investigate ways to reduce these emissions, reclamation and dust and mercury control methods used at open pit gold mining operations in Nevada were studied in a laboratory setting. Using this information along with field data, and building off previous work, total annual Hg emissions were estimated for two active gold mines in northern Nevada. Results showed that capping mining waste materials with a low-Hg substrate can reduce Hg emissions from 50 to nearly 100%. The spraying of typical dust control solutions often results in higher Hg emissions, especially as materials dry after application. The concentrated application of a dithiocarbamate Hg control reagent appears to reduce Hg emissions, but further testing mimicking the actual distribution of this chemical within an active leach solution is needed to make a more definitive assessment.

  14. An intervention with access to C-reactive protein rapid test reduces antibiotic overprescribing in acute exacerbations of chronic bronchitis and COPD

    DEFF Research Database (Denmark)

    F. Strykowski, David; Nielsen, Anni Brit Sternhagen; Llor, Carles

    2015-01-01

    Background. In acute exacerbation of chronic obstructive pulmonary disease (AECOPD) antibiotic overprescribing leads to antimicrobial resistance and underprescribing may cause poor patient outcomes. Objective. This study aimed to evaluate changes in over- and underprescribing of antibiotics after...... = 0.075). No statistically significant changes were found in the PIG. Conclusion. Antibiotic overprescribing was only reduced when CRP test was available. Simultaneously, underprescribing was not significantly increased, but this could be due to sample size limitations....

  15. Cigarette smoke induced genotoxicity and respiratory tract pathology: evidence to support reduced exposure time and animal numbers in tobacco product testing.

    Science.gov (United States)

    Dalrymple, Annette; Ordoñez, Patricia; Thorne, David; Walker, David; Camacho, Oscar M; Büttner, Ansgar; Dillon, Debbie; Meredith, Clive

    2016-06-01

    Many laboratories are working to develop in vitro models that will replace in vivo tests, but occasionally there remains a regulatory expectation of some in vivo testing. Historically, cigarettes have been tested in vivo for 90 days. Recently, methods to reduce and refine animal use have been explored. This study investigated the potential of reducing animal cigarette smoke (CS) exposure to 3 or 6 weeks, and the feasibility of separate lung lobes for histopathology or the Comet assay. Rats were exposed to sham air or CS (1 or 2 h) for 3 or 6 weeks. Respiratory tissues were processed for histopathological evaluation, and Alveolar type II cells (AEC II) isolated for the Comet assay. Blood was collected for Pig-a and micronucleus quantification. Histopathological analyses demonstrated exposure effects, which were generally dependent on CS dose (1 or 2 h, 5 days/week). Comet analysis identified that DNA damage increased in AEC II following 3 or 6 weeks CS exposure, and the level at 6 weeks was higher than 3 weeks. Pig-a mutation or micronucleus levels were not increased. In conclusion, this study showed that 3 weeks of CS exposure was sufficient to observe respiratory tract pathology and DNA damage in isolated AEC II. Differences between the 3 and 6 week data imply that DNA damage in the lung is cumulative. Reducing exposure time, plus analyzing separate lung lobes for DNA damage or histopathology, supports a strategy to reduce and refine animal use in tobacco product testing and is aligned to the 3Rs (replacement, reduction and refinement).

  16. Lead Testing in Soil Contaminated with Pesticides and Reducing its Effects by the Activity of Activated Charcoal

    Directory of Open Access Journals (Sweden)

    Devesh Chand Thakur

    2014-07-01

    Full Text Available Background: Lead poisoning is classically defined as exposure to high levels of lead typically associated with severe health effects, but being a heavy metal which is potentially toxic, if present at even minor concentrations, it is of great concern to environmentalists and medical professionals alike. Activated charcoal has been known to adsorb heavy metals and thus, was used in this study as well. Aim: The main aim of this study was to decrease the lead content of agricultural soil which is attributed to the use of pesticides containing lead by using activated charcoal. Material and Methods: The lead contamination in agricultural soil and plant dry mass samples which increases due to the effect of pesticides was detected by using Field Portable X-Ray Fluroscence (FP-XRF spectrophotometer. Soil was taken in plastic trays and the plants were grown and watered daily. The collected ground water was also tested. For the estimation of lead in water samples, Graphite Furnace Atomic Absorption Spectroscopy (GFAAS was employed. Results: This study suggested the remediation of soil lead content by using activated charcoal. The study also revealed that activated charcoal not only adsorbs lead but also inhibits the accumulation of lead in ground water. Conclusion: This study promotes a cost effective process to treat agricultural lands polluted with leaded pesticides. Water purifiers, refrigerator etc. contain varying amounts of activated charcoal, after usage of these appliances it can be recycled and used as a source of activated charcoal. This can be applied in pesticide contaminated fields either in the form of slurry or by spraying.

  17. Structural evaluation of spent nuclear fuel storage facilities under aircraft crash impact (2). Horizontal impact test onto reduced scale metal cask due to aircraft engine missile

    International Nuclear Information System (INIS)

    Namba, Kosuke; Shirai, Koji; Saegusa, Toshiari

    2009-01-01

    In this study, to confirm the sealing performance of a metal cask subjected to impact force due to possible commercial aircraft crash against a spent fuel storage facility, the horizontal impact test was carried out. In the test, an aircraft engine missile with a speed of 57.3 m/s attacked the reduced scale metal cask containing helium gas, which stands vertically. Then the leak rate and sliding displacement of the lid were measured. The leak rate increased rapidly and reached to 4.0 x 10 -6 Pa·m 3 /sec. After that, the leak rate decreased slowly and converged to 1.0x10 -6 Pa·m 3 /sec after 20 hours from the impact test. The leak rate of a full scale cask was evaluated using that of reduced scale cask obtained by the test. Then the leak rate of the full scale cask was 3.5x10 -5 Pa·m 3 /sec. This result showed that the sealing performance of the full scale metal cask would not be affected immediately by the horizontal impact of the aircraft engine with a speed of 57.3 m/s. (author)

  18. Barriers and facilitators to reducing frequent laboratory testing for patients who are stable on warfarin: a mixed methods study of de-implementation in five anticoagulation clinics.

    Science.gov (United States)

    Barnes, Geoffrey D; Misirliyan, Sevan; Kaatz, Scott; Jackson, Elizabeth A; Haymart, Brian; Kline-Rogers, Eva; Kozlowski, Jay; Krol, Gregory; Froehlich, James B; Sales, Anne

    2017-07-14

    Patients on chronic warfarin therapy require regular laboratory monitoring to safely manage warfarin. Recent studies have challenged the need for routine monthly blood draws in the most stable warfarin-treated patients, suggesting the safety of less frequent laboratory testing (up to every 12 weeks). De-implementation efforts aim to reduce the use of low-value clinical practices. To explore barriers and facilitators of a de-implementation effort to reduce the use of frequent laboratory tests for patients with stable warfarin management in nurse/pharmacist-run anticoagulation clinics, we performed a mixed-methods study conducted within a state-wide collaborative quality improvement collaborative. Using a mixed-methods approach, we conducted post-implementation semi-structured interviews with a total of eight anticoagulation nurse or pharmacist staff members at five participating clinic sites to assess barriers and facilitators to de-implementing frequent international normalized ratio (INR) laboratory testing among patients with stable warfarin control. Interview guides were based on the Tailored Implementation for Chronic Disease (TICD) framework. Informed by interview themes, a survey was developed and administered to all anticoagulation clinical staff (n = 62) about their self-reported utilization of less frequent INR testing and specific barriers to de-implementing the standard (more frequent) INR testing practice. From the interviews, four themes emerged congruent with TICD domains: (1) staff overestimating their actual use of less frequent INR testing (individual health professional factors), (2) barriers to appropriate patient engagement (incentives and resources), (3) broad support for an electronic medical record flag to identify potentially eligible patients (incentives and resources), and (4) the importance of personalized nurse/pharmacist feedback (individual health professional factors). In the survey (65% response rate), staff report offering less

  19. Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy: prevention of unnecessary elimination diets and determination of eliciting doses.

    Science.gov (United States)

    Dambacher, Wendy M; de Kort, Ellen H M; Blom, W Marty; Houben, Geert F; de Vries, Esther

    2013-02-08

    Children with cow's milk allergy (CMA) need a cow's milk protein (CMP) free diet to prevent allergic reactions. For this, reliable allergy-information on the label of food products is essential to avoid products containing the allergen. On the other hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination diets, can lead to potentially hazardous health situations. Our objective was to evaluate if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents unnecessary elimination diets in the long term. Secondly, to determine the minimum eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children. All children with suspected CMA under our care (Oct'05-Jun'09) were prospectively enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly assigned separate days. The MED was determined by noting the 'lowest observed adverse effect level' (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC a dietary advice was given. Parents were contacted by phone several months later about the diet of their child. 116 children were available for analysis. In 76 children CMA was rejected. In 60 of them CMP was successfully reintroduced, in 2 the parents refused introduction, in another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared. In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have a higher cumulative distribution of MED than older children. Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the long term in most children. The MEDs form potential useful information for offering dietary advice to patients and their caretakers.

  20. Rehearsal of To-Be-Remembered Items Is Unnecessary to Perform Directed Forgetting within Working Memory: Support for an Active Control Mechanism

    Science.gov (United States)

    Festini, Sara B.; Reuter-Lorenz, Patricia A.

    2017-01-01

    Directed forgetting tasks instruct people to forget targeted memoranda. In the context of working memory, people attempt to forget representations that are currently held in mind. Here, we evaluated candidate mechanisms of directed forgetting within working memory, by (a) testing the influence of articulatory suppression, a rehearsal-reducing and…

  1. Reliable experimental setup to test the pressure modulation of Baerveldt Implant tubes for reducing post-operative hypotony

    Science.gov (United States)

    Ramani, Ajay

    constant fluid movement over the surfaces of the absorbable sutures, by better means of rocking/shaking test suture samples to simulate flow conditions. (Abstract shortened by UMI.).

  2. Characteristic test results of reduced-scale lead and 3D laminated rubber bearings for seismic isolation design of liquid metal reactor

    International Nuclear Information System (INIS)

    Yoo, B.; Lee, Jae Han; Kwon, H. S.

    1999-06-01

    Through the fabrications and the tests of reduced scale rubber bearing by several times since 1995, the technology related to the bearings has been improved. In this report, several lead rubber bearings (LLRB) with different lead plug diameters, high damping rubber bearing (HLRB), and 3D-LRB made of UNISON NR (natural rubber) compounds are tested to get the hysteretic characteristics of rubber bearings. Specially, the HLRB and 3D-LRB are tested for the vertical deformation characteristics. All the test data are plotted and analyzed to be compared with design target values such as equivalent horizontal stiffness and equivalent damping ration. The variations of the equivalent horizontal stiffness and damping for the lead and the 3D-LRB are evaluated from test data in the range of 25% to 150% of shear strain in horizontal direction. As increasing the lead plug diameter up to 48 mm, the values of yield load, equivalent stiffness, and equivalent damping are increased, and the maximum damping of 31 % are horizontal performance during compression and shear tests. Through the vertical performance tests of HLRB and 3D-LRB, it is reveal that the vertical stiffness of HLRB is 15.57 ton/mm, which is much lower than target value by 1/4, and the vertical stiffness of 3D-LRB show in the range of 2.17 ton/mm to 4.4 ton/mm, which are higher than the design target 1.25 ton/mm by about 2 times. The vertical equivalent damping of HLRB is 11.48%, but the ones of 3D-LRB show large variations between 8 % and 54%. There are no difference between the first and after curves of the vertical hysteresis of 3D-LRB and no dependency of test speed because the dish springs take the vertical behaviors of 3D-LRB. (author). 8 refs., 38 tabs., 47 figs

  3. Increasing preload volume with water reduces rated appetite but not food intake in healthy men even with minimum delay between preload and test meal.

    Science.gov (United States)

    Gray, Richard W; French, Stephen J; Robinson, Tristan M; Yeomans, Martin R

    2003-02-01

    The role of gastric volume in the short-term control of eating in humans remains unclear, with some studies reporting that food volume alone can reduce appetite but others finding no such effect. A recent study in our laboratory, found effects of preload volume on subjective appetite (hunger, fullness) but not intake, and found effects of preload energy on intake but not appetite. That study used an interval of 30 min between serving preloads and the test meal, and the present study attempted to maximise the effects of the volume manipulation by removing the delay between the preload and test meal. We administered four soup-based preloads varying in volume (150 and 450 ml) using water, and energy density (1.4 and 4.2 kJ/ml) using maltodextrin, producing three energy levels (209, 629, 629 and 1886 kJ; repeated measures). These were followed immediately by an unlimited hot pasta lunch, during which food weight was monitored continuously by computer. Increasing soup volume at constant energy (629 kJ) reduced appetite ratings, but not intake. In contrast, increasing soup energy at constant volume (450 ml) reduced intake, without affecting appetite. The discrepancies between our results and other reported studies suggest that volume is more influential when intakes are large, or that there may be a threshold concentration for nutrients in the GI tract before volume alone is tangibly expressed in subsequent eating.

  4. Unnecessary roughness? Testing the hypothesis that predators destined for molecular gut-content analysis must be hand-collected to avoid cross-contamination

    Science.gov (United States)

    Molecular gut-content analysis enables direct detection of arthropod predation with minimal disruption of on-going ecosystem processes. Mass-collection methods, such as sweep-netting, vacuum sampling, and foliage beating, could lead to regurgitation or even rupturing of predators along with uneaten ...

  5. Theoretical modeling developed to evaluate the hardness and reduced modulus for the C/a-Si composite film using nanoindentation tests

    International Nuclear Information System (INIS)

    Han, C.-F.; Lin, J.-F.; Chung, C.-K.; Wu, B.-H.

    2008-01-01

    A general mechanical model, which is composed of the mechanical models employed to describe the contact behaviors and deformations arising in all layers (including the substrate), is successfully developed in the present study for multilayer specimens in order to evaluate the contact projected area by a theoretical model, and thus the hardness and reduced modulus, using nanoindentation tests. The governing differential equations for the depth solutions of the indenter tip formed at all layers of the specimen under their contact load are developed individually. The influence of the material properties of the substrate on a multilayer specimen's hardness and reduced modulus at various indentation depths can thus be evaluated. Transition and pop-in occurred at depths near, but still before, the C (top layer)/a-Si (buffer layer) interface and the a-Si/Si (substrate) interface, respectively. Using the present analysis, the depths corresponding to the transition and pop-in behaviors can be predicted effectively

  6. What scaling means in wind engineering: Complementary role of the reduced scale approach in a BLWT and the full scale testing in a large climatic wind tunnel

    Science.gov (United States)

    Flamand, Olivier

    2017-12-01

    Wind engineering problems are commonly studied by wind tunnel experiments at a reduced scale. This introduces several limitations and calls for a careful planning of the tests and the interpretation of the experimental results. The talk first revisits the similitude laws and discusses how they are actually applied in wind engineering. It will also remind readers why different scaling laws govern in different wind engineering problems. Secondly, the paper focuses on the ways to simplify a detailed structure (bridge, building, platform) when fabricating the downscaled models for the tests. This will be illustrated by several examples from recent engineering projects. Finally, under the most severe weather conditions, manmade structures and equipment should remain operational. What “recreating the climate” means and aims to achieve will be illustrated through common practice in climatic wind tunnel modelling.

  7. Validation of a methodology to develop a test facility in reduced scale related to boron dispersion in a pressurizer of an iPWR

    Energy Technology Data Exchange (ETDEWEB)

    Nascimento, Samira R.V.; Lira, Carlos A.B.O.; Lapa, Celso M.F.; Lima, Fernando R.A.; Bezerra, Jair L.; Silva, Mário A.B., E-mail: cabol@ufpe.br [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Centro de Tecnologia e Geociências. Departamento de Energia Nuclear; Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Centro Regional de Ciências Nucleares do Nordeste (CRCN/CNEN-PE), Recife, PE (Brazil)

    2017-11-01

    The conception and the project of a 1:200 reduced scale test facility have been developed in earlier researches. Such a facility aims to investigate boron homogenization process inside the pressurizer of an iPWR (integral PWR) by considering water mixing from this component with that coming from the reactor core. For this kind of reactor, the pressurizer is located at the top of the pressure vessel demanding the need of identifying the proper mechanisms in order to warrant an adequate homogenization for the water mixture. Once the installation of the experimental setup was concluded, its behavior has been analyzed by considering the concentration of a tracer diluted in the circulation water, whose measurements were obtained at the pressurizer outlet orifices. Two experiments representing boration(boron concentration increase)/deboration(boron concentration decrease) scenarios have been accomplished. Sample acquisition was carried out for every ten minutes during a total time equal to 180 minutes. Results showed that the combination of Fractional Scaling Analysis with local Froude number consisted of an appropriate methodology to provide the reduced scale test facility parameters, inasmuch the measured concentrations from the experiments reproduced the theoretical behavior with sufficient accuracy. (author)

  8. Validation of a methodology to develop a test facility in reduced scale related to boron dispersion in a pressurizer of an iPWR

    International Nuclear Information System (INIS)

    Nascimento, Samira R.V.; Lira, Carlos A.B.O.; Lapa, Celso M.F.; Lima, Fernando R.A.; Bezerra, Jair L.; Silva, Mário A.B.

    2017-01-01

    The conception and the project of a 1:200 reduced scale test facility have been developed in earlier researches. Such a facility aims to investigate boron homogenization process inside the pressurizer of an iPWR (integral PWR) by considering water mixing from this component with that coming from the reactor core. For this kind of reactor, the pressurizer is located at the top of the pressure vessel demanding the need of identifying the proper mechanisms in order to warrant an adequate homogenization for the water mixture. Once the installation of the experimental setup was concluded, its behavior has been analyzed by considering the concentration of a tracer diluted in the circulation water, whose measurements were obtained at the pressurizer outlet orifices. Two experiments representing boration(boron concentration increase)/deboration(boron concentration decrease) scenarios have been accomplished. Sample acquisition was carried out for every ten minutes during a total time equal to 180 minutes. Results showed that the combination of Fractional Scaling Analysis with local Froude number consisted of an appropriate methodology to provide the reduced scale test facility parameters, inasmuch the measured concentrations from the experiments reproduced the theoretical behavior with sufficient accuracy. (author)

  9. A randomized, controlled trial to test the efficacy of an online, parent-based intervention for reducing the risks associated with college-student alcohol use

    Science.gov (United States)

    Donovan, Elizabeth; Wood, Mollie; Frayjo, Kezia; Black, Ryan A.; Surette, Daniel A.

    2011-01-01

    Alcohol consumption among college students remains a major public health concern. Universal, Web-based interventions to reduce risks associated with student alcohol consumption have been found to be effective in changing their alcohol-related behavior. Recent studies also indicate that parent-based interventions, delivered in booklet form, are effective. A parent-based intervention that is also Web-based may be well suited to a dispersed parent population; however, no such tool is currently available. The purpose of this study was to test the efficacy of an online parent-based intervention designed to (1) increase communication between parents and students about alcohol and (2) reduce risks associated with alcohol use to students. A total of 558 participants, comprising 279 parent-teen dyads, were enrolled in the study. The findings suggested that parents who participated in the online intervention were more likely to discuss protective behavioral strategies, particularly those related to manner of drinking and stopping/limiting drinking, with their teens, as compared with parents in an e-newsletter control group. Moreover, students whose parents received the intervention were more likely to use a range of protective behavioral strategies, particularly those related to manner of drinking and stopping/limiting drinking, as compared with students whose parents did not receive the intervention. A universal, online, parent-based intervention to reduce risks associated with student alcohol consumption may be an efficient and effective component of a college’s overall prevention strategy. PMID:21963316

  10. An inter-laboratory study to test the ability of amendments to reduce the availability of Cd, Pb, and Zn in situ

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Sally [Box 352100 University of Washington, Seattle, WA 98195 (United States)]. E-mail: slb@u.washington.edu; Christensen, Barbara [Box 352100 University of Washington, Seattle, WA 98195 (United States); Lombi, Enzo [CSIRO Land and Water PMB, 2 Glen Osmond, Adelaide, South Australia (Australia)]. E-mail: enzo.lombi@csiro.au; McLaughlin, Mike [CSIRO Land and Water PMB, 2 Glen Osmond, Adelaide, South Australia (Australia)]. E-mail: mike.mclaughlin@csiro.au; McGrath, Steve [Rothamsted Research, Harpenden, Herts AL5 2JQ (United Kingdom)]. E-mail: steve.mcgrath@bbsrc.ac.uk; Colpaert, Jan [Limburgs Universitair, Centrum Universitaire Campus, Building D, BE 3590 Diepenbeek (Belgium); Vangronsveld, Jaco [Limburgs Universitair, Centrum Universitaire Campus, Building D, BE 3590 Diepenbeek (Belgium)]. E-mail: jvangron@luc.ac.be

    2005-11-15

    An international inter-laboratory research program investigated the effectiveness of in situ remediation of soils contaminated by cadmium, lead and zinc, measuring changes in soil and soil solution chemistry, plants and soil microbiota. A common soil, from mine wastes in Jasper County MO, was used. The soil was pH 5.9, had low organic matter (1.2 g kg{sup -1} C) and total Cd, Pb, and Zn concentrations of 92, 5022, and 18 532 mg kg{sup -1}, respectively. Amendments included lime, phosphorus (P), red mud (RM), cyclonic ashes (CA), biosolids (BIO), and water treatment residuals (WTR). Both soil solution and NH{sub 4}NO{sub 3} extractable metals were decreased by all treatments. Phytotoxicity of metals was reduced, with plants grown in P treatments having the highest yields and lowest metal concentration (0.5, 7.2 and 406 mg kg{sup -1} Cd, Pb, and Zn). Response of soil micro-organisms was similar to plant responses. Phosphorus addition reduced the physiologically based extraction test Pb from 84% of total Pb extracted in the untreated soil to 34.1%. - Addition of phosphorus to Pb, Zn and Cd contaminated mine waste was able to reduce metal toxicity for a range of biological endpoints.

  11. Study protocol: the development of a randomised controlled trial testing a postcard intervention designed to reduce suicide risk among young help-seekers

    Directory of Open Access Journals (Sweden)

    McGorry Patrick

    2009-09-01

    Full Text Available Abstract Background Suicidal behaviour and deliberate self harm are common among adolescents. Limited evidence exists regarding interventions that can reduce risk; however research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from services can reduce risk. The aim of the study is to test a postcard intervention among people aged 15-24 who presented to mental health services but are not accepted, yet are at risk of suicide. Methods/design The study is a 3-year randomised controlled trial conducted at Orygen Youth Health Research Centre in Melbourne Australia. Participants are young help-seekers aged 15-24 who are at risk of suicide. Participants will be recruited over a 12 month period. The intervention comprises a regular postcard to be sent monthly for 12 months. The postcard enquires after their well being and includes information regarding individual sources of help and evidence-based self help strategies. Participants are assessed at baseline, 12 and 18 months. Discussion This paper describes the development of a study which aims to reduce suicide risk in a sample of young help-seekers. If effective, this intervention could have significant clinical and research implications for a population who can be hard to treat and difficult to research. Trial Registration The study was registered with the Australian Clinical Trials Registry; number: ACTRN012606000274572.

  12. An inter-laboratory study to test the ability of amendments to reduce the availability of Cd, Pb, and Zn in situ

    International Nuclear Information System (INIS)

    Brown, Sally; Christensen, Barbara; Lombi, Enzo; McLaughlin, Mike; McGrath, Steve; Colpaert, Jan; Vangronsveld, Jaco

    2005-01-01

    An international inter-laboratory research program investigated the effectiveness of in situ remediation of soils contaminated by cadmium, lead and zinc, measuring changes in soil and soil solution chemistry, plants and soil microbiota. A common soil, from mine wastes in Jasper County MO, was used. The soil was pH 5.9, had low organic matter (1.2 g kg -1 C) and total Cd, Pb, and Zn concentrations of 92, 5022, and 18 532 mg kg -1 , respectively. Amendments included lime, phosphorus (P), red mud (RM), cyclonic ashes (CA), biosolids (BIO), and water treatment residuals (WTR). Both soil solution and NH 4 NO 3 extractable metals were decreased by all treatments. Phytotoxicity of metals was reduced, with plants grown in P treatments having the highest yields and lowest metal concentration (0.5, 7.2 and 406 mg kg -1 Cd, Pb, and Zn). Response of soil micro-organisms was similar to plant responses. Phosphorus addition reduced the physiologically based extraction test Pb from 84% of total Pb extracted in the untreated soil to 34.1%. - Addition of phosphorus to Pb, Zn and Cd contaminated mine waste was able to reduce metal toxicity for a range of biological endpoints

  13. Wind tunnel tests of biodegradable fugitive dust suppressants being considered to reduce soil erosion by wind at radioactive waste construction sites

    International Nuclear Information System (INIS)

    Ligotke, M.W.; Dennis, G.W.; Bushaw, L.L.

    1993-10-01

    Wind tunnel tests were performed of three fugitive dust control agents derived from potato and sugar beet products. These materials are being considered for use as dust suppressants to reduce the potential for transport of radioactive materials by wind from radioactive waste construction and remediation sites. Soil and dust control agent type, solution concentrations, application quantities, aging (or drying) conditions, surface disturbance, and wind and saltating sand eolian erosive stresses were selected and controlled to simulate application and exposure of excavated soil surfaces in the field. A description of the tests, results, conclusions, and recommendations are presented in this report. The results of this study indicate that all three dust control agents can protect exposed soil surfaces from extreme eolian stresses. It is also clear that the interaction and performance of each agent with various soil types may differ dramatically. Thus, soils similar to that received from ML should be best protected by high concentration (∼2.5%) solutions of potato starch at low water application levels (∼1 to 2 L/m 2 ). Because the effectiveness of PS on this soil type is degraded after a moderate amount of simulated rainfall, other options or additives should be considered if surfaces are to be protected for long intervals or during periods of intermittent rainfall and hot, windy conditions. On the other hand, XDCA should be considered when excavating sandy soils. It should be noted, however, that because the Hanford soil test results are based on a small number of tests, it would be prudent to perform additional tests prior to selecting a fugitive dust control agent for use at the Hanford Site. While fermented potato waste was not the best fixative used on either soil, it did perform reasonably well on both soil types (better than XDCA on Idaho soil and better than PS on Hanford soil)

  14. A Vehicle Management End-to-End Testing and Analysis Platform for Validation of Mission and Fault Management Algorithms to Reduce Risk for NASA's Space Launch System

    Science.gov (United States)

    Trevino, Luis; Johnson, Stephen B.; Patterson, Jonathan; Teare, David

    2015-01-01

    &MA, Structures and Environments, GNC, Orion, the Crew Office, Flight Operations, and Ground Operations by assessing performance of the M&FM algorithms in terms of their ability to reduce Loss of Mission and Loss of Crew probabilities. In addition, through state machine and diagnostic modeling, analysis efforts investigate a broader suite of failure effects and detection and responses that can be tested in VMET and confirm that responses do not create additional risks or cause undesired states through interactive dynamic effects with other algorithms and systems. VMET further contributes to risk reduction by prototyping and exercising the M&FM algorithms early in their implementation and without any inherent hindrances such as meeting FSW processor scheduling constraints due to their target platform - ARINC 653 partitioned OS, resource limitations, and other factors related to integration with other subsystems not directly involved with M&FM. The plan for VMET encompasses testing the original M&FM algorithms coded in the same C++ language and state machine architectural concepts as that used by Flight Software. This enables the development of performance standards and test cases to characterize the M&FM algorithms and sets a benchmark from which to measure the effectiveness of M&FM algorithms performance in the FSW development and test processes. This paper is outlined in a systematic fashion analogous to a lifecycle process flow for engineering development of algorithms into software and testing. Section I describes the NASA SLS M&FM context, presenting the current infrastructure, leading principles, methods, and participants. Section II defines the testing philosophy of the M&FM algorithms as related to VMET followed by section III, which presents the modeling methods of the algorithms to be tested and validated in VMET. Its details are then further presented in section IV followed by Section V presenting integration, test status, and state analysis. Finally, section VI

  15. Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis.

    Science.gov (United States)

    Yang, Lu; Zhu, Yuchun; Tang, Zhuang; Chen, Yongji; Gao, Liang; Liu, Liangren; Han, Ping; Li, Xiang; Wei, Qiang

    2015-05-01

    To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs). A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared effects of empiric antibiotics with no treatment or placebo on lowering PSA levels and minimizing unnecessary PBs in patients with moderately increased PSA levels. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. The inclusion criteria for the study were met by 6 RCTs (1 placebo controlled and 5 no treatment controlled) involving 656 patients. The synthesized data from these RCTs indicated that there were no significant differences between the antibiotic and control groups in the PSA levels after treatment (mean difference [MD] = 0.15, 95% CI:-0.50 to 0.81, P = 0.65], number of patients with decreased PSA levels after treatment (relative risk [RR] = 1.22, 95% CI: 0.90-1.65, P = 0.20], prostate-specific antigen density levels after treatment (MD =-0.04, 95% CI:-0.15 to 0.07, P = 0.47), f/t% PSA after treatment (MD =-1.47, 95% CI:-4.65 to 1.71, P = 0.37), number of patients with responsive PSA (RR = 1.02, 95% CI: 0.58-1.81, P = 0.94), and individual Pca-positiverate in these patients (RR = 1.07, 95% CI: 0.53-2.16, P = 0.86), and Pca-positiverates (RR = 0.85, 95% CI: 0.48-1.50, P = 0.57). However, the antibiotic group had a significant change in the net PSA decrease after treatment compared with the control group (MD = 1.44, 95% CI: 0.70-2.17, P = 0.0001). The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Portal imaging practice patterns of children's oncology group institutions: Dosimetric assessment and recommendations for minimizing unnecessary exposure

    International Nuclear Information System (INIS)

    Olch, Arthur J.; Geurts, Mark; Thomadsen, Bruce; Famiglietti, Robin; Chang, Eric L.

    2007-01-01

    Purpose: To determine and analyze the dosimetric consequences of current portal imaging practices for pediatric patients, and make specific recommendations for reducing exposure from portal imaging procedures. Methods and Materials: A survey was sent to approximately 250 Children's Oncology Group (COG) member institutions asking a series of questions about their portal imaging practices. Three case studies are presented with dosimetric analysis to illustrate the magnitude of unintended dose received by nontarget tissues using the most common techniques from the survey. Results: The vast majority of centers use double-exposure portal image techniques with a variety of open field margins. Only 17% of portal images were obtained during treatment, and for other imaging methods, few centers subtract monitor units from the treatment delivery. The number of monitor units used was nearly the same regardless of imager type, including electronic portal imaging devices. Eighty-six percent imaged all fields the first week and 17% imaged all fields every week. An additional 1,112 cm 3 of nontarget tissue received 1 Gy in one of the example cases. Eight new recommendations are made, which will lower nontarget radiation doses with minimal impact on treatment verification accuracy. Conclusion: Based on the survey, changes can be made in portal imaging practices that will lower nontarget doses. It is anticipated that treatment verification accuracy will be minimally affected. Specific recommendations made to decrease the imaging dose and help lower the rate of radiation-induced secondary cancers in children are proposed for inclusion in future COG protocols using radiation therapy

  17. Isiris: A Novel Method of Removing Foreign Bodies from the Lower Urinary Tract to Avoid Unnecessary Hospitalization and Anesthesia.

    Science.gov (United States)

    Smith, Peter Mark; Harbias, Aman; Robinson, Richard; Palmer, Anne; Grey, Benjamin Robin

    2016-01-01

    Polyembolokoilamania refers to the practice of inserting foreign bodies (FBs) into natural orifices. A FB within the urethra is a relatively rare phenomenon with 646 cases recorded last year in the United Kingdom. Management of these patients presents technical challenges and complexities because of underlying psychiatric disorders that are often associated. This case illustrates a novel way of removing FBs from the genitourinary tract, requiring less resources, preventing hospital admission, and attempts to break the cycle of behavior, leading to recurrent attendance with polyembolokoilamania. A 38-year-old Caucasian male prisoner, with psychiatric history presented to the emergency department (ED) with a history of inserting FBs into his urethra on 12 different occasions over a 6-week period. Of these 12 attendances, 3 resulted in admission and 2 required emergency intervention in theater under general anesthesia. After the third attendance in 5 days, it was decided to use Isiris™, a single-use flexible cystoscopy device with a built-in ureteral stent grasper, to remove the FBs and check the integrity of the urethra. The procedure was performed within the ED, without the need for admission to a ward bed or general anesthesia. Furthermore, only two members of staff were required to remove all of the urethral FBs. Isiris, although marketed as a stent removal device, enabled us to remove all the patient's FBs in one procedure. Isiris is an easy to use device, similar to a flexible cystoscope, that a specialist nurse or resident would be familiar using. It allows efficient and safe removal of lower urinary tract FBs, even out of hours. It requires minimal staffing support and can be done in the ED. It has the potential to reduce associated sequela of urethral polyembolokoilamania, saving resources while preserving the availability of the emergency theater.

  18. Proceedings of the international meeting on development, fabrication, and application of Reduced Enrichment fuels for Research and Test Reactors (RERTR). Base technology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1983-08-01

    The international effort to develop new fuel materials and designs which will make it feasible to fuel research and test reactors throughout the world with low-enrichment uranium, instead of high-enrichment uranium, has made significant progress during the past year. This progress has taken place at research centers located in many different countries, and is of crucial interest to reactor operators and licensors whose geographical distribution is even more varied. It is appropriate, therefore, that international meetings be held periodically to foster direct communication among the specialists in this area. To achieve this purpose, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the third of a series which begun in 1978. The papers presented at this meeting were divided into sessions according to relevant subject: status of RERTR program and safety issues; development of new fuel types; testing of new fuel elements; specific reactor applications. These proceedings were edited by various members of the RERTR Program.

  19. A simple point of care test can indicate the need for periodontal therapy to reduce the risk for adverse pregnancy outcomes in mothers attending antenatal clinics.

    Science.gov (United States)

    Turton, Mervyn Sydney; Henkel, Ralf Reinhold; Africa, Charlene Wilma Joyce

    2017-12-01

    Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics. At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki. Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p periodontal therapy to reduce the risk of adverse pregnancy outcomes and could form part of the routine antenatal examination.

  20. Proceedings of the international meeting on development, fabrication, and application of Reduced Enrichment fuels for Research and Test Reactors (RERTR). Base technology

    International Nuclear Information System (INIS)

    1983-08-01

    The international effort to develop new fuel materials and designs which will make it feasible to fuel research and test reactors throughout the world with low-enrichment uranium, instead of high-enrichment uranium, has made significant progress during the past year. This progress has taken place at research centers located in many different countries, and is of crucial interest to reactor operators and licensors whose geographical distribution is even more varied. It is appropriate, therefore, that international meetings be held periodically to foster direct communication among the specialists in this area. To achieve this purpose, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the third of a series which begun in 1978. The papers presented at this meeting were divided into sessions according to relevant subject: status of RERTR program and safety issues; development of new fuel types; testing of new fuel elements; specific reactor applications. These proceedings were edited by various members of the RERTR Program

  1. First tests of a traveling-wave chopper for the ATLAS positive ion linac

    International Nuclear Information System (INIS)

    Pardo, R. C.

    1998-01-01

    A ten segment traveling-wave chopper has been constructed and successfully tested at 5% of the design 12 MHz repetition rate. The chopper must remove unbunched tails from a partially bunched heavy-ion beam in order to avoid undue emittance growth in the linac and the production of undesirable satellite beam bunches. When poorly bunched beams traverse the traditional sine-wave chopper, it produces unacceptable transverse emittance growth and unnecessary beam loss. These effects are expected to be much reduced in the traveling wave chopper. First tests have confirmed the validity of these claims, clearly showing much reduced transverse emittance growth as compared to the original sine wave chopper and excellent selectivity for the desired beam. Details of these tests will be presented and compared to calculations. Operation of the new chopper at the full 12 MHz rate is the next goal. Development of a driver power supply capable of full CW operation will also be described

  2. Design and Testing of Novel Lethal Ovitrap to Reduce Populations of Aedes Mosquitoes: Community-Based Participatory Research between Industry, Academia and Communities in Peru and Thailand.

    Science.gov (United States)

    Paz-Soldan, Valerie A; Yukich, Josh; Soonthorndhada, Amara; Giron, Maziel; Apperson, Charles S; Ponnusamy, Loganathan; Schal, Coby; Morrison, Amy C; Keating, Joseph; Wesson, Dawn M

    2016-01-01

    Dengue virus (and Chikungunya and Zika viruses) is transmitted by Aedes aegypti and Aedes albopictus mosquitoes and causes considerable human morbidity and mortality. As there is currently no vaccine or chemoprophylaxis to protect people from dengue virus infection, vector control is the only viable option for disease prevention. The purpose of this paper is to illustrate the design and placement process for an attractive lethal ovitrap to reduce vector populations and to describe lessons learned in the development of the trap. This study was conducted in 2010 in Iquitos, Peru and Lopburi Province, Thailand and used an iterative community-based participatory approach to adjust design specifications of the trap, based on community members' perceptions and feedback, entomological findings in the lab, and design and research team observations. Multiple focus group discussions (FGD) were held over a 6 month period, stratified by age, sex and motherhood status, to inform the design process. Trap testing transitioned from the lab to within households. Through an iterative process of working with specifications from the research team, findings from the laboratory testing, and feedback from FGD, the design team narrowed trap design options from 22 to 6. Comments from the FGD centered on safety for children and pets interacting with traps, durability, maintenance issues, and aesthetics. Testing in the laboratory involved releasing groups of 50 gravid Ae. aegypti in walk-in rooms and assessing what percentage were caught in traps of different colors, with different trap cover sizes, and placed under lighter or darker locations. Two final trap models were mocked up and tested in homes for a week; one model was the top choice in both Iquitos and Lopburi. The community-based participatory process was essential for the development of novel traps that provided effective vector control, but also met the needs and concerns of community members.

  3. Design and Testing of Novel Lethal Ovitrap to Reduce Populations of Aedes Mosquitoes: Community-Based Participatory Research between Industry, Academia and Communities in Peru and Thailand.

    Directory of Open Access Journals (Sweden)

    Valerie A Paz-Soldan

    Full Text Available Dengue virus (and Chikungunya and Zika viruses is transmitted by Aedes aegypti and Aedes albopictus mosquitoes and causes considerable human morbidity and mortality. As there is currently no vaccine or chemoprophylaxis to protect people from dengue virus infection, vector control is the only viable option for disease prevention. The purpose of this paper is to illustrate the design and placement process for an attractive lethal ovitrap to reduce vector populations and to describe lessons learned in the development of the trap.This study was conducted in 2010 in Iquitos, Peru and Lopburi Province, Thailand and used an iterative community-based participatory approach to adjust design specifications of the trap, based on community members' perceptions and feedback, entomological findings in the lab, and design and research team observations. Multiple focus group discussions (FGD were held over a 6 month period, stratified by age, sex and motherhood status, to inform the design process. Trap testing transitioned from the lab to within households.Through an iterative process of working with specifications from the research team, findings from the laboratory testing, and feedback from FGD, the design team narrowed trap design options from 22 to 6. Comments from the FGD centered on safety for children and pets interacting with traps, durability, maintenance issues, and aesthetics. Testing in the laboratory involved releasing groups of 50 gravid Ae. aegypti in walk-in rooms and assessing what percentage were caught in traps of different colors, with different trap cover sizes, and placed under lighter or darker locations. Two final trap models were mocked up and tested in homes for a week; one model was the top choice in both Iquitos and Lopburi.The community-based participatory process was essential for the development of novel traps that provided effective vector control, but also met the needs and concerns of community members.

  4. An optimized work-flow to reduce time-to-detection of carbapenemase-producing Enterobacteriaceae (CPE) using direct testing from rectal swabs.

    Science.gov (United States)

    O'Connor, C; Kiernan, M G; Finnegan, C; O'Hara, M; Power, L; O'Connell, N H; Dunne, C P

    2017-05-04

    Rapid detection of patients with carbapenemase-producing Enterobacteriaceae (CPE) is essential for the prevention of nosocomial cross-transmission, allocation of isolation facilities and to protect patient safety. Here, we aimed to design a new laboratory work-flow, utilizing existing laboratory resources, in order to reduce time-to-diagnosis of CPE. A review of the current CPE testing processes and of the literature was performed to identify a real-time commercial polymerase chain reaction (PCR) assay that could facilitate batch testing of CPE clinical specimens, with adequate CPE gene coverage. Stool specimens (210) were collected; CPE-positive inpatients (n = 10) and anonymized community stool specimens (n = 200). Rectal swabs (eSwab™) were inoculated from collected stool specimens and a manual DNA extraction method (QIAamp® DNA Stool Mini Kit) was employed. Extracted DNA was then processed on the Check-Direct CPE® assay. The three step process of making the eSwab™, extracting DNA manually and running the Check-Direct CPE® assay, took method of CPE screening; average time-to-diagnosis of 48/72 h. Utilizing this CPE work-flow would allow a 'same-day' result. Antimicrobial susceptibility testing results, as is current practice, would remain a 'next-day' result. In conclusion, the Check-Direct CPE® assay was easily integrated into a local laboratory work-flow and could facilitate a large volume of CPE screening specimens in a single batch, making it cost-effective and convenient for daily CPE testing.

  5. The emergence of the Activity Reduces Conflict Associated Strain (ARCAS) model: a test of a conditional mediation model of workplace conflict and employee strain.

    Science.gov (United States)

    Dijkstra, Maria T M; Beersma, Bianca; Cornelissen, Roosmarijn A W M

    2012-07-01

    To test and extend the emerging Activity Reduces Conflict-Associated Strain (ARCAS) model, we predicted that the relationship between task conflict and employee strain would be weakened to the extent that people experience high organization-based self-esteem (OBSE). A survey among Dutch employees demonstrated that, consistent with the model, the conflict-employee strain relationship was weaker the higher employees' OBSE and the more they engaged in active problem-solving conflict management. Our data also revealed that higher levels of OBSE were related to more problem-solving conflict management. Moreover, consistent with the ARCAS model, we could confirm a conditional mediation model in which organization-based self-esteem through its relationship with problem-solving conflict management weakened the relationship between task conflict and employee strain. Potential applications of the results are discussed.

  6. An improved brine shrimp larvae lethality microwell test method.

    Science.gov (United States)

    Zhang, Yi; Mu, Jun; Han, Jinyuan; Gu, Xiaojie

    2012-01-01

    This article described an improved brine shrimp larvae lethality microwell test method. A simply designed connecting vessel with alternative photoperiod was used to culture and collect high yield of active Artemia parthenogenetica nauplii for brine shrimp larvae lethality microwell test. Using this method, pure A. parthenogenetica nauplii suspension was easily cultured and harvested with high density about 100-150 larvae per milliliter and the natural mortality was reduced to near zero by elimination of unnecessary artificial disturbance. And its sensitivity was validated by determination of LC(50)-24 h of different reference toxicants including five antitumor agents, two pesticides, three organic pollutants, and four heavy metals salts, most of which exhibited LC(50)-24 h between 0.07 and 58.43 mg/L except for bleomycin and mitomycin C with LC(50)-24 h over 300 mg/L.

  7. 3-minute smartphone-based and tablet-based psychomotor vigilance tests for the assessment of reduced alertness due to sleep deprivation.

    Science.gov (United States)

    Grant, Devon A; Honn, Kimberly A; Layton, Matthew E; Riedy, Samantha M; Van Dongen, Hans P A

    2017-06-01

    The psychomotor vigilance test (PVT) is widely used to measure reduced alertness due to sleep loss. Here, two newly developed, 3-min versions of the psychomotor vigilance test, one smartphone-based and the other tablet-based, were validated against a conventional 10-min laptop-based PVT. Sixteen healthy participants (ages 22-40; seven males, nine females) completed a laboratory study, which included a practice and a baseline day, a 38-h total sleep deprivation (TSD) period, and a recovery day, during which they performed the three different versions of the PVT every 3 h. For each version of the PVT, the number of lapses, mean response time (RT), and number of false starts showed statistically significant changes across the sleep deprivation and recovery days. The number of lapses on the laptop was significantly correlated with the numbers of lapses on the smartphone and tablet. The mean RTs were generally faster on the smartphone and tablet than on the laptop. All three versions of the PVT exhibited a time-on-task effect in RTs, modulated by time awake and time of day. False starts were relatively rare on all three PVTs. For the number of lapses, the effect sizes across 38 h of TSD were large for the laptop PVT and medium for the smartphone and tablet PVTs. These results indicate that the 3-min smartphone and tablet PVTs are valid instruments for measuring reduced alertness due to sleep deprivation and restored alertness following recovery sleep. The results also indicate that the loss of sensitivity on the 3-min PVTs may be mitigated by modifying the threshold defining lapses.

  8. Evaluation of critical pathways, radionuclides, and remedial measures for reducing the radiological dose to returning populations at a former nuclear test site

    Energy Technology Data Exchange (ETDEWEB)

    Robison, W. L., LLNL

    1997-11-01

    Bikini Island, the major residence island at Bikini Atoll, was contaminated with radioactive fallout as a result of the BRAVO test conducted on March 1, 1954. We have identified the critical radionuclides and supplied radiological data needed to develop dose estimates for all possible exposure pathways. These estimates show that the major dose to returning populations would result from ingestion of cesium-137 (137 Cs) in locally grown terrestrial foods where the predicted population average effective dose exceeds current federal guidelines. Consequently, we designed several long-term field experiments to develop and evaluate methods to reduce the 137 Cs content in locally grown foods.This paper gives a general outline of the remediation experiments with a more detailed description of a preferred combined option. Our comparative evaluation on various remedial methods show that the combined option--potassium treatment of the entire islands with limited excavation of soil in village an d housing areas--will be effective in reducing the dose to about 10% of pretreatment levels, and offers very significant benefits with respect to adverse environmental impacts as well as savings in overall costs, time, and required expert resources.

  9. Testing road surface treatments to reduce erosion in forest roads in Honduras [Tratamientos de la superficie de rodadura para reducir la erosion en caminos forestales en Honduras

    Science.gov (United States)

    Rivera, Samuel; Kershner, Jeffrey L.; Keller, Gordon R.

    2009-01-01

    Testing road surface treatments to reduce erosion in forest roads in Honduras. Cien. Inv. Agr. 36(3):425-432. Using forest roads produces more erosion and sedimentation than any other forest or agricultural activity. This study evaluated soil losses from a forest road in central Honduras over two consecutive years. We divided a 400-m segment of road into 8 experimental units, each 50 m in length. Four units were treated with Best Management Practices (BMPs) and four were left untreated. The BMP treatments included reshaping the road prism, installing culverts and reshaping of road ditches, compacting 20-cm layers of the road tread, crowning the road surface (3% slope, double drainage), longitudinal sloping (less than 12%), and adding a 10-cm layer of gravel (crush size = 0.63 cm). Soil movement was measured daily during the rainy seasons. The highest soil loss occurred in the control road, around 500 m3 km-1 per year, while the road treated with BMP lost approximately 225 m3km-1 per year. These results show that road surface erosion can be reduced up to 50% with the implementation of surface treatments.

  10. Too much food may cause reduced growth of blue mussels (Mytilus edulis) - Test of hypothesis and new 'high Chl a BEG-model'

    Science.gov (United States)

    Larsen, Poul S.; Lüskow, Florian; Riisgård, Hans Ulrik

    2018-04-01

    Growth of the blue mussel (Mytilus edulis) is closely related to the biomass of phytoplankton (expressed as concentration of chlorophyll a, Chl a), but the effect of too much food in eutrophicated areas has so far been overlooked. The hypothesis addressed in the present study suggests that high Chl a concentrations (> about 8 μg Chl a l-1) result in reduced growth because mussels are not evolutionarily adapted to utilize such high phytoplankton concentrations and to physiologically regulate the amount of ingested food in such a way that the growth rate remains high and constant. We first make a comparison of literature values for actually measured weight-specific growth rates (μ, % d-1) of small (20 to 25 mm) M. edulis, either grown in controlled laboratory experiments or in net bags in Danish waters, as a function of Chl a. A linear increase up to about μ = 8.3% d-1 at 8.1 μg Chl a l-1 fits the "standard BEG-model" after which a marked decrease takes place, and this supports the hypothesis. A "high Chl a BEG-model", applicable to newly settled post-metamorphic and small juvenile (non-spawning) mussels in eutrophicated Danish and other temperate waters, is developed and tested, and new data from a case study in which the growth of mussels in net bags was measured along a Chl a gradient are presented. Finally, we discuss the phenomenon of reduced growth of mussels in eutrophicated areas versus a possible impact of low salinity. It is concluded that it is difficult to separate the effect of salinity from the effect of Chl a, but the present study shows that too much food may cause reduced growth of mussels in eutrophicated marine areas regardless of high or moderate salinity above about 10 psu.

  11. A Vehicle Management End-to-End Testing and Analysis Platform for Validation of Mission and Fault Management Algorithms to Reduce Risk for NASAs Space Launch System

    Science.gov (United States)

    Trevino, Luis; Johnson, Stephen B.; Patterson, Jonathan; Teare, David

    2015-01-01

    ) early in the development lifecycle for the SLS program, NASA formed the M&FM team as part of the Integrated Systems Health Management and Automation Branch under the Spacecraft Vehicle Systems Department at the Marshall Space Flight Center (MSFC). To support the development of the FM algorithms, the VMET developed by the M&FM team provides the ability to integrate the algorithms, perform test cases, and integrate vendor-supplied physics-based launch vehicle (LV) subsystem models. Additionally, the team has developed processes for implementing and validating the M&FM algorithms for concept validation and risk reduction. The flexibility of the VMET capabilities enables thorough testing of the M&FM algorithms by providing configurable suites of both nominal and off-nominal test cases to validate the developed algorithms utilizing actual subsystem models such as MPS, GNC, and others. One of the principal functions of VMET is to validate the M&FM algorithms and substantiate them with performance baselines for each of the target vehicle subsystems in an independent platform exterior to the flight software test and validation processes. In any software development process there is inherent risk in the interpretation and implementation of concepts from requirements and test cases into flight software compounded with potential human errors throughout the development and regression testing lifecycle. Risk reduction is addressed by the M&FM group but in particular by the Analysis Team working with other organizations such as S&MA, Structures and Environments, GNC, Orion, Crew Office, Flight Operations, and Ground Operations by assessing performance of the M&FM algorithms in terms of their ability to reduce Loss of Mission (LOM) and Loss of Crew (LOC) probabilities. In addition, through state machine and diagnostic modeling, analysis efforts investigate a broader suite of failure effects and associated detection and responses to be tested in VMET to ensure reliable failure

  12. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF to identify factors that influence physicians’ decisions to order pre-operative tests

    Directory of Open Access Journals (Sweden)

    Patey Andrea M

    2012-06-01

    consequences associated with reducing testing, from negative (delay or cancel patients’ surgeries, to indifference (little or no change in patient outcomes, to positive (save money, avoid unnecessary investigations (Beliefs about consequences. Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals, there was still a report of a gap between their motivation and practice (Behavioural regulation. Conclusion We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.

  13. Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

    Science.gov (United States)

    Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M

    2012-06-09

    (delay or cancel patients' surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation). We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.

  14. A Self-Paced, Web-Based, Positive Emotion Skills Intervention for Reducing Symptoms of Depression: Protocol for Development and Pilot Testing of MARIGOLD.

    Science.gov (United States)

    Cheung, Elaine O; Addington, Elizabeth L; Bassett, Sarah M; Schuette, Stephanie A; Shiu, Eva W; Cohn, Michael A; Leykin, Yan; Saslow, Laura R; Moskowitz, Judith T

    2018-06-05

    Living with elevated symptoms of depression can have debilitating consequences for an individual's psychosocial and physical functioning, quality of life, and health care utilization. A growing body of evidence demonstrates that skills for increasing positive emotion can be helpful to individuals with depression. Although Web-based interventions to reduce negative emotion in individuals with depression are available, these interventions frequently suffer from poor retention and adherence and do not capitalize on the potential benefits of increasing positive emotion. The aim of this study was to develop and test a Web-based positive emotion skills intervention tailored for individuals living with elevated depressive symptoms, as well as to develop and test enhancement strategies for increasing retention and adherence to that intervention. This study protocol describes the development and testing for Mobile Affect Regulation Intervention with the Goal of Lowering Depression (MARIGOLD), a Web-based positive emotion skills intervention, adapted for individuals with elevated depressive symptomatology. The intervention development is taking place in three phases. In phase 1, we are tailoring an existing positive emotion skills intervention for individuals with elevated symptoms of depression and are pilot testing the tailored version of the intervention in a randomized controlled trial with two control conditions (N=60). In phase 2, we are developing and testing three enhancements aimed at boosting retention and adherence to the Web-based intervention (N=75): facilitator contact, an online discussion board, and virtual badges. In phase 3, we are conducting a multifactorial, nine-arm pilot trial (N=600) to systematically test these enhancement strategies, individually and in combination. The primary outcome is depressive symptom severity. Secondary outcomes include positive and negative emotion, psychological well-being, and coping resources. The project was funded in

  15. Use of a molecular diagnostic test in AFB smear positive tuberculosis suspects greatly reduces time to detection of multidrug resistant tuberculosis.

    Directory of Open Access Journals (Sweden)

    Nestani Tukvadze

    Full Text Available The WHO has recommended the implementation of rapid diagnostic tests to detect and help combat M/XDR tuberculosis (TB. There are limited data on the performance and impact of these tests in field settings.The performance of the commercially available Genotype MTBDRplus molecular assay was compared to conventional methods including AFB smear, culture and drug susceptibility testing (DST using both an absolute concentration method on Löwenstein-Jensen media and broth-based method using the MGIT 960 system. Sputum specimens were obtained from TB suspects in the country of Georgia who received care through the National TB Program.Among 500 AFB smear-positive sputum specimens, 458 (91.6% had both a positive sputum culture for Mycobacterium tuberculosis and a valid MTBDRplus assay result. The MTBDRplus assay detected isoniazid (INH resistance directly from the sputum specimen in 159 (89.8% of 177 specimens and MDR-TB in 109 (95.6% of 114 specimens compared to conventional methods. There was high agreement between the MTBDRplus assay and conventional DST results in detecting MDR-TB (kappa = 0.95, p<0.01. The most prevalent INH resistance mutation was S315T (78% in the katG codon and the most common rifampicin resistance mutation was S531L (68% in the rpoB codon. Among 13 specimens from TB suspects with negative sputum cultures, 7 had a positive MTBDRplus assay (3 with MDR-TB. The time to detection of MDR-TB was significantly less using the MTBDRplus assay (4.2 days compared to the use of standard phenotypic tests (67.3 days with solid media and 21.6 days with broth-based media.Compared to conventional methods, the MTBDRplus assay had high accuracy and significantly reduced time to detection of MDR-TB in an area with high MDR-TB prevalence. The use of rapid molecular diagnostic tests for TB and drug resistance should increase the proportion of patients promptly placed on appropriate therapy.

  16. Reducing turnaround time for laboratory test results does not improve retention of stable HIV-infected adults on POV program: experience from Uganda.

    Science.gov (United States)

    Maselle, Edna; Muhanguzi, Asaph; Muhumuza, Simon; Nansubuga, Jeniffer; Nawavvu, Cecilia; Namusobya, Jeniffer; Kamya, Moses R; Semitala, Fred C

    2014-01-01

    HIV/ AIDS clinics in resource limited settings (RLS) face increasing numbers of patients and workforce shortage [1, 2]. To address these challenges, efficient models of care like pharmacy only visits (POV) and nurse only visits (NOV) are recommended [3]. The Makerere University Joint AIDS Program (MJAP), a PEPFAR funded program providing care to over 42,000 HIV infected adults has implemented the POV model since 2009. In this model, stable patients on antiretroviral therapy (ART) with adherence to ART >95% and Karnofsky score >90% are reviewed by a doctor every four months but visit pharmacy for ART re-fills every two months. A study conducted in August 2011 showed low retention on the POV program with symptomatic diseases, pending CD4 count, complete blood count results, and poor adherence to ART as the major reasons for the non-retention in the POV program. To improve retention on POV, the TAT (Turnaround Time) for laboratory results (the main reason for non-retention in the previous study) was reduced from one month to one week. In August 2012, the study was repeated to assess the effect of reducing TAT on improving retention one year after patients were placed on POV. A cohort analysis of data from patients in August 2011 and in August 2012 on POV was done. We compared retention of POV before and after reducing the TAT for laboratory results. Retention on POV was 12.0% (95% CI 9.50-14.7) among 619 patients in 2011, (70% Females), mean age was 33 years, Standard Deviation (SD) 8.5 compared to 11.1% (95% CI 9.15-13.4) among 888 patients (70% Females), mean age 38.3 years, SD 8.9 in 2012 (p=0.59). The main reasons for non-retention on the POV program in 2012 were poor adherence to ART (23%) and missed clinic appointments (14%). Reducing TAT for laboratory test results did not improve retention of stable HIV-infected adults on POV in our clinic. Strategies for improving adherence to ART and keeping clinic appointments need to be employed to balance workload and

  17. Maternal high-fat diet during pregnancy and lactation reduces the appetitive behavioral component in female offspring tested in a brief-access taste procedure.

    Science.gov (United States)

    Treesukosol, Yada; Sun, Bo; Moghadam, Alexander A; Liang, Nu-Chu; Tamashiro, Kellie L; Moran, Timothy H

    2014-04-01

    Maternal high-fat diet appears to disrupt several energy balance mechanisms in offspring. Here, female offspring from dams fed a high-fat diet (HF) did not significantly differ in body weight compared with those fed chow (CHOW), when weaned onto chow diet. Yet when presented with both a chow and a high-fat diet, high-fat intake was significantly higher in HF compared with CHOW offspring. To assess taste-based responsiveness, offspring (12 wk old) were tested in 30-min sessions (10-s trials) to a sucrose concentration series in a brief-access taste test. Compared with CHOW, the HF offspring initiated significantly fewer trials but did not significantly differ in the amount of concentration-dependent licking. Thus, rather than affect lick response (consummatory), maternal diet affects spout approach (appetitive), which may be attributed to motivation-related mechanisms. Consistent with this possibility, naltrexone, an opioid receptor antagonist, further reduced trial initiation, but not licking in both groups. With naltrexone administration, the group difference in trial initiation was no longer evident, suggesting differences in endogenous opioid activity between the two groups. Relative expression of μ-opioid receptor in the ventral tegmental area was significantly lower in HF rats. When trial initiation was not required in one-bottle intake tests, no main effect of maternal diet on the intake of sucrose and corn oil emulsions was observed. Thus, the maternal high-fat diet-induced difference in diet preference is not likely due to changes in the sensory orosensory component of the taste stimulus but may depend on alterations in satiety signals or absorptive mechanisms.

  18. A field test of a web-based workplace health promotion program to improve dietary practices, reduce stress, and increase physical activity: randomized controlled trial.

    Science.gov (United States)

    Cook, Royer F; Billings, Douglas W; Hersch, Rebekah K; Back, Anita S; Hendrickson, April

    2007-06-19

    Most work sites engage in some form of health promotion programming designed to improve worker health and reduce health care costs. Although these programs have typically been delivered through combinations of seminars and print materials, workplace health promotion programs are increasingly being delivered through the Internet. The purpose of this research was to evaluate the effectiveness of a Web-based multimedia health promotion program for the workplace, designed to improve dietary practices, reduce stress, and increase physical activity. Using a randomized controlled trial design with pretest-posttest comparisons within each group, 419 employees of a human resources company were randomly assigned to the Web-based condition or to a condition that provided print materials on the same topics. All subjects were assessed at pretest and posttest through an online questionnaire containing multiple measures of health behavior and attitudes. The test period was 3 months. Questionnaire data were analyzed mainly by analysis of covariance and t tests. Retention rates were good for both groups-85% for the Web-based group and 87% for the print group. Subjects using the Web-based program performed significantly better than the print group on Attitudes Toward a Healthful Diet (F(1,415) = 7.104, P = .008) and Dietary Stage of Change (F(1,408) = 6.487, P = .01), but there were no significant group differences on the five other dietary measures. Both groups also showed improvement from pretest to posttest on most dietary measures, as indicated by significant t tests. Within the Web-based group, dosage analyses showed significant effects of the number of times the subject accessed the program on measures of Dietary Self-Efficacy (F(2,203) = 5.270, P = .003), Attitudes Toward a Healthful Diet (F(2,204) = 2.585, P = .045), and Dietary Stage of Change (F(2,200) = 4.627, P = .005). No significant differences were found between the two groups on measures of stress or physical

  19. Clinical application of ‘Justification’ and ‘Optimization’ principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”

    International Nuclear Information System (INIS)

    Sodhi, Kushaljit S.; Krishna, Satheesh; Saxena, Akshay K.; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y.

    2015-01-01

    Highlights: • Practice of ALARA (As Low As Reasonably Achievable) principle in the developed world is currently well established. However, there is striking lack of published data regarding such experience in the developing countries. Therefore, the goal of this study is to prospectively evaluate CT request forms to assess how many children could be saved from harmful radiation exposure if ‘Justification’ and ‘Optimization’ principles of ALARA are applied before obtaining CT imaging in a developing country. • A consecutive 1302 CT request forms over a six month study period (May 16, 2013 to November 15, 2013) in a tertiary pediatric children’s hospital in India were prospectively reviewed by two pediatric radiologists before obtaining CT imaging. First, ‘Justification’ of CT was evaluated and then ‘Optimization’ was applied for evaluation of appropriateness of the requested CT studies. The number (and percentage) of CT studies that was avoided by applying ‘Justification’ and ‘Optimization’ principle of ALARA were calculated. The difference in number of declined and optimized CT requests between CT requests from inpatient and outpatient departments was compared using Chi-Square test. • Based on evaluation of the CT request forms for ‘Justification’ and ‘Optimization’ principle of ALARA by pediatric radiology reviewers, 111 individual anatomic part CT requests from 105 pediatric patients were avoided. Therefore, 8.06% (105 out of 1302 pediatric patients) were saved from unnecessary or additional radiation exposure The rates of declined or optimized CT requests from inpatient department was significantly higher than that from outpatient departments (p < 0.05). • To conclude, a substantial number of pediatric patients, particularly coming from inpatients departments, can be saved from unnecessary or additional radiation exposure from CT imaging when ‘Justification’ and ‘Optimization’ principle of ALARA are applied

  20. Acoustics SIMOPS: managing the unnecessary

    Energy Technology Data Exchange (ETDEWEB)

    Hanton, Samuel John [Nautronix Marine Technology Solutions, Rio de Janeiro, RJ (Brazil)

    2012-07-01

    Time is money, and offshore operations are expensive. The desire therefore, is to increase efficiency through the condensing of schedules. This inevitably leads to SIMOPS of some degree, and this paper discusses SIMOPS along with, more specifically, the challenges they provide to acoustic positioning. (author)

  1. Automotive RF immunity test set-up analysis : why test results can't compare

    NARCIS (Netherlands)

    Coenen, Mart; Pues, H.; Bousquet, T.

    2011-01-01

    Though the automotive RF emission and RF immunity requirements are highly justifiable, the application of those requirements in an non-intended manner leads to false conclusions and unnecessary redesigns for the electronics involved. When the test results become too dependent upon the test set-up

  2. Stability of U(VI) and Tc(VII) Reducing Microbial Communities to Environmental Perturbation: Development and Testing of a Thermodynamic Network Model

    International Nuclear Information System (INIS)

    McKinley, James P.; Istok, Jonathan

    2005-01-01

    Previously published research from in situ field experiments at the NABIR Field Research Center have shown that cooperative metabolism of denitrifiers and Fe(III)/sulfate reducers is essential for creating subsurface conditions favorable for U(VI) and Tc(VII) bioreduction (Istok et al., 2004). The overall goal of this project is to develop and test a thermodynamic network model for predicting the effects of substrate additions and environmental perturbations on the composition and functional stability of subsurface microbial communities. The overall scientific hypothesis is that a thermodynamic analysis of the energy-yielding reactions performed by broadly defined groups of microorganisms can be used to make quantitative and testable predictions of the change in microbial community composition that will occur when a substrate is added to the subsurface or when environmental conditions change. An interactive computer program was developed to calculate the overall growth equation and free energy yield for microorganisms that grow by coupling selected combinations of electron acceptor and electron donor half-reactions. Each group performs a specific function (e.g. oxidation of acetate coupled to reduction of nitrate); collectively the groups provide a theoretical description of the entire natural microbial community. The microbial growth data are combined with an existing thermodynamic data base for associated geochemical reactions and used to simulate the coupled microbial-geochemical response of a complex natural system to substrate addition or any other environmental perturbations

  3. The Use of Clinical Decision Support in Reducing Diagnosis of and Treatment of Asymptomatic Bacteriuria.

    Science.gov (United States)

    Keller, Sara C; Feldman, Leonard; Smith, Janessa; Pahwa, Amit; Cosgrove, Sara E; Chida, Natasha

    2018-06-01

    Clinical decision support (CDS) embedded within the electronic health record (EHR) is a potential antibiotic stewardship strategy for hospitalized patients. Reduction in urine testing and treating asymptomatic bacteriuria (ASB) is an important strategy to promote antibiotic stewardship. We created an intervention focused on reducing urine testing for asymptomatic patients at a large tertiary care center. The objective of this study was to design an intervention to reduce unnecessary urinalysis and urine culture (UC) orders as well as the treatment of ASB. We performed a quasiexperimental study among adult inpatients at a single academic institution. We implemented a bundled intervention, including information broadcast in newsletters, hospitalwide screensavers, and passive CDS messages in the EHR. We investigated the impact of this strategy on urinalysis, UC orders, and on the treatment of ASB by using an interrupted time series analysis. Our intervention led to reduced UC order as well as reduced antibiotic orders in response to urinalysis orders and UC results. This easily implementable bundle may play an important role as an antibiotic stewardship strategy. © 2018 Society of Hospital Medicine.

  4. A Vehicle Management End-to-End Testing and Analysis Platform for Validation of Mission and Fault Management Algorithms to Reduce Risk for NASA's Space Launch System

    Science.gov (United States)

    Trevino, Luis; Patterson, Jonathan; Teare, David; Johnson, Stephen

    2015-01-01

    integrates specific M&FM algorithms, specialized nominal and off-nominal test cases, and vendor-supplied physics-based launch vehicle subsystem models. Additionally, the team has developed processes for implementing and validating these algorithms for concept validation and risk reduction for the SLS program. The flexibility of the Vehicle Management End-to-end Testbed (VMET) enables thorough testing of the M&FM algorithms by providing configurable suites of both nominal and off-nominal test cases to validate the developed algorithms utilizing actual subsystem models such as MPS. The intent of VMET is to validate the M&FM algorithms and substantiate them with performance baselines for each of the target vehicle subsystems in an independent platform exterior to the flight software development infrastructure and its related testing entities. In any software development process there is inherent risk in the interpretation and implementation of concepts into software through requirements and test cases into flight software compounded with potential human errors throughout the development lifecycle. Risk reduction is addressed by the M&FM analysis group working with other organizations such as S&MA, Structures and Environments, GNC, Orion, the Crew Office, Flight Operations, and Ground Operations by assessing performance of the M&FM algorithms in terms of their ability to reduce Loss of Mission and Loss of Crew probabilities. In addition, through state machine and diagnostic modeling, analysis efforts investigate a broader suite of failure effects and associated detection and responses that can be tested in VMET to ensure that failures can be detected, and confirm that responses do not create additional risks or cause undesired states through interactive dynamic effects with other algorithms and systems. VMET further contributes to risk reduction by prototyping and exercising the M&FM algorithms early in their implementation and without any inherent hindrances such as meeting FSW

  5. Development of filler wires for welding of reduced activation ferritic martensitic steel for India's test blanket module of ITER

    Energy Technology Data Exchange (ETDEWEB)

    Srinivasan, G.; Arivazhagan, B.; Albert, S.K.; Bhaduri, A.K. [Indira Gandhi Centre for Atomic Research, Kalpakkam (India)

    2010-07-01

    Indigenous development of reduced activation ferritic-martensitic (RAFM) steel has become necessary for India as a participant in the International Thermo-nuclear Experimental Reactor (ITER) programme. Optimisation of RAFM steel is in an advanced stage for the fabrication of test blanket module (TBM) components. Simultaneously, development of RAFM steel filler wires has been undertaken since there is no commercial filler wires are available for fabrication of components using RAFM steel. The purpose of this study is to develop filler wires that can be directly used for both gas tungsten arc welding (GTAW) and for narrow-gap gas tungsten arc welding (NG-GTAW) that reduces the deposited weld metal volume and heat affected zone (HAZ) width. Further, the filler wires would also be used for hybrid laser-MIG welding for thick section joints. In view of meeting all the requirements, a detailed specification was prepared for the development of filler wires for welding of RAFM steel. Meanwhile, welding trials have been carried out on 2.5 mm thick plates of the RAFM steel using GTAW process at various heat inputs with a preheat temperature of 250 C followed by various post weld heat treatments (PWHT). The microstructure of the weld metal in most of the cases showed the presence of some amount of delta-ferrite. Filler wires as per specifications have also been developed with minor variations on the chemistry against the specified values. Welding parameters and PWHT parameters were optimized to qualify the filler wires without the presence of delta-ferrite in the weld metal and with optimized mechanical properties. Results showed that the weld metals are free from delta-ferrite. Tensile properties at ambient temperature and at 500 C are well above the specified values, and are much higher than the base metal values. Ductile Brittle Transition Temperature (DBTT) has been evaluated as -81 C based on the 68 J criteria. The present study highlights the basis and methodology

  6. Development of filler wires for welding of reduced activation ferritic martenstic steel for India's test blanket module of ITER

    Energy Technology Data Exchange (ETDEWEB)

    Srinivasan, G., E-mail: gsrini@igcar.gov.in [Materials Technology Division, Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102, Tamilnadu (India); Arivazhagan, B.; Albert, S.K.; Bhaduri, A.K. [Materials Technology Division, Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102, Tamilnadu (India)

    2011-06-15

    Highlights: > Weld microstructure produced by RAFMS filler wires are free from delta ferrite. > Cooling rates of by weld thermal cycles influences the presence of delta ferrite. > Weld parameters modified with higher pre heat temperature and high heat input. > PWHT optimized based on correlation of hardness between base and weld metals. > Optimised mechanical properties achieved by proper tempering of the martensite. - Abstract: Indigenous development of reduced activation ferritic martensitic steel (RAFMS) has become mandatory to India to participate in the International Thermo-nuclear Experimental Reactor (ITER) programme. Optimisation of RAFMS is in an advanced stage for the fabrication of test blanket module (TBM) components. Simultaneously, development of RAFMS filler wires has been undertaken since there is no commercial filler wires are available for fabrication of components using RAFMS. Purpose of this study is to develop filler wires that can be directly used for both tungsten inert gas welding (TIG) and narrow gap tungsten inert gas welding (NG-TIG), which reduces the deposited weld metal volume and heat affected zone (HAZ) width. Further, the filler wires would also be used for hybrid laser welding for thick section joints. In view of meeting all the requirements, a detailed specification was prepared for the development of filler wires for welding of RAFM steel. Meanwhile, autogenous welding trials have been carried out on 2.5 mm thick plates of the RAFM steel using TIG process at various heat inputs with a preheat temperature of 250 deg. C followed by various post weld heat treatments (PWHT). The microstructure of the weld metal in most of the cases showed the presence of some delta-ferrite. Filler wires as per specifications have also been developed with minor variations on the chemistry against the specified values. Welding parameters and PWHT parameters were optimised to qualify the filler wires without the presence of delta-ferrite in the weld

  7. The effectiveness of home-based HIV counseling and testing on reducing stigma and risky sexual behavior among adults and adolescents: A systematic review and meta-analyses.

    Science.gov (United States)

    Feyissa, Garumma Tolu; Lockwood, Craig; Munn, Zachary

    2015-07-17

    Human immunodeficiency virus counselling and testing is a critical and essential gateway to Human immunodeficiency virus prevention, treatment, care and support services. Though some primary studies indicate that home-based counselling and testing is more effective than facility based counselling and testing to reduce stigma and risky sexual behavior, to the best of the author's knowledge, no systematic review has tried to establish consistency in the findings across populations. The objective of this review was to determine the effectiveness of home-based Human immunodeficiency virus counselling and testing in reducing Human immunodeficiency virus-related stigma and risky sexual behavior among adults and adolescents. All adults and adolescents aged 13 years or above. TYPE OF INTERVENTION: This review considered any studies that evaluated home-based Human immunodeficiency virus counseling and testing as an intervention. TYPES OF STUDIES: This review considered quantitative (experimental and observational) studies. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: stigma, violence, sexual behavior and clinical outcomes. The search strategy aimed to find both published and unpublished studies reported in English Language from 2001 to 2014 in MEDLINE, Web of Science, EMBASE, Scopus and CINAHL. The search for unpublished studies included: WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, Mednar, Google Scholar, AIDSinfo and ProQuest Dissertations and Theses Database. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Quantitative data were pooled using the meta

  8. The effects of pen partitions and thermal pig simulators on airflow in a livestock test room

    DEFF Research Database (Denmark)

    Bjerg, B.; Svidt, Kjeld; Zhang, G.

    2000-01-01

    measurements and CFD simulations showed that the introduction of pen partitions and thermal pig simulators reduced the air velocities in the occupied zone of the test room. Detailed geometric modelling of the animals might often be unnecessary for simulation of airflow in livestock rooms. This will especially......The aim of this work was to investigate the influence of pen partitions and heated simulated pigs on airflow in a slot ventilated test room and to evaluate computer fluid dynamics (CFD) as a tool to predict airflow in livestock rooms. To obtain two-dimensional flow in the occupied zone, four...... guiding plates were mounted beneath the ceiling in the test room. Experiments were carried out in three arrangements: (a) the room with guiding plates; (b) the room with guiding plates and eight heated pig simulators; and (c) the room with guiding plates, eight heated pig simulators and 0.8 m high...

  9. Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues.

    Science.gov (United States)

    Minear, Mollie A; Alessi, Stephanie; Allyse, Megan; Michie, Marsha; Chandrasekharan, Subhashini

    2015-01-01

    Noninvasive prenatal genetic testing (NIPT) for chromosomal aneuploidy involving the analysis of cell-free fetal DNA became commercially available in 2011. The low false-positive rate of NIPT, which reduces unnecessary prenatal invasive diagnostic procedures, has led to broad clinician and patient adoption. We discuss the ethical, legal, and social issues raised by rapid and global dissemination of NIPT. The number of women using NIPT is anticipated to expand, and the number of conditions being tested for will continue to increase as well, raising concerns about the routinization of testing and negative impacts on informed decision making. Ensuring that accurate and balanced information is available to all pregnant women and that access to NIPT is equitable will require policy guidance from regulators, professional societies, and payers. Empirical evidence about stakeholders' perspectives and experiences will continue to be essential in guiding policy development so that advances in NIPT can be used effectively and appropriately to improve prenatal care.

  10. Heparin-induced thrombocytopenia: reducing misdiagnosis via collaboration between an inpatient anticoagulation pharmacy service and hospital reference laboratory.

    Science.gov (United States)

    Burnett, Allison E; Bowles, Harmony; Borrego, Matthew E; Montoya, Tiffany N; Garcia, David A; Mahan, Charles

    2016-11-01

    Misdiagnosis of heparin-induced thrombocytopenia (HIT) is common and exposes patients to high-risk therapies and potentially serious adverse events. The primary objective of this study was to evaluate the impact of collaboration between an inpatient pharmacy-driven anticoagulation management service (AMS) and hospital reference laboratory to reduce inappropriate HIT antibody testing via pharmacist intervention and use of the 4T pre-test probability score. Secondary objectives included clinical outcomes and cost-savings realized through reduced laboratory testing and decreased unnecessary treatment of HIT. This was a single center, pre-post, observational study. The hospital reference laboratory contacted the AMS when they received a blood sample for an enzyme-linked immunosorbent HIT antibody (HIT Ab). Trained pharmacists prospectively scored each HIT Ab ordered by using the 4T score with subsequent communication to physicians recommending for or against processing and reporting of lab results. Utilizing retrospective chart review and a database for all patients with a HIT Ab ordered during the study period, we compared the incidence of HIT Ab testing before and after implementation of the pharmacy-driven 4T score intervention. Our intervention significantly reduced the number of inappropriate HIT Ab tests processed (176 vs. 63, p reference laboratories can result in reduction of misdiagnosis of HIT and significant cost savings with similar safety.

  11. A research program to reduce interior noise in general aviation airplanes: Investigation of the characteristics of an acoustic panel test facility

    Science.gov (United States)

    Grosveld, F.; Vanaken, J.

    1978-01-01

    Sound pressure levels in the test facility were studied that are caused by varying: (1) microphone positions; (2) equalizer setting; and (3) panel clamping forces. Measurements were done by using a Beranek tube or this Beranek tube in combinations with an extension tube and a special test section. In all configurations tests were executed with and without a test panel installed. The influence of the speaker back panel and the back panel of the Beranek tube on the sound pressure levels inside the test tube were also investigated. It is shown that the definition of noise reduction is more useful in relation to this test facility than transmission loss.

  12. Willingness to pay function for two fuel treatments to reduce wildfire acreage burned: A scope test and comparison of White and Hispanic households

    Science.gov (United States)

    John B. Loomis; Le Trong Hung; Armando Gonzalez-Caban

    2009-01-01

    This research uses the Contingent Valuation Method to test whether willingness to pay increases for larger reductions in acres of forests burned by wildfires across the states of California. Florida and Montana. This is known as a test of scope, a measure of internal validity of the contingent valuation method (CVM). The scope test is conducted separately for White...

  13. Duplicate laboratory test reduction using a clinical decision support tool.

    Science.gov (United States)

    Procop, Gary W; Yerian, Lisa M; Wyllie, Robert; Harrison, A Marc; Kottke-Marchant, Kandice

    2014-05-01

    Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

  14. Reduced benefit from mnemonic strategies in early-stage Alzheimer's disease: a brief testing-the-limits paradigm for clinical practice.

    Science.gov (United States)

    Uttner, Ingo; Schurig, Niklas; von Arnim, Christine A F; Lange-Asschenfeldt, Christian; Tumani, Hayrettin; Riepe, Matthias W

    2010-10-01

    Discriminating incipient Alzheimer's disease (AD) from major depression (MD) and age related memory decline is a challenge in clinical practice. Since AD is characterized by an early loss of neuronal and functional plasticity, a dynamic test strategy, such as the testing-the-limits (TtL) approach, that measures learning capacity can be a helpful diagnostic tool. To evaluate this, a short recognition paradigm consisting of a pre-test (baseline) and two post-test conditions with an interposed encoding instruction was developed and administered to individuals with incipient AD (n = 19; Mini Mental Status Examination (MMSE) 26.5), patients with depressive disorders (n = 11; MMSE 30), and healthy controls (n = 11; MMSE 30). In addition, participants completed a set of traditional neuropsychological tests that focused on the subjects' cognitive baseline performance. Intergroup comparisons (Kruskal-Wallis, U test) revealed significantly higher post-test failure rates in AD patients. Pre-test performance of MD and AD patients did not differ. Intra-group comparisons (Friedman, Wilcoxon test) showed that all three subject samples benefit from intervention in post-test 1. In contrast to MD and healthy individuals, who revealed significantly lower failure rates in post-test 2 compared to the pre-test, AD patients did not improve. Out of the 15 traditional test scores obtained, only two discriminated simultaneously between AD and each of the other groups. Our data confirm the finding of an impaired cognitive plasticity already present in very early stages of AD and illustrate the efficiency of a dynamic test approach in identifying incipient dementia.

  15. MWTF jumper connector integral seal block development and leak testing

    International Nuclear Information System (INIS)

    Ruff, E.S.; Jordan, S.R.

    1995-01-01

    In fiscal year 1993, tests of an o-ring/tetraseal retainer designed to replace a gasket-type seal used in PUREX-type process jumper connectors encouraged the design of an improved seal block. This new seal block combines several parts into one unitized component called an integral seal block. This report summarizes development and leak testing of the new integral seal block. The integral seal block uses a standard o-ring nested in a groove to accomplish leak tightness. This seal block eliminates the need to machine acme threads into the lower skirt casting and seal retainers, eliminates tolerance stack-up, reduces parts inventory, and eliminates an unnecessary leak path in the jumper connector assembly. This report also includes test data on various types of o-ring materials subjected to heat and pressure. Materials tested included Viton, Kalrez, and fluorosilicone, with some incidental data on teflon coated silicone o-rings. Test experience clearly demonstrates the need to test each seal material for temperature and pressure in its intended application. Some materials advertised as being open-quotes betterclose quotes at higher temperatures did not perform up to expectations. Inspection of the fluorosilicone and Kalrez seals after thermal testing indicates that they are much more susceptible to heat softening than Viton

  16. Improving a Complement-fixation Test for Equine Herpesvirus Type-1 by Pretreating Sera with Potassium Periodate to Reduce Non-specific Hemolysis

    Science.gov (United States)

    BANNAI, Hiroshi; NEMOTO, Manabu; TSUJIMURA, Koji; YAMANAKA, Takashi; KONDO, Takashi; MATSUMURA, Tomio

    2013-01-01

    Non-specific hemolysis has often been observed during complement-fixation (CF) tests for equine herpesvirus type-1 (EHV-1), even when the sera have virus-specific CF antibodies. This phenomenon has also been reported in CF tests for various infectious diseases of swine. We found that the sera from 22 of 85 field horses (25.9%) showed non-specific hemolysis during conventional CF testing for EHV-1. Because pretreatment of swine sera with potassium periodate (KIO4) improves the CF test for swine influenza, we applied this method to horse sera. As we expected, horse sera treated with KIO4 did not show non-specific hemolysis in the EHV-1 CF test, and precise determination of titers was achieved. PMID:24834005

  17. Automotive RF immunity test set-up analysis

    NARCIS (Netherlands)

    Coenen, M.J.; Pues, H.; Bousquet, T.; Gillon, R.; Gielen, G.; Baric, A.

    2011-01-01

    Though the automotive RF emission and RF immunity requirements are highly justifiable, the application of those requirements in an non-intended manner leads to false conclusions and unnecessary redesigns for the electronics involved. When the test results become too dependent upon the test set-up

  18. Testing Testing Testing.

    Science.gov (United States)

    Deville, Craig; O'Neill, Thomas; Wright, Benjamin D.; Woodcock, Richard W.; Munoz-Sandoval, Ana; Gershon, Richard C.; Bergstrom, Betty

    1998-01-01

    Articles in this special section consider (1) flow in test taking (Craig Deville); (2) testwiseness (Thomas O'Neill); (3) test length (Benjamin Wright); (4) cross-language test equating (Richard W. Woodcock and Ana Munoz-Sandoval); (5) computer-assisted testing and testwiseness (Richard Gershon and Betty Bergstrom); and (6) Web-enhanced testing…

  19. Pooled HIV-1 viral load testing using dried blood spots to reduce the cost of monitoring antiretroviral treatment in a resource-limited setting.

    Science.gov (United States)

    Pannus, Pieter; Fajardo, Emmanuel; Metcalf, Carol; Coulborn, Rebecca M; Durán, Laura T; Bygrave, Helen; Ellman, Tom; Garone, Daniela; Murowa, Michael; Mwenda, Reuben; Reid, Tony; Preiser, Wolfgang

    2013-10-01

    Rollout of routine HIV-1 viral load monitoring is hampered by high costs and logistical difficulties associated with sample collection and transport. New strategies are needed to overcome these constraints. Dried blood spots from finger pricks have been shown to be more practical than the use of plasma specimens, and pooling strategies using plasma specimens have been demonstrated to be an efficient method to reduce costs. This study found that combination of finger-prick dried blood spots and a pooling strategy is a feasible and efficient option to reduce costs, while maintaining accuracy in the context of a district hospital in Malawi.

  20. Does Pharmacogenetic Testing for CYP450 2D6 and 2C19 among Patients with Diagnoses within the Schizophrenic Spectrum Reduce Treatment Costs?

    DEFF Research Database (Denmark)

    Herbild, Louise; Andersen, Stig Ejdrup; Werge, Thomas

    2013-01-01

    The effect of pharmacogenetic testing for CYP450 2D6 and 2C19 on treatment costs have not yet been documented. This study used Danish patient registers to calculate health care costs of treating patients with diagnoses within the schizophrenic spectrum for one year with or without pharmacogenetic...... testing for polymorphisms in the genes for the CYP2D6 and CYP2C19 enzymes. In a randomized, controlled trial, stratified with respect to metabolizer genotype, 104 patients were assigned to treatment based on pharmacogenetic testing and 103 patients to treatment as usual. Random exclusion of extensive...

  1. Too much food may cause reduced growth of blue mussels (Mytilus edulis) – Test of hypothesis and new ‘high Chl a BEG-model’

    DEFF Research Database (Denmark)

    Larsen, Poul S.; Lüskow, Florian; Riisgård, Hans Ulrik

    2018-01-01

    Growth of the blue mussel (Mytilus edulis) is closely related to the biomass of phytoplankton (expressed as concentration of chlorophyll a, Chl a), but the effect of too much food in eutrophicated areas has so far been overlooked. The hypothesis addressed in the present study suggests that high Chl...... a concentrations (> about 8 μg Chl a l−1) result in reduced growth because mussels are not evolutionarily adapted to utilize such high phytoplankton concentrations and to physiologically regulate the amount of ingested food in such a way that the growth rate remains high and constant. We first make a comparison...... the effect of Chl a, but the present study shows that too much food may cause reduced growth of mussels in eutrophicated marine areas regardless of high or moderate salinity above about 10 psu....

  2. Design, fabrication, and initial test of a fixture for reducing the natural frequency of the Mod-O wind turbine tower

    Science.gov (United States)

    Winemiller, J. R.; Sullivan, T. L.; Sizemore, R. L.; Yee, S. T.

    1979-01-01

    It was desired to observe the behavior of a two bladed wind turbine where the tower first bending natural frequency is less than twice the rotor speed. The system then passes through resonance when accelerating to operating speed. The frequency of the original Mod-O tower was reduced by placing it on a spring fixture. The fixture is adjustable to provide a range of tower bending frequencies. Fixture design details are given and behavior during initial operation is described.

  3. Usefulness of nucleic acid testing to reduce risk of hepatitis B virus transfusion-transmitted infection in Argentina: high rate of recent infections.

    Science.gov (United States)

    Blanco, Sebastián; Balangero, Marcos César; Valle, Mildre Cledy; Montini, Oscar Luis; Carrizo, Luis Horacio; Gallego, Sandra Verónica

    2017-03-01

    Results from 10-year experience using nucleic acid test (NAT) screening in a blood bank of Córdoba are presented, showing the first data on prevalence of recent hepatitis B virus (HBV) infections and occult HBV infections (OBIs) in Argentina. Molecular screening was performed by COBAS AmpliScreen human immunodeficiency virus Type 1 (HIV-1) test Version 1.5 and COBAS AmpliScreen hepatitis C virus (HCV) test Version 2.0 and COBAS TaqScreen MPX and MPX Version 2.0 test (Roche Molecular Systems). To characterize OBI, additional molecular and serologic assays were performed. As results of NAT, 0.075% of the donors (155/205,388) tested positive for HIV, 0.05% (106/205,388) for HCV, and 0.045% (76/168,215) for HBV. Donors who tested positive for HIV or HCV by NAT were also positive by serology. There was one of 33,643 donors recently infected with HBV. At time of donation, six of 76 (7.9%) donors with confirmed HBV infection presented virologic and serologic profiles consistent with OBI. By additional studies three were OBI, two were window period infections, and one remained unclassified. NAT contributed significantly to the reduction of the potential risk of HBV transmission with a frequency of one in 56,072, detecting three in 168,215 donors without serologic evidence of infection. NAT also detected three in 168,215 OBIs. The finding of high frequency of recent infections (1/33,643), unexpected for this country, highlights the need of promoting unified effective regulations that enforce the use of NAT in all blood banks in Argentina and points out the importance of assessing the risk of HBV transmission in blood banks of other countries considered to be low-endemic. © 2016 AABB.

  4. Recycling of Zn-containing Fe-bearing steelmaking waste by the reducing smelting process in pig iron. I. Laboratory tests

    Directory of Open Access Journals (Sweden)

    Kendera Ján

    1997-09-01

    Full Text Available Results of the laboratory test treatment of the zinc containing steelwork dusts in a hot liquid pig iron are described. These results show that it is necessary to use an external reductant. The zinc content of the dust emission is ca. 20 %. The charge of the steel-works dusts diminished the Si and Mn content of pig iron.

  5. Effectiveness of emergency nurses' use of the Ottawa Ankle Rules to initiate radiographic tests on improving healthcare outcomes for patients with ankle injuries: A systematic review.

    Science.gov (United States)

    Ho, Jonathan Ka-Ming; Chau, Janita Pak-Chun; Cheung, Nancy Man-Ching

    2016-11-01

    The Ottawa Ankle Rules provide guidelines for clinicians on the recommendation of radiographic tests to verify fractures in patients with ankle injuries. The use of the Ottawa Ankle Rules by emergency nurses has been suggested to minimise unnecessary radiographic-test requests and reduce patients' length of stay in emergency departments. However, the findings of studies in this area are inconsistent. A systematic review was conducted to synthesise the most accurate evidence available on the extent to which emergency nurses' use of the Ottawa Ankle Rules to initiate radiographic tests improves healthcare outcomes for patients with ankle injuries. The systematic review attempted to identify all relevant published and unpublished studies in English and Chinese from databases such as Ovid MEDLINE, EMBASE, ProQuest Health and Medical Complete, EBM Reviews, SPORTDiscus, CINAHL Plus, the British Nursing Index, Scopus, the Chinese Biomedical Literature Database, China Journal Net, WanFang Data, the National Central Library Periodical Literature System, HyRead, the Digital Dissertation Consortium, MedNar and Google Scholar. Two reviewers independently assessed the eligibility of all of the studies identified during the search, based on their titles and abstracts. If a study met the criteria for inclusion, or inconclusive information was available in its title and abstract, the full text was retrieved for further analysis. The methodological quality of all of the eligible studies was assessed independently by the two reviewers. The search of databases and other sources yielded 1603 records. The eligibility of 17 full-text articles was assessed, and nine studies met the inclusion criteria. All nine studies were subjected to narrative analysis, and five were meta-analysed. All of the studies investigated the use of the refined Ottawa Ankle Rules. The results indicated that emergency nurses' use of the refined Ottawa Ankle Rules minimised unnecessary radiographic-test requests

  6. Application of Barcoding to Reduce Error of Patient Identification and to Increase Patient's Information Confidentiality of Test Tube Labelling in a Psychiatric Teaching Hospital.

    Science.gov (United States)

    Liu, Hsiu-Chu; Li, Hsing; Chang, Hsin-Fei; Lu, Mei-Rou; Chen, Feng-Chuan

    2015-01-01

    Learning from the experience of another medical center in Taiwan, Kaohsiung Municipal Kai-Suan Psychiatric Hospital has changed the nursing informatics system step by step in the past year and a half . We considered ethics in the original idea of implementing barcodes on the test tube labels to process the identification of the psychiatric patients. The main aims of this project are to maintain the confidential information and to transport the sample effectively. The primary nurses had been using different work sheets for this project to ensure the acceptance of the new barcode system. In the past two years the errors in the blood testing process were as high as 11,000 in 14,000 events per year, resulting in wastage of resources. The actions taken by the nurses and the new barcode system implementation can improve the clinical nursing care quality, safety of the patients, and efficiency, while decreasing the cost due to the human error.

  7. Reduced entomopathogen abundance in Myrmica ant nests-testing a possible immunological benefit of myrmecophily using Galleria mellonella as a model

    DEFF Research Database (Denmark)

    Schär, Sämi; Larsen, Louise L.M.; Meyling, Nicolai Vitt

    2015-01-01

    Social insects such as ants have evolved collective rather than individual immune defence strategies against diseases and parasites at the level of their societies (colonies), known as social immunity. Ants frequently host other arthropods, so-called myrmecophiles, in their nests. Here, we tested...... that immunological benefits of entering ant nests may provide us a new explanation of why natural selection acts in favour of such a life-history strategy....

  8. Peak-Seeking Control For Reduced Fuel Consumption: Flight-Test Results For The Full-Scale Advanced Systems Testbed FA-18 Airplane

    Science.gov (United States)

    Brown, Nelson

    2013-01-01

    A peak-seeking control algorithm for real-time trim optimization for reduced fuel consumption has been developed by researchers at the National Aeronautics and Space Administration (NASA) Dryden Flight Research Center to address the goals of the NASA Environmentally Responsible Aviation project to reduce fuel burn and emissions. The peak-seeking control algorithm is based on a steepest-descent algorithm using a time-varying Kalman filter to estimate the gradient of a performance function of fuel flow versus control surface positions. In real-time operation, deflections of symmetric ailerons, trailing-edge flaps, and leading-edge flaps of an F/A-18 airplane are used for optimization of fuel flow. Results from six research flights are presented herein. The optimization algorithm found a trim configuration that required approximately 3 percent less fuel flow than the baseline trim at the same flight condition. This presentation also focuses on the design of the flight experiment and the practical challenges of conducting the experiment.

  9. ALGOS: the development of a randomized controlled trial testing a case management algorithm designed to reduce suicide risk among suicide attempters

    Directory of Open Access Journals (Sweden)

    Duhem Stephane

    2011-01-01

    Full Text Available Abstract Background Suicide attempts (SA constitute a serious clinical problem. People who attempt suicide are at high risk of further repetition. However, no interventions have been shown to be effective in reducing repetition in this group of patients. Methods/Design Multicentre randomized controlled trial. We examine the effectiveness of «ALGOS algorithm»: an intervention based in a decisional tree of contact type which aims at reducing the incidence of repeated suicide attempt during 6 months. This algorithm of case management comprises the two strategies of intervention that showed a significant reduction in the number of SA repeaters: systematic telephone contact (ineffective in first-attempters and «Crisis card» (effective only in first-attempters. Participants who are lost from contact and those refusing healthcare, can then benefit from «short letters» or «postcards». Discussion ALGOS algorithm is easily reproducible and inexpensive intervention that will supply the guidelines for assessment and management of a population sometimes in difficulties with healthcare compliance. Furthermore, it will target some of these subgroups of patients by providing specific interventions for optimizing the benefits of case management strategy. Trial Registration The study was registered with the ClinicalTrials.gov Registry; number: NCT01123174.

  10. Prostate health index significantly reduced unnecessary prostate biopsies in patients with PSA 2-10 ng/mL and PSA >10 ng/mL: Results from a Multicenter Study in China.

    Science.gov (United States)

    Na, Rong; Ye, Dingwei; Qi, Jun; Liu, Fang; Helfand, Brian T; Brendler, Charles B; Conran, Carly A; Packiam, Vignesh; Gong, Jian; Wu, Yishuo; Zheng, Siqun L; Mo, Zengnan; Ding, Qiang; Sun, Yinghao; Xu, Jianfeng

    2017-08-01

    The performance of prostate health index (phi) in predicting prostate biopsy outcomes has been well established for patients with prostate-specific antigen (PSA) values between 2 and 10 ng/mL. However, the performance of phi remains unknown in patients with PSA >10 ng/mL, the vast majority in Chinese biopsy patients. We aimed to assess the ability of phi to predict prostate cancer (PCa) and high-grade disease (Gleason Score ≥7) on biopsy in a Chinese population. This is a prospective, observational, multi-center study of consecutive patients who underwent a transrectal ultrasound guided prostate biopsy at four hospitals in Shanghai, China from August 2013 to December 2014. In the cohort of 1538 patients, the detection rate of PCa was 40.2%. phi had a significantly better predictive performance for PCa than total PSA (tPSA). The areas under the receiver operating characteristic curve (AUC) were 0.90 and 0.79 for phi and tPSA, respectively, P 10 ng/mL (N = 838, 54.5%). The detection rates of PCa were 35.9% and 57.7% in patients with tPSA 10.1-20 and 20.1-50 ng/mL, respectively. The AUCs of phi (0.79 and 0.89, for these two groups, respectively) were also significantly higher than tPSA (0.57 and 0.63, respectively), both P 10 ng/mL). © 2017 Wiley Periodicals, Inc.

  11. Estratégias dirigidas aos profissionais para a redução das cesáreas desnecessárias no Brasil Strategies directed to professionals for reducing unnecessary cesarean sections in Brazil

    Directory of Open Access Journals (Sweden)

    Samira El Maerrawi T. Haddad

    2011-05-01

    Full Text Available O Brasil está entre os países com as mais elevadas taxas de cesárea, sobretudo na saúde suplementar. No entanto, tanto no setor público, como no privado, algumas características são semelhantes para os anseios e expectativas das gestantes em relação ao parto. Existe preferência para o parto vaginal entre as mulheres de todos os níveis social, econômico ou cultural, o que desloca o foco da influência negativa da mulher para os outros sujeitos envolvidos na assistência ao parto. Nenhum fator isoladamente é capaz de justificar a complexidade da decisão pelo parto por cesárea, porém o médico e o tipo de hospital são os maiores fatores associados. Os diversos efeitos prejudiciais da realização não criteriosa de parto cesárea são cientificamente comprovados. É fundamental a conscientização de médicos e demais profissionais sobre as consequências reais dessa decisão, os desvios éticos quando condutas são tomadas sem que o foco seja exclusivamente a saúde do paciente e a necessidade de capacitação e atualização constantes para o manejo das diversas situações possíveis para o nascimento.Brazil is among the countries with the highest cesarean section rates, especially in the supplementary health sector. However, some characteristics are similar in both the public and private sectors in terms of the wishes and expectations of pregnant women regarding their delivery. There is a preference for vaginal delivery among women of all social, economic, and cultural levels, a fact that shifts the focus of the negative influence of this variable from women to other subjects involved in delivery care. No isolated factor is able to justify the complexity of making a decision for cesarean section, but the physician and the type of hospital are the main associated factors. The several harmful effects of a non-judicious performance of cesarean section are scientifically recognized. It is important to raise the awareness of doctors and of other health professionals about the real consequences of this decision, the ethical deviations when conducts are chosen without exclusively focusing on the patient`s health, and the need for constant updating for the management of the various possible conditions of childbirth.

  12. A Novel Approach to Improving Utilization of Laboratory Testing.

    Science.gov (United States)

    Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D

    2018-02-01

    - The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

  13. Idiographic duo-trio tests using a constant-reference based on preference of each consumer: Sample presentation sequence in difference test can be customized for individual consumers to reduce error.

    Science.gov (United States)

    Kim, Min-A; Sim, Hye-Min; Lee, Hye-Seong

    2016-11-01

    As reformulations and processing changes are increasingly needed in the food industry to produce healthier, more sustainable, and cost effective products while maintaining superior quality, reliable measurements of consumers' sensory perception and discrimination are becoming more critical. Consumer discrimination methods using a preferred-reference duo-trio test design have been shown to be effective in improving the discrimination performance by customizing sample presentation sequences. However, this design can add complexity to the discrimination task for some consumers, resulting in more errors in sensory discrimination. The objective of the present study was to investigate the effects of different types of test instructions using the preference-reference duo-trio test design where a paired-preference test is followed by 6 repeated preferred-reference duo-trio tests, in comparison to the analytical method using the balanced-reference duo-trio. Analyses of d' estimates (product-related measure) and probabilistic sensory discriminators in momentary numbers of subjects showing statistical significance (subject-related measure) revealed that only preferred-reference duo-trio test using affective reference-framing, either by providing no information about the reference or information on a previously preferred sample, improved the sensory discrimination more than the analytical method. No decrease in discrimination performance was observed with any type of instruction, confirming that consumers could handle the test methods. These results suggest that when repeated tests are feasible, using the affective discrimination method would be operationally more efficient as well as ecologically more reliable for measuring consumers' sensory discrimination ability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. NOS module - reducing the nitrogen oxides and dust emissions of wood-fired systems; NOS-Modul. Installation und Test - Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Salerno, B.

    2005-07-01

    This final report for the Swiss Federal Office of Energy (SFOE) presents the results of a project that examined the potential of reducing dust and nitrogen oxides emissions of biomass-fired systems. Two prototype installations are described with capacities of 70 - 300 kW and 150 - 500 kW, the latter being a mobile installation installed together with a silo in a container. The prototypes can burn problematical biomass such as cereals, chicken droppings, damp wood-chippings and straw. Various factors and configurations influencing the formation of emissions are examined. Cyclone technology, a catalyst using chrome-nickel shavings and a ceramic heat-exchanger are discussed. Measurements made are presented in tabular and graphical form and discussed.

  15. Development of a Committee of Artificial Neural Networks for the Performance Testing of Compressors for Thermal Machines in Very Reduced Times

    Directory of Open Access Journals (Sweden)

    Coral Rodrigo

    2015-03-01

    Full Text Available This paper presents a new test method able to infer - in periods of less than 7 seconds - the refrigeration capacity of a compressor used in thermal machines, which represents a time reduction of approximately 99.95% related to the standardized traditional methods. The method was developed aiming at its application on compressor manufacture lines and on 100% of the units produced. Artificial neural networks (ANNs were used to establish a model able to infer the refrigeration capacity based on the data collected directly on the production line. The proposed method does not make use of refrigeration systems and also does not require using the compressor oil.

  16. A Proactive Approach to Penicillin Allergy Testing in Hospitalized Patients.

    Science.gov (United States)

    Chen, Justin R; Tarver, Scott A; Alvarez, Kristin S; Tran, Trang; Khan, David A

    Penicillin allergy testing is underutilized in inpatients despite its potential to immediately impact antibiotic treatment. Although most tested patients are able to tolerate penicillin, limited availability and awareness of this tool leads to the use of costly and harmful substitutes. We established an inpatient service at a large academic hospital to identify and test patients with a history of penicillin allergy with the goals of removing inaccurate diagnoses, reducing the use of beta-lactam alternatives, and educating patients and clinicians about the procedure. Eligible inpatients were flagged daily through the electronic medical record and prioritized via a specialized algorithm. A trained clinical pharmacist performed penicillin skin tests and challenges preemptively or by provider request. Clinical characteristics and antibiotic use were analyzed in tested patients. A total of 1203 applicable charts were detected by our system leading to 252 direct evaluations over 18 months. Overall, 228 subjects (90.5%) had their penicillin allergy removed. Of these, 223 were cleared via testing and 5 by discovery of prior penicillin tolerance. Among patients testing negative, 85 (38%) subsequently received beta-lactams, preventing 504 inpatient days and 648 outpatient days on alternative agents. Penicillin allergy testing using a physician-pharmacist team model effectively removes reported allergies in hospitalized patients. The electronic medical record is a valuable asset for locating and stratifying individuals who benefit most from intervention. Proactive testing substantially reduces unnecessary inpatient and outpatient use of beta-lactam alternatives that may otherwise go unaddressed. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Theory-driven, web-based, computer-tailored advice to reduce and interrupt sitting at work: development, feasibility and acceptability testing among employees.

    Science.gov (United States)

    De Cocker, Katrien; De Bourdeaudhuij, Ilse; Cardon, Greet; Vandelanotte, Corneel

    2015-09-24

    Because of the adverse health effects in adults, interventions to influence workplace sitting, a large contributor to overall daily sedentary time, are needed. Computer-tailored interventions have demonstrated good outcomes in other health behaviours, though few have targeted sitting time at work. Therefore, the present aims were to (1) describe the development of a theory-driven, web-based, computer-tailored advice to influence sitting at work, (2) report on the feasibility of reaching employees, and (3) report on the acceptability of the advice. Employees from a public city service (n = 179) were invited by e-mail to participate. Employees interested to request the advice (n = 112) were sent the website link, a personal login and password. The online advice was based on different aspects of the Theory of Planned Behaviour, Self-Determination Theory and Self-Regulation Theory. Logistic regressions were conducted to compare characteristics (gender, age, education, employment status, amount of sitting and psychosocial correlates of workplace sitting) of employees requesting the advice (n = 90, 80.4%) with those who did not. Two weeks after visiting the website, 47 employees (52.2%) completed an online acceptability questionnaire. Those with a high education were more likely to request the advice than those with a low education (OR = 2.4, CI = 1.0-5.8), and those with a part-time job were more likely to request the advice compared to full-time employees (OR = 2.9, CI = 1.2-7.1). The majority found the advice interesting (n = 36/47, 76.6%), relevant (n = 33/47, 70.2%) and motivating (n = 29/47, 61.7%). Fewer employees believed the advice was practicable (n = 15/47, 31.9%). After completing the advice, 58.0% (n = 25/43) reported to have started interrupting their sitting and 32.6% (n = 17/43) additionally intended to do so; 14.0 % (n = 6/43) reported to have reduced their sitting and another 51.2% (n = 22/43) intended to do so. More efforts are needed to reach lower

  18. Access to Point-of-Care Tests Reduces the Prescription of Antibiotics Among Antibiotic-Requesting Subjects With Respiratory Tract Infections

    DEFF Research Database (Denmark)

    Llor, Carl; Bjerrum, Lars; Munck, Anders

    2014-01-01

    BACKGROUND: General practitioners (GPs) often feel uncomfortable when patients request an antibiotic when there is likely little benefit. This study evaluates the effect of access to point-of-care tests on decreasing the prescription of antibiotics in respiratory tract infections in subjects who...... explicitly requested an antibiotic prescription. METHODS: Spanish GPs registered all cases of respiratory tract infections over a 3-week period before and after an intervention undertaken in 2008 and 2009. Patients with acute sinusitis, pneumonia, and exacerbations of COPD were excluded. Two types...... requesting antibiotics received a prescription before and 60% after the intervention, without statistical differences being observed. In the group of GPs assigned to the full intervention group, the percentages were 55.1% and 36.2%, respectively, with a difference of 18.9% (95% CI: 6.4%-30.6%, P

  19. Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials.

    Science.gov (United States)

    Lu, Jun; Meng, Haoyu; Meng, Zhaoyi; Sun, Ying; Pribis, John P; Zhu, Chunyan; Li, Quan

    2015-01-01

    Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery. A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics. Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P open-heart surgery. Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery.

  20. Dansyl-PQRamide, a putative antagonist of NPFF receptors, reduces anxiety-like behavior of ethanol withdrawal in a plus-maze test in rats.

    Science.gov (United States)

    Kotlinska, Jolanta; Pachuta, Agnieszka; Bochenski, Marcin; Silberring, Jerzy

    2009-06-01

    Much evidence indicates that endogenous opioid peptides are involved in effects caused by ethanol. The aim of the present study was to determine whether dansyl-PQR amide, a putative antagonist of receptors for an anti-opioid peptide-neuropeptide FF (NPFF) could affect anxiety-like behavior measured during withdrawal from acute-, and chronic ethanol administration in the elevated plus maze test in rats. Our study indicated that intracerebroventricular (i.c.v.) administration of dansyl-PQRamide (2.4 and 4.8 nmol) reversed anxiety-like behavior measured as a percent time spent in the open arms, and a percent open arm entries onto the open arms in the elevated plus-maze test in rats. These effects were inhibited by NPFF (10 and/or 20 nmol, i.c.v.) in the experiments performed during withdrawal from acute- and chronic ethanol administration. During withdrawal from acute ethanol, naloxone (1mg/kg, i.p.), a nonselective opioid receptor antagonist, attenuated only an increased percent time spent in the open arms induced by dansyl-PQR amide (4.8 nmol). Dansyl-PQR amide, NPFF and naloxone given alone to naive rats did not have influence on spontaneous locomotor activity of animals. Furthermore, NPFF potentiated anxiety-like behavior during withdrawal from chronic, but not acute, ethanol administration in rats. Our data suggest that NPFF system is involved in regulation of affective symptoms of ethanol withdrawal. It seems that involvement of the NPFF system in ethanol withdrawal anxiety-like behavior is associated with regulation of the opioid system activity.

  1. An Approach for Measuring the Sorptive Behavior of Odorants Using a Multifunction Thermal Desorber Unit: Preliminary Tests on Reduced Sulfur Compounds

    Directory of Open Access Journals (Sweden)

    Sang-Woo Joo

    2008-03-01

    Full Text Available In this study, the sorptive behavior of reduced sulfur compounds (RSC was investigated using a combination of thermal desorber (TD unit and gas chromatography (GC. To examine the sorptive properties of RSC on textile materials, two types of experiments were conducted under experimental conditions favorable for sorptive processes. In all the experiments, gaseous standards of hydrogen sulfide, methanethiol, dimethyl sulfide, and dimethyl disulfide were supplied to initiate the adsorption processes on textile pieces. The textile pieces were then forced to release those adsorbed RSC under a fixed condition. It was found that the extent of adsorption, if evaluated quantitatively, occurred at approximately 1/1000 to 1/100 of the level of RSC standards supplied originally to induce adsorption. It also indicated that RSC adsorption was affected very sensitively by the initial exposure durations to induce RSC adsorption with an exponential decrease in relative recovery (RR values with increasing exposure time. The relative sorptive patterns, when compared between different RSCs, were affected most sensitively by such factors as molecular weight and/or physical contact conditions.

  2. Failure of introduction of food allergens after negative oral food challenge tests in children

    NARCIS (Netherlands)

    J.P.M. van der Valk; R. Gerth van Wijk (Roy); Y. Vergouwe; N.W. de Jong (Nicolette)

    2015-01-01

    textabstractOne of the purposes to perform an oral food challenge (FC) test is to avoid unnecessary elimination of food allergens. In case of a negative FC test result, the food can be introduced. It is, however, unknown if patients act according to the outcome of the test. This study evaluates the

  3. Strategies to reduce blood product utilization in obstetric practice.

    Science.gov (United States)

    Neb, Holger; Zacharowski, Kai; Meybohm, Patrick

    2017-06-01

    Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial. Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.

  4. Using Participatory System Dynamics Modeling to Examine the Local HIV Test and Treatment Care Continuum in Order to Reduce Community Viral Load.

    Science.gov (United States)

    Weeks, Margaret R; Li, Jianghong; Lounsbury, David; Green, Helena Danielle; Abbott, Maryann; Berman, Marcie; Rohena, Lucy; Gonzalez, Rosely; Lang, Shawn; Mosher, Heather

    2017-12-01

    Achieving community-level goals to eliminate the HIV epidemic requires coordinated efforts through community consortia with a common purpose to examine and critique their own HIV testing and treatment (T&T) care system and build effective tools to guide their efforts to improve it. Participatory system dynamics (SD) modeling offers conceptual, methodological, and analytical tools to engage diverse stakeholders in systems conceptualization and visual mapping of dynamics that undermine community-level health outcomes and identify those that can be leveraged for systems improvement. We recruited and engaged a 25-member multi-stakeholder Task Force, whose members provide or utilize HIV-related services, to participate in SD modeling to examine and address problems of their local HIV T&T service system. Findings from the iterative model building sessions indicated Task Force members' increasingly complex understanding of the local HIV care system and demonstrated their improved capacity to visualize and critique multiple models of the HIV T&T service system and identify areas of potential leverage. Findings also showed members' enhanced communication and consensus in seeking deeper systems understanding and options for solutions. We discuss implications of using these visual SD models for subsequent simulation modeling of the T&T system and for other community applications to improve system effectiveness. © Society for Community Research and Action 2017.

  5. Radioactive waste disposal: testing and control for setting of plugging and sealing materials in reduced scale models, in boreholes or in shaft excavations

    International Nuclear Information System (INIS)

    1991-01-01

    In the case of an underground disposal of radioactive waste, the free space between the storage containers and the rock embedment must be backfilled in order to restore both mechanical and thermal continuity of the dug out material and to form a physico-chemical barrier against the diffusion into the subsoil of the radionucleides which may be released by the possible failure of a container. The aim of this research program is to formulate a hydraulic binder based sealing material, whose rheological properties at fresh state allow an easy placing and whose mechanical and physico-chemical properties at hardened state guarantee the effectiveness of the impervious barrier. A first part, done in laboratory, pointed out the formulations to be tested on scale models. These models simulate a storage in vertical shafts (high level radioactive waste) and in galleries (medium level radioactive waste), show the efficiency of placing techniques and the behaviour of the sealing submitted to the heat generated by the waste. The sorptive mortar PETRISOL, patented by SOLETANCHE, brings over a solution meeting not only the technical requirements but also the public expectations as far as environmental protection is concerned. 13 figs.; 14 tabs

  6. Construction test modules to reduce the air conditioning consumption; Modulos de prueba de edificaciones para reducir el consumo de aire acondicionado

    Energy Technology Data Exchange (ETDEWEB)

    Acoltzi, Higinio [Instituto de Investigaciones Electricas, (Mexico); Alvarez, Gabriela [CENIDET (Mexico)

    2002-09-01

    In this work a mathematical model of the energy behavior of test modules to scale and its experimental verification is presented. The model determines the electrical energy consumption history, necessary to maintain the comfort conditions in the interior of the modules, with respect to the variation of the materials of the ceilings and windows, to establish the application criteria of these materials in the construction industry. Also are presented the measured results of energy consumption accumulated for the modules with ceilings, of monolithic slab as well as of joist and small arches, with wooden window frames and reflectasol filtrasol and clear glasses. [Spanish] En este trabajo se presenta un modelo matematico del comportamiento energetico de modulos de prueba a escala y su verificacion experimental. El modelo determina la historia del consumo de energia electrica, necesario para mantener las condiciones de confort al interior de los modulos, con respecto a la variacion de los materiales de los techos y ventanas, para establecer criterios de aplicacion de dichos materiales en la industria de la construccion. Tambien se presenta los resultados medidos del consumo de energia acumulada para los modulos con techos, tanto de losa monolitica como de vigueta y bovedilla, con ventanas de marco de madera y vidrios reflectasol, filtrasol y claro.

  7. Welcome address to 30th international meeting on Reduced Enrichment for Research and Test Reactors, 6 October 2008, Washington, D.C., USA

    International Nuclear Information System (INIS)

    Sokolov, Y.

    2008-01-01

    down blended. By investing in these measures, we could alleviate proliferation concerns associated with the continued uses of HEU and help reduce the risk of nuclear terrorism. I believe that this is an initiative in which all countries - Nuclear Weapon States and Non-Nuclear Weapon States alike - could play a role, and from which all would clearly benefit. The Agency stands ready to continue to take its share of this work through supporting and assisting its Member States in their efforts

  8. Stability of U(VI) and Tc(VII) Reducing Microbial Communities to EnvironmentalPerturbation: Development and Testing of a Thermodynamic Network Model. Technical Report

    International Nuclear Information System (INIS)

    Jonathan D. Istok

    2008-01-01

    'Bioimmobilization' of redox-sensitive metals and radionuclides is being investigated as a way to remediate contaminated groundwater and sediments. In this approach, growth-limiting substrates are added to stimulate the activity of targeted groups of indigenous microorganisms and create conditions favorable for the microbially-mediated precipitation ('bioimmobilization') of targeted contaminants. This project investigated a fundamentally new approach for modeling this process that couples thermodynamic descriptions for microbial growth with associated geochemical reactions. In this approach, a synthetic microbial community is defined as a collection of defined microbial groups; each with a growth equation derived from bioenergetic principles. The growth equations and standard-state free energy yields are appended to a thermodynamic database for geochemical reactions and the combined equations are solved simultaneously to predict the effect of added substrates on microbial biomass, community composition, and system geochemistry. This approach, with a single set of thermodynamic parameters (one for each growth equation), was used to predict the results of laboratory and field bioimmobilization experiments at two geochemically diverse research sites. Predicted effects of ethanol or acetate addition on uranium and technetium solubility, major ion geochemistry, mineralogy, microbial biomass and community composition were in general agreement with experimental observations although the available experimental data precluded rigorous model testing. Model simulations provide insight into the long-standing difficulty in transferring experimental results from the laboratory to the field and from one field site to the next, especially if the form, concentration, or delivery of growth substrate is varied from one experiment to the next. Although originally developed for use in better understanding bioimmobilization of uranium and technetium via reductive precipitation, the

  9. The Veracity of Troponin Test Requests for Patients Presenting to the Emergency Department with Chest Pain; A Clinical Audit

    Directory of Open Access Journals (Sweden)

    Anita Sabzghabaei

    2017-10-01

    Full Text Available Introduction: Troponin test is one of the methods for diagnosing acute coronary syndrome, but the overuse and misuse of this test has increased the costs imposed on the health system and the patients. Objective: The present study was conducted to investigate the veracity of troponin test requests for patients presenting to an emergency department with chest pain and examine the effectiveness of training emergency medicine assistants in reducing unnecessary and inappropriate requests in emergency departments. Methods: This clinical audit was conducted in the emergency department of Imam Hossein Hospital, Tehran, Iran, in 2014. Sampling was carried out using the census method and all the cases presenting to the emergency department for whom a troponin test was requested by the emergency medical assistants were included in the research. First, the veracity of the current troponin test requests was assessed; then, training was given to the personnel, and the veracity of the troponin test requests was once again verified after the training was completed. The rate of veracious troponin requests for the patients was measured based on two factors, including the interval between the patients’ admission and the troponin test request, and the interval between the onset of pain and the troponin test request. The veracity of the troponin test request was compared before and after training using the Phi test and Cramer’s V test in IBM SPSS-21. Results: This study examined a total of 500 patients (250 before training and 250 after, who had a mean age of 57.65±18.15 years, including 51.6% men. Significant differences were observed between the mean time of the patients’ admission and the overall and post-training troponin test results (P=0.000, and also between the mean time of the onset of pain and the overall and post-training troponin test results (P=0.000. The number of positive troponin test results did not differ significantly between the patients

  10. Optimizing urine drug testing for monitoring medication compliance in pain management.

    Science.gov (United States)

    Melanson, Stacy E F; Ptolemy, Adam S; Wasan, Ajay D

    2013-12-01

    It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient. Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management. We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. Wiley Periodicals, Inc.

  11. Reducing The Nuclear Danger

    Science.gov (United States)

    1995-10-01

    off convention • Eliminate the civil use of HEU (includes RERTR ) • Reduce stockpiles of civil HEU and plutonium • Promote alternatives to the...these countries. ANL supports the Department’s Reduced Enrichment for Research and Test Reactor ( RERTR ) Program by providing the technical means to...scientists and engineers at 60 institutes in Russia, Ukraine, Kazakhstan and Belarus. The United States and Russia have agreed to pursue a joint RERTR

  12. Interventions to Educate Family Physicians to Change Test Ordering

    Directory of Open Access Journals (Sweden)

    Roger Edmund Thomas MD, PhD, CCFP, MRCGP

    2016-03-01

    Full Text Available The purpose is to systematically review randomised controlled trials (RCTs to change family physicians’ laboratory test-ordering. We searched 15 electronic databases (no language/date limitations. We identified 29 RCTs (4,111 physicians, 175,563 patients. Six studies specifically focused on reducing unnecessary tests, 23 on increasing screening tests. Using Cochrane methodology 48.5% of studies were low risk-of-bias for randomisation, 7% concealment of randomisation, 17% blinding of participants/personnel, 21% blinding outcome assessors, 27.5% attrition, 93% selective reporting. Only six studies were low risk for both randomisation and attrition. Twelve studies performed a power computation, three an intention-to-treat analysis and 13 statistically controlled clustering. Unweighted averages were computed to compare intervention/control groups for tests assessed by >5 studies. The results were that fourteen studies assessed lipids (average 10% more tests than control, 14 diabetes (average 8% > control, 5 cervical smears, 2 INR, one each thyroid, fecal occult-blood, cotinine, throat-swabs, testing after prescribing, and urine-cultures. Six studies aimed to decrease test groups (average decrease 18%, and two to increase test groups. Intervention strategies: one study used education (no change: two feedback (one 5% increase, one 27% desired decrease; eight education + feedback (average increase in desired direction >control 4.9%, ten system change (average increase 14.9%, one system change + feedback (increases 5-44%, three education + system change (average increase 6%, three education + system change + feedback (average 7.7% increase, one delayed testing. The conclusions are that only six RCTs were assessed at low risk of bias from both randomisation and attrition. Nevertheless, despite methodological shortcomings studies that found large changes (e.g. >20% probably obtained real change.

  13. Acoustic emission testing of piston check valves

    International Nuclear Information System (INIS)

    Stewart, D.L.

    1994-01-01

    Based on test experience at Comanche Peak Unit 1, an acoustic emission data evaluation matrix for piston check valves has been developed. The degradations represented in this matrix were selected based on Edwards piston check valve failure data reported in the Nuclear Plant Reliability Data System. Evidence to support this matrix was collected from site test data on a variety of valve types. Although still under refinement, the matrix provides three major attributes for closure verification, which have proven useful in developing test procedures for inservice testing and preventing unnecessary disassembly

  14. Dual skin tests with Mycobacterium avium sensitin and PPD to detect misdiagnosis of latent tuberculosis infection.

    Science.gov (United States)

    Larson, E M; O'Donnell, M; Chamblee, S; Horsburgh, C R; Marsh, B J; Moreland, J D; Johnson, L S; von Reyn, C Fordham

    2011-11-01

    A positive tuberculin skin test (TST) may indicate cross-reacting immunity to non-tuberculous mycobacteria (NTM) and not latent tuberculosis infection (LTBI). To assess misclassification of LTBI, as assessed by skin testing with Mycobacterium avium sensitin (MaS), and to determine how this misclassification affects the analysis of risk factors for LTBI. In a population-based survey, participants underwent skin testing with M. tuberculosis purified protein derivative (PPD) and MaS. A PPD-dominant skin test was a reaction that was ≥ 3 mm larger than the MaS reaction; a MaS-dominant skin test was a reaction that was ≥ 3 mm larger than the PPD reaction. Of 447 randomly selected persons, 135 (30%) had a positive PPD test. Of these, 21 (16%) were MaS- dominant, and were therefore attributable to NTM and misclassified as LTBI. PPD reactions of 5-14 mm were more likely to be misclassified than those ≥ 15 mm (OR = 5.0, 95%CI 1.9-13.2). Adjusting for misclassification had only a small impact on the analysis of risk factors for LTBI. A substantial number of individuals who are diagnosed with LTBI are actually sensitized to NTM. Using dual skin testing would reduce misdiagnosis and prevent unnecessary treatment.

  15. Test and Evaluation of Reduced Rate Multiplexers.

    Science.gov (United States)

    1981-08-01

    employed by your organization , please notify RADC. (DCLp) Griffiss AFB NY 13441. This will assist .us in maintaining a current mailin list. Do not return...be organized as follows. There will be some general discussions applicable to the overall program. A separate section will be devoted to each of the...modulation transmitted as a vestigial . sideband line signal, -16 dB carrier 2853 Hz added in quadrature, 4 level 4800 baud 9600 BIS, 4800/7200/9600 B

  16. Heterophilic antibodies interfering with radioimmunoassay. A false-positive pregnancy test

    Energy Technology Data Exchange (ETDEWEB)

    Vladutiu, A.O.; Sulewski, J.M.; Pudlak, K.A.; Stull, C.G.

    1982-11-19

    A young woman with amenorrhea had a consistently positive pregnancy test result (serum radioimmunoassay measurement of ..beta..-human chorionic gonadotropin hormone). No fetal or placental tissue was found after uterine curettage and exploratory laparotomy. The false-positive pregnancy test result was due to heterophilic antibovine and antigoat antibodies in the patient's serum. These antibodies interfered with radioimmunoassays using goat antibodies. This case shows that serum heterophilic antibodies can interfere with immunoassays and result in unnecessary diagnostic procedures and/or unnecessary treatment.

  17. Heterophilic antibodies interfering with radioimmunoassay. A false-positive pregnancy test

    International Nuclear Information System (INIS)

    Vladutiu, A.O.; Sulewski, J.M.; Pudlak, K.A.; Stull, C.G.

    1982-01-01

    A young woman with amenorrhea had a consistently positive pregnancy test result (serum radioimmunoassay measurement of #betta#-human chorionic gonadotropin hormone). No fetal or placental tissue was found after uterine curettage and exploratory laparotomy. The false-positive pregnancy test result was due to heterophilic antibovine and antigoat antibodies in the patient's serum. These antibodies interfered with radioimmunoassays using goat antibodies. This case shows that serum heterophilic antibodies can interfere with immunoassays and result in unnecessary diagnostic procedures and/or unnecessary treatment

  18. Scintigraphic ventriculography and stress testing

    International Nuclear Information System (INIS)

    Goris, M.L.; Hung, J.; Debusk, R.F.

    1982-01-01

    Scintigraphic stress ventriculography yields information which is complex and defies description by the difference in ejection fraction between rest and maximum exercise only. The complexity results in part from the ''derived'' nature of the ejection fraction measurement, which is physiologically secondary to stroke volume and end-diastolic volume. Furthermore, the nature of the stress test in which the pulse (stress) is not independent from the response forces an analysis which considers ''when'' as much as ''what'' happens. Automation in data processing, however, has made oversimplification unnecessary and allows a more exhaustive but correct analysis

  19. Increased Protein Consumption during the Day from an Energy-Restricted Diet Augments Satiety but Does Not Reduce Daily Fat or Carbohydrate Intake on a Free-Living Test Day in Overweight Women.

    Science.gov (United States)

    Gwin, Jess A; Maki, Kevin C; Leidy, Heather J

    2017-12-01

    Background: Higher-protein (HP) energy-restriction diets improve weight management to a greater extent than normal-protein (NP) versions. Potential mechanisms of action with regard to assessment of eating behaviors across the day have not been widely examined during energy restriction. Objectives: The objectives of this study were to test whether the consumption of an HP energy-restriction diet reduces carbohydrate and fat intakes through improvements in daily appetite, satiety, and food cravings compared with NP versions and to test whether protein type within the NP diets alters protein-related satiety. Methods: Seventeen overweight women [mean ± SEM age: 36 ± 1 y; body mass index (kg/m 2 ): 28.4 ± 0.1] completed a randomized, controlled-feeding crossover study. Participants were provided with the following ∼1250-kcal/d energy-restricted (-750-kcal/d deficit) diets, each for 6 d: HP [124 g protein/d; 60% from beef and 40% from plant sources (HP-BEEF)] or NP (48 g protein/d) that was protein-type matched (NP-BEEF) or unmatched [100% from plant-based sources (NP-PLANT)]. On day 6 of each diet period, participants completed a 12-h testing day containing repetitive appetite, satiety, and food-craving questionnaires. On day 7, the participants were asked to consume their protein requirement within each respective diet but were provided with a surplus of carbohydrate- and fat-rich foods to consume, ad libitum, at each eating occasion across the day. All outcomes reported were primary study outcomes. Results: The HP-BEEF diet reduced daily hunger by 16%, desire to eat by 15%, prospective food consumption by 14%, and fast-food cravings by 15% but increased daily fullness by 25% compared with the NP-BEEF and NP-PLANT diets (all P protein throughout the day did not reduce the energy consumed ad libitum from the fat- and carbohydrate-rich foods (HP-BEEF: 2000 ± 180 kcal/d; NP-BEEF: 2120 ± 190 kcal/d; NP-PLANT: 2070 ± 180 kcal/d). None of the outcomes differed

  20. Reducing costs by reducing size

    International Nuclear Information System (INIS)

    Hayns, M.R.; Shepherd, J.

    1991-01-01

    The present paper discusses briefly the many factors, including capital cost, which have to be taken into account in determining whether a series of power stations based on a small nuclear plant can be competitive with a series based on traditional large unit sizes giving the guaranteed level of supply. The 320 MWe UK/US Safe Integral Reactor is described as a good example of how the factors discussed can be beneficially incorporated into a design using proven technology. Finally it goes on to illustrate how the overall costs of a generating system can indeed by reduced by use of the 320 MWe Safe Integral Reactor rather than conventional units of around 1200 MWe. (author). 9 figs

  1. Risk evaluation for motor operated valves in an Inservice Testing Program at a PWR nuclear power plant in Taiwan

    International Nuclear Information System (INIS)

    Li, Y.C.; Chen, K.T.; Su, Y.L.; Ting, K.; Chien, F.T.; Li, G.D.; Huang, S.H.

    2012-01-01

    Safety related valves such as Motor Operated Valves (MOV), Air Operated Valves (AOV) or Check Valves (CV) play an important role in nuclear power plant. Functioning of these valves mainly aim at emergency reactivity control, post-accident residue heat removal, post-accident radioactivity removal and containment isolation when a design basis accident occurred. In order to maintain these valves under operable conditions, an Inservice Testing Program (IST) is defined for routine testing tasks based on the ASME Boiler and Pressure Vessel Code section XI code requirements. Risk based Inservice Testing Programs have been studied and developed extensively in the nuclear energy industry since the 1990s. Risk Based evaluations of IST can bring positive advantages to the licensee such as identifying the vulnerability of the system, reducing unnecessary testing burden, concentrating testing resources on the critical pass oriented valves and saving plant’s personnel dose exposure. This risk evaluation is incorporated with quantitative and qualitative analyses to the Motor Operated Valves under current Inservice Testing Program for PWR nuclear power plant in Taiwan. With the outcome of the risk classifications for the safety related MOVs through numerical or deterministic analyses, a risk based testing frequency relief is suggested to demonstrate the benefits received from the risk based Inservice Testing Program. The goal made of this study, it could be as a reference and cornerstone for the licensee to perform overall scope Risk-Informed Inservice Testing Program (RI-IST) evaluation by referring relevant methodologies established in this study.

  2. Application of Sleeper Cab Thermal Management Technologies to Reduce Idle Climate Control Loads in Long-Haul Trucks

    Energy Technology Data Exchange (ETDEWEB)

    Lustbader, J. A.; Venson, T.; Adelman, S.; Dehart, C.; Yeakel, S.; Castillo, M. S.

    2012-10-01

    Each intercity long-haul truck in the U.S. idles approximately 1,800 hrs per year, primarily for sleeper cab hotel loads. Including workday idling, over 2 billion gallons of fuel are used annually for truck idling. NREL's CoolCab project works closely with industry to design efficient thermal management systems for long-haul trucks that keep the cab comfortable with minimized engine idling and fuel use. The impact of thermal load reduction technologies on idle reduction systems were characterized by conducting thermal soak tests, overall heat transfer tests, and 10-hour rest period A/C tests. Technologies evaluated include advanced insulation packages, a solar reflective film applied to the vehicle's opaque exterior surfaces, a truck featuring both film and insulation, and a battery-powered A/C system. Opportunities were identified to reduce heating and cooling loads for long-haul truck idling by 36% and 34%, respectively, which yielded a 23% reduction in battery pack capacity of the idle-reduction system. Data were also collected for development and validation of a CoolCalc HVAC truck cab model. CoolCalc is an easy-to-use, simplified, physics-based HVAC load estimation tool that requires no meshing, has flexible geometry, excludes unnecessary detail, and is less time-intensive than more detailed computer-aided engineering modeling approaches.

  3. Selecting short-statured children needing growth hormone testing: Derivation and validation of a clinical decision rule

    Directory of Open Access Journals (Sweden)

    Bréart Gérard

    2008-07-01

    Full Text Available Abstract Background Numerous short-statured children are evaluated for growth hormone (GH deficiency (GHD. In most patients, GH provocative tests are normal and are thus in retrospect unnecessary. Methods A retrospective cohort study was conducted to identify predictors of growth hormone (GH deficiency (GHD in children seen for short stature, and to construct a very sensitive and fairly specific predictive tool to avoid unnecessary GH provocative tests. GHD was defined by the presence of 2 GH concentration peaks Results The initial study included 167 patients, 36 (22% of whom had GHD, including 5 (3% with certain GHD. Independent predictors of GHD were: growth rate Conclusion We have derived and performed an internal validation of a highly sensitive decision rule that could safely help to avoid more than 2/3 of the unnecessary GH tests. External validation of this rule is needed before any application.

  4. Tank closure reducing grout

    International Nuclear Information System (INIS)

    Caldwell, T.B.

    1997-01-01

    A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr 90 , the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel

  5. Reducing transfusion requirements in liver transplantation.

    Science.gov (United States)

    Donohue, Ciara I; Mallett, Susan V

    2015-12-24

    Liver transplantation (LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusion-free transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical "piggyback" techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management (PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT.

  6. The introduction of compulsory compliance testing of medical diagnostic x-ray equipment in Western Australia

    International Nuclear Information System (INIS)

    Rafferty, M. W.; Jacob, C. S.

    1995-01-01

    Performance testing of medical diagnostic X-ray equipment can reveal equipment faults which, while not always clinically detectable, may contribute to reduced image quality and unnecessary radiation exposure of both patients and staff. Routine testing of such equipment is highly desirable to identify such faults and allows them to be rectified. The Radiological council of Western Australia is moving towards requiring compulsory compliance testing of all (new and existing) medical diagnostic X-ray equipment that all new mobile radiographic and new mammographic X-ray equipment be issued with a compliance test certificate as a prerequisite for registration. Workbooks which provide details of the tests required and recommended test methods have been prepared for medical radiographic (mobile and fixed), fluoroscopic and mammographic X-ray equipment. It is intended that future workbooks include details of the tests and methods for dental and computed tomography X-ray units. The workbooks are not limited to the compliance testing of items as specified in the Regulations, but include tests for other items such as film processing, darkrooms and image quality (for fluoroscopic equipment). Many of the workbook tests could be used within a regular quality assurance program for diagnostic X-ray equipment. Persons who conduct such compliance tests will need to be licensed and have all test certificates endorsed by a qualified expert. Suitable training and assessment of compliance testers will be required. Notification of such tests (including non-compliant items and corrective actions taken) will be required by the Radiological Council as a condition of equipment registration. 9 refs

  7. Radiological bile acid absorption test {sup 75}SeHCAT in patients with diarrhoea of unknown cause

    Energy Technology Data Exchange (ETDEWEB)

    Rudberg, U. [St. Goeran`s Hospital, Stockholm (Sweden). Dept. of Diagnostic Radiology; Nylander, B. [St. Goeran`s Hospital, Stockholm (Sweden). Dept. of Internal Medicine

    1996-09-01

    Purpose: The purpose with this study was to investigate the usefulness of the {sup 75}SeHCAT test in patients suffering from `functional` diarrhoea and to disclose earlier radiological investigations performed in the course of disease. Material and Methods: Twenty patients with chronic diarrhoea of unknown cause were investigated with the {sup 75}SeHCAT test. The cholestyramine test and an estimation of oro-caecal transit time (OCTT) were also performed in 13 and 10 patients respectively. Results: Ten patients had low 7-day retention ({<=}15%). Nine of these were tested with cholestyramine and 8 showed complete relief from the diarrhoea. The cholestyramine test had no effect on the 4 patients with normal bile acid retention. No correlation was found between the retention of {sup 75}SeHCAT and OCCT. A total of 80 inconclusive gastrointestinal barium examinations were performed during the course of disease. Conclusion: Pathological bile acid retention, studied with the radiological {sup 75}SeHCAT test, is common in patients with diarrhoea of unknown cause. The test should be performed earlier in the course of disease in order to prevent unnecessary radiological investigations and to reduce patient suffering and distress. (orig.).

  8. A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive Italian women.

    Science.gov (United States)

    Cortesi, L; Razzaboni, E; Toss, A; De Matteis, E; Marchi, I; Medici, V; Tazzioli, G; Andreotti, A; De Santis, G; Pignatti, M; Federico, M

    2014-01-01

    Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization.

  9. Blood test ordering for unexplained complaints in general practice: the VAMPIRE randomised clinical trial protocol. [ISRCTN55755886

    NARCIS (Netherlands)

    van Bokhoven, Marloes A.; Koch, Hèlen; van der Weijden, Trudy; Grol, Richard P. T. M.; Bindels, Patrick J. E.; Dinant, Geert-Jan

    2006-01-01

    BACKGROUND: General practitioners (GPs) frequently order blood tests when they see patients presenting with unexplained complaints. Due to the low prevalence of serious pathology in general practice, the risk of false-positive test results is relatively high. This may result in unnecessary further

  10. 3G - An Unnecessary Step Forward?

    DEFF Research Database (Denmark)

    Tan, Su-En

    2004-01-01

    Today’s mobile telecommunication world is a fast changing one with many changes happening daily. What has been happening in this field is one that is both exciting and surprising. Leading the introduction of 3rd Generation mobile communication services are countries such as Japan and South Korea ...

  11. [Genetically modified food--unnecessary controversy?].

    Science.gov (United States)

    Tchórz, Michał; Radoniewicz-Chagowska, Anna; Lewandowska-Stanek, Hanna; Szponar, Elzbieta; Szponar, Jarosław

    2012-01-01

    Fast development of genetic engineering and biotechnology allows use of genetically modified organisms (GMO) more and more in different branches of science and economy. Every year we can see an increase of food amount produced with the use of modification of genetic material. In our supermarkets we can find brand new types of plants, products including genetically modified ingredients or meat from animals fed with food containing GMO. This article presents general information about genetically modified organisms, it also explains the range of genetic manipulation, use of newly developed products and current field area for GMO in the world. Based on scientific data the article presents benefits from development of biotechnology in reference to modified food. It also presents the voice of skeptics who are extremely concerned about the impact of those organisms on human health and natural environment. Problems that appear or can appear as a result of an increase of GMO are very important not only from a toxicologist's or a doctor's point of view but first of all from the point of view of ordinary consumers--all of us.

  12. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development.

    Science.gov (United States)

    Flowers, Paul; Wu, Olivia; Lorimer, Karen; Ahmed, Bipasha; Hesselgreaves, Hannah; MacDonald, Jennifer; Cayless, Sandi; Hutchinson, Sharon; Elliott, Lawrie; Sullivan, Ann; Clutterbuck, Dan; Rayment, Michael; McDaid, Lisa

    2017-01-01

    Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. Overall, trials included in this review ( n  = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk

  13. General practitioner views on the determinants of test ordering: a theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care.

    LENUS (Irish Health Repository)

    Cadogan, S L

    2016-07-19

    Research suggests that variation in laboratory requesting patterns may indicate unnecessary test use. Requesting patterns for serum immunoglobulins vary significantly between general practitioners (GPs). This study aims to explore GP\\'s views on testing to identify the determinants of behaviour and recommend feasible intervention strategies for improving immunoglobulin test use in primary care.

  14. Diagnostic testing for celiac disease among patients with abdominal symptoms a systematic review

    NARCIS (Netherlands)

    van der Windt, D.A.W.M.; Jellema, A.P.; Mulder, C.J.J.; Kneepkens, C.M.F.; van der Horst, H.E.

    2010-01-01

    Context: The symptoms and consequences of celiac disease usually resolve with a lifelong gluten-free diet. However, clinical presentation is variable and most patients presenting with abdominal symptoms in primary care will not have celiac disease and unnecessary diagnostic testing should be

  15. Diagnostic testing for celiac disease among patients with abdominal symptoms: a systematic review

    NARCIS (Netherlands)

    van der Windt, Daniëlle A. W. M.; Jellema, Petra; Mulder, Chris J.; Kneepkens, C. M. Frank; van der Horst, Henriëtte E.

    2010-01-01

    The symptoms and consequences of celiac disease usually resolve with a lifelong gluten-free diet. However, clinical presentation is variable and most patients presenting with abdominal symptoms in primary care will not have celiac disease and unnecessary diagnostic testing should be avoided. To

  16. Diagnostic x-ray equipment compliance and facility survey. Recommended procedures for equipment and facility testing

    International Nuclear Information System (INIS)

    1994-01-01

    The Radiation Protection Bureau has set out guidelines for the testing of diagnostic x-ray equipment and facilities. This guide provides information for the x-ray inspector, test engineer, technologist, medical physicist and any other person responsible for verifying the regulatory compliance or safety of diagnostic x-ray equipment and facilities. Diagnostic x-radiation is an essential part of present day medical practice. The largest contributor of irradiation to the general population comes from diagnostic x-radiation. Although individual irradiations are usually small, there is a concern of possible excess cancer risk when large populations are irradiated. Unnecessary irradiations to patients from radiological procedures can be significantly reduced with little or no decrease in the value of medical diagnostic information. This can be achieved by using well designed x-ray equipment which is installed, used and maintained by trained personnel, and by the adoption of standardized procedures. In general, when patient surface dose is reduced, there is a corresponding decrease in dose to x-ray equipment operators and other health care personnel. 2 tabs., 4 figs

  17. Diagnostic x-ray equipment compliance and facility survey. Recommended procedures for equipment and facility testing

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    The Radiation Protection Bureau has set out guidelines for the testing of diagnostic x-ray equipment and facilities. This guide provides information for the x-ray inspector, test engineer, technologist, medical physicist and any other person responsible for verifying the regulatory compliance or safety of diagnostic x-ray equipment and facilities. Diagnostic x-radiation is an essential part of present day medical practice. The largest contributor of irradiation to the general population comes from diagnostic x-radiation. Although individual irradiations are usually small, there is a concern of possible excess cancer risk when large populations are irradiated. Unnecessary irradiations to patients from radiological procedures can be significantly reduced with little or no decrease in the value of medical diagnostic information. This can be achieved by using well designed x-ray equipment which is installed, used and maintained by trained personnel, and by the adoption of standardized procedures. In general, when patient surface dose is reduced, there is a corresponding decrease in dose to x-ray equipment operators and other health care personnel. 2 tabs., 4 figs.

  18. Repeat prostate-specific antigen (PSA) test before prostate biopsy: a 20% decrease in PSA values is associated with a reduced risk of cancer and particularly of high-grade cancer.

    Science.gov (United States)

    De Nunzio, Cosimo; Lombardo, Riccardo; Nacchia, Antonio; Tema, Giorgia; Tubaro, Andrea

    2018-07-01

    To analyse the impact of repeating a prostate-specific antigen (PSA) level assessment on prostate biopsy decision in a cohort of men undergoing prostate biopsy. From 2015 onwards, we consecutively enrolled, at a single institution in Italy, men undergoing 12-core transrectal ultrasonography-guided prostate needle biopsy. Indication for prostate biopsy was a PSA level of ≥4 ng/mL. Demographic, clinical, and histopathological data were collected. The PSA level was tested at enrolment (PSA 1 ) and 4 weeks later on the day before biopsy (PSA 2 ). Variations in PSA level were defined as: stable PSA 2 within a 10% variation, stable PSA 2 within a 20% variation, PSA 2 decreased by ≥10%, PSA 2 decreased by ≥20%, PSA 2 increased by ≥10%, PSA 2 increased by ≥20%, and PSA 2 PSA within 20% variation had a higher risk of prostate cancer (odds ratio [OR] 1.80, P PSA2 decreased by ≥20% had a lower risk of prostate cancer (OR 0.37, P PSA2 increased by ≥10% had an increased risk of high-grade prostate cancer (OR 1.93, P PSA returned to normal values (PSA levels significantly reduced the risk of high-grade prostate cancer. Further multicentre studies should validate our present results. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

  19. Testing the Efficacy of Combined Motivational Interviewing and Cognitive Behavioral Skills Training to Reduce Methamphetamine Use and Improve HIV Medication Adherence Among HIV-Positive Gay and Bisexual Men.

    Science.gov (United States)

    Parsons, Jeffrey T; John, Steven A; Millar, Brett M; Starks, Tyrel J

    2018-03-13

    Prior research has identified subgroups of HIV-positive gay and bisexual men (GBM) based upon information, motivation, and behavioral skills (IMB) profiles related to HIV medication adherence and methamphetamine use. We conducted a randomized controlled trial of a combined motivational interview (MI) and cognitive behavioral therapy (CBT) intervention tailored specifically to the unique context of HIV-positive GBM, and tested whether IMB profiles moderated treatment effects. HIV-positive GBM (N = 210) were randomized to MI + CBT or an attention-matched education control. Both conditions resulted in reduced methamphetamine use, improved medication adherence (and higher CD4 and lower viral loads), and fewer acts of condomless anal sex at 3, 6, 9 and 12 months post-intervention. Furthermore, the MI + CBT condition achieved greater improvements in medication adherence for men who had greater barriers to change compared to similarly-classified men in the control condition, suggesting the importance of pre-intervention profiles for tailoring future interventions.

  20. Reducing rotor weight

    Energy Technology Data Exchange (ETDEWEB)

    Cheney, M.C. [PS Enterprises, Inc., Glastonbury, CT (United States)

    1997-12-31

    The cost of energy for renewables has gained greater significance in recent years due to the drop in price in some competing energy sources, particularly natural gas. In pursuit of lower manufacturing costs for wind turbine systems, work was conducted to explore an innovative rotor designed to reduce weight and cost over conventional rotor systems. Trade-off studies were conducted to measure the influence of number of blades, stiffness, and manufacturing method on COE. The study showed that increasing number of blades at constant solidity significantly reduced rotor weight and that manufacturing the blades using pultrusion technology produced the lowest cost per pound. Under contracts with the National Renewable Energy Laboratory and the California Energy Commission, a 400 kW (33m diameter) turbine was designed employing this technology. The project included tests of an 80 kW (15.5m diameter) dynamically scaled rotor which demonstrated the viability of the design.

  1. Limiting the testing of urea: Urea along with every plasma creatinine test?

    Science.gov (United States)

    Zhang, Gao-Ming; Guo, Xu-Xiao; Zhang, Guo-Ming

    2017-09-01

    We found that it is not necessary to simultaneously detect both creatinine (CREA) and urea until the concentration of CREA is lower than the certain level. To reduce urea testing, we suggest measuring urea only when CREA or estimated glomerular filtration rate (eGFR) exceeds a predetermined limit. CREA and urea data were analyzed consisting of almost all of people age above 65 years old check-up (n=95441) in Shuyang countryside, and inpatients (n=101631), outpatients (n=18474) and Routine Health Check-up (n=20509) in Shuyang People's Hospital. The proportions of elevated urea were derived. The data used in this study was generated from people more than 13 years old in both outpatients and inpatients. When the limits for initiating urea testing were used at 85 μmol/L CREA and 120 mL/min/1.73 m 2 eGFR, the percentage of unnecessary urea test are 94.5% and 64.7% (elderly health check-up), 67.9% and 84.5% (outpatients), 88.5% and 73.2% (inpatients), 92.2% and 81.7% (routine health check-up). The missing rate of urea are 1%, 2.5%, 4.6% and 9.2%, 0.1%, 0.4%, 0.9% and 1.8%, 0.4%, 0.8%, 1.4%, and 2.5%, 0.05%, 0.1%, 1.1%, and 0.8% of ureas exceeding 9.28 mmol/L and 8.3 mmol/L in above each group, respectively. If the CREA≤85 μmol/L or eGFR≥90 mL/min/1.73 m 2 , there is 97.5% urea urea missed is 2.5%. We suggest that the initiating urea testing should be based on the upper limit of Reference Intervals serum CREA of females or a 120 mL/min/1.73 m 2 eGFR limit. Conservatively, the urea testing would be reduced by 65% at least. © 2017 Wiley Periodicals, Inc.

  2. Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial.

    Science.gov (United States)

    Do, Nga T T; Ta, Ngan T D; Tran, Ninh T H; Than, Hung M; Vu, Bich T N; Hoang, Long B; van Doorn, H Rogier; Vu, Dung T V; Cals, Jochen W L; Chandna, Arjun; Lubell, Yoel; Nadjm, Behzad; Thwaites, Guy; Wolbers, Marcel; Nguyen, Kinh V; Wertheim, Heiman F L

    2016-09-01

    Inappropriate antibiotic use for acute respiratory tract infections is common in primary health care, but distinguishing serious from self-limiting infections is difficult, particularly in low-resource settings. We assessed whether C-reactive protein point-of-care testing can safely reduce antibiotic use in patients with non-severe acute respiratory tract infections in Vietnam. We did a multicentre open-label randomised controlled trial in ten primary health-care centres in northern Vietnam. Patients aged 1-65 years with at least one focal and one systemic symptom of acute respiratory tract infection were assigned 1:1 to receive either C-reactive protein point-of-care testing or routine care, following which antibiotic prescribing decisions were made. Patients with severe acute respiratory tract infection were excluded. Enrolled patients were reassessed on day 3, 4, or 5, and on day 14 a structured telephone interview was done blind to the intervention. Randomised assignments were concealed from prescribers and patients but not masked as the test result was used to assist treatment decisions. The primary outcome was antibiotic use within 14 days of follow-up. All analyses were prespecified in the protocol and the statistical analysis plan. All analyses were done on the intention-to-treat population and the analysis of the primary endpoint was repeated in the per-protocol population. This trial is registered under number NCT01918579. Between March 17, 2014, and July 3, 2015, 2037 patients (1028 children and 1009 adults) were enrolled and randomised. One adult patient withdrew immediately after randomisation. 1017 patients were assigned to receive C-reactive protein point-of-care testing, and 1019 patients were assigned to receive routine care. 115 patients in the C-reactive protein point-of-care group and 72 patients in the routine care group were excluded in the intention-to-treat analysis due to missing primary endpoint. The number of patients who used antibiotics

  3. The role of molecular diagnostic testing in the management of thyroid nodules.

    Science.gov (United States)

    Moore, Maureen D; Panjwani, Suraj; Gray, Katherine D; Finnerty, Brendan M; Zarnegar, Rasa; Fahey, Thomas J

    2017-06-01

    Fine needle aspiration (FNA) with cytologic examination remains the standard of care for investigation of thyroid nodules. However, as many as 30% of FNA samples are cytologically indeterminate for malignancy, which confounds clinical management. To reduce the burden of repeat diagnostic testing and unnecessary surgery, there has been extensive investigation into molecular markers that can be detected on FNA specimens to more accurately stratify a patient's risk of malignancy. Areas covered: In this review, the authors discuss recent evidence and progress in molecular markers used in the diagnosis of thyroid cancer highlighting somatic gene alterations, molecular technologies and microRNA analysis. Expert commentary: The goal of molecular markers is to improve diagnostic accuracy and aid clinicians in the preoperative management of thyroid lesions. Modalities such as direct mutation analysis, mRNA gene expression profiling, next-generation sequencing, and miRNA expression profiling have been explored to improve the diagnostic accuracy of thyroid nodule FNA. Although no perfect test has been discovered, molecular diagnostic testing has revolutionized the management of thyroid nodules.

  4. Economic impact of clinical variability in preoperative testing for major outpatient surgery.

    Science.gov (United States)

    Gil-Borrelli, Christian Carlo; Agustí, Salomé; Pla, Rosa; Díaz-Redondo, Alicia; Zaballos, Matilde

    2016-05-01

    With the purpose of decreasing the existing variability in the criteria of preoperative evaluation and facilitating the clinical decision-making process, our hospital has a protocol of preoperative tests to use with ASA I and ASA II patients. The aim of the study was to calculate the economic impact caused by clinicians' non-adherence to the protocol for the anaesthesiological evaluation of ASA 1 and ASA II patients. A retrospective study of costs with a random sample of 353 patients that were seen in the consultation for Anesthesiology over a period of one year. Aspects related to the costs, patient's profiles and specialties were analysed, according to the degree of fulfillment of the protocol. The lack of adherence to the the protocol was 70%. 130 chest X-rays and 218 ECG were performed without indication. This generated an excess costs of 34 € per patient. Taking into account the expenses of both tests and the attended population undergoing ambulatory surgery during the one-year period, an excess spending for the hospital of between 69.164 € and 83.312 € was estimated. Clinical variability should be reduced and the creation of synergies between the different departments should be enhanced in order to adjust the request for unnecessary complementary tests to decrease health care and to improve the quality of patient care. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. A test of the stress-buffering model of social support in smoking cessation: is the relationship between social support and time to relapse mediated by reduced withdrawal symptoms?

    Science.gov (United States)

    Creswell, Kasey G; Cheng, Yu; Levine, Michele D

    2015-05-01

    Social support has been linked to quitting smoking, but the mechanisms by which social support affects cessation are poorly understood. The current study tested a stress-buffering model of social support, which posits that social support protects or "buffers" individuals from stress related to quitting smoking. We hypothesized that social support would be negatively associated with risk of relapse, and that this effect would be mediated by reduced withdrawal and depressive symptoms (i.e., cessation-related stress) over time. Further, we predicted that trait neuroticism would moderate this mediational effect, such that individuals high in negative affectivity would show the greatest stress-buffering effects of social support. Participants were weight-concerned women (n = 349) ages 18-65 enrolled in a randomized, double-blind, placebo-controlled smoking cessation trial of bupropion and cognitive behavioral therapy. Social support was assessed at baseline, and biochemically-verified abstinence, withdrawal-related symptoms, and depressive symptoms were assessed at 1-, 3-, 6-, and 12-months follow-up. Social support was negatively related to risk of relapse in survival models and negatively related to withdrawal symptoms and depression in mixed effects models. These relationships held after controlling for the effects of pre-quit day negative affect and depression symptoms, assignment to treatment condition, and number of cigarettes smoked per day. A temporal mediation model showed that the effect of social support on risk of relapse was mediated by reductions in withdrawal symptoms over time but not by depression over time. Contrary to hypotheses, we did not find that neuroticism moderated this mediation effect. Increased social support may buffer women from the harmful effects of cessation-related withdrawal symptoms, which in turn improve cessation outcomes. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and

  6. Role of Gonadotropin-releasing Hormone Stimulation Test in Diagnosing Gonadotropin Deficiency in Both Males and Females with Delayed Puberty

    Directory of Open Access Journals (Sweden)

    Qi-Hong Sun

    2015-01-01

    Conclusions: Our data suggest that isolated use of the gonadorelin stimulation test is almost sufficient to discriminate between HH and CDP in males, but unnecessary in females. The most useful predictor is serum basal or peak LH to differentiate these two disorders in males, but serum basal LH or FSH in females.

  7. Denver screening protocol for blunt cerebrovascular injury reduces the use of multi-detector computed tomography angiography.

    Science.gov (United States)

    Beliaev, Andrei M; Barber, P Alan; Marshall, Roger J; Civil, Ian

    2014-06-01

    Blunt cerebrovascular injury (BCVI) occurs in 0.2-2.7% of blunt trauma patients and has up to 30% mortality. Conventional screening does not recognize up to 20% of BCVI patients. To improve diagnosis of BCVI, both an expanded battery of screening criteria and a multi-detector computed tomography angiography (CTA) have been suggested. The aim of this study is to investigate whether the use of CTA restricted to the Denver protocol screen-positive patients would reduce the unnecessary use of CTA as a pre-emptive screening tool. This is a registry-based study of blunt trauma patients admitted to Auckland City Hospital from 1998 to 2012. The diagnosis of BCVI was confirmed or excluded with CTA, magnetic resonance angiography and, if these imaging were non-conclusive, four-vessel digital subtraction angiography. Thirty (61%) BCVI and 19 (39%) non-BCVI patients met eligibility criteria. The Denver protocol applied to our cohort of patients had a sensitivity of 97% (95% confidence interval (CI): 83-100%) and a specificity of 42% (95% CI: 20-67%). With a prevalence of BCVI in blunt trauma patients of 0.2% and 2.7%, post-test odds of a screen-positive test were 0.03 (95% CI: 0.002-0.005) and 0.046 (95% CI: 0.314-0.068), respectively. Application of the CTA to the Denver protocol screen-positive trauma patients can decrease the use of CTA as a pre-emptive screening tool by 95-97% and reduces its hazards. © 2013 Royal Australasian College of Surgeons.

  8. 'Test n Treat (TnT)': a cluster-randomised feasibility trial of frequent, rapid-testing and same-day, on-site treatment to reduce rates of chlamydia in high-risk further education college students: statistical analysis plan.

    Science.gov (United States)

    Phillips, Rachel; Oakeshott, Pippa; Kerry-Barnard, Sarah; Reid, Fiona

    2018-06-05

    There are high rates of sexually transmitted infections (STIs) in ethnically diverse, sexually active students aged 16-24 years attending London further education (FE) colleges. However, uptake of chlamydia screening remains low. The TnT study aims to assess the feasibility of conducting a future trial in FE colleges to investigate if frequent, rapid, on-site testing and treatment (TnT) reduces chlamydia rates. This article presents the statistical analysis plan for the main study publication as approved and signed off by the Trial Management Group prior to the first data extraction for the final report. TnT is a cluster-randomised feasibility trial conducted over 7 months with parallel qualitative and economic assessments. Colleges will be randomly allocated into the intervention (TnT) or the control group (no TnT). Six FE colleges in London will be included. At each college for 2 days, 80 consecutive sexually active students aged 16-24 years (total 480 students across all six colleges) will be recruited from public areas and asked to provide baseline samples. One and 4 months after recruitment intervention colleges will be visited on two consecutive days by the TnT team where participating students will be texted and invited to come for same-day, on-site, rapid chlamydia testing and, if positive, treatment. Participants in the control colleges will receive 'thank you' texts 1 and 4 months after recruitment. Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to participants with positive results. Key feasibility outcomes include: recruitment rates, testing and treatment uptake rates (at 1 and 4 months) and follow-up rates (at 7 months). ISRCTN 58038795 . Registered on 31 August 2016.

  9. Imaging techniques for ultrasonic testing

    International Nuclear Information System (INIS)

    2013-01-01

    These seminar proceedings contain 16 lectures on the following topics: 1. From imaging to quantification - ultrasound methods in medical diagnostics; 2. SAFT, TOFD, Phased Array - classical applications and recent developments in ultrasonic imaging; 3. Innovative ultrasonic imaging methods in research and application; 4. Industrial ultrasonic testing of fibre-reinforced structures of complex geometry; 5. Visualisation of crack tips in the inspection of wheel set shafts with longitudinal boreholes as a means of avoiding unnecessary wheel set changes; 6. Areal analysis of the propagation of Lamb waves on curved, anisotropic structures; 7. High-resolution representation in immersion technique testing; 8. Variants in generating images from phased array measurement data - practical examples involving copper, carbon-fibre reinforced plastic and other materials; 9. GIUM - an unconventional method of microstructure imaging using ultrasonic stimulation and laser vibrometry scanning; 10. Innovative air-ultrasonic testing concepts for improved imaging; 11. Use of imaging methods for improving the quality of test results from nondestructive testing; 12. Modelling and visualisation of EMUS stimulation for transducer optimisation; 13. Use of SAFT in the manufacture of energy conversion machines; 14. Ultrasonic imaging tests for improved defect characterisation during weld seam inspection on longitudinally welded large-diameter pipes; 15. SAFT reconstruction for testing austenitic weld seams and dissimilar metal weld seams for transverse cracks; 16. Imaging-based optimisation method for quantitative ultrasonic testing of anisotropic inhomogeneous austenitic welded joints with determination and utilisation of their elastic properties. One contribution has been abstracted separately. [de

  10. Reducing pollution at five critical points of shale gas production: Strategies and institutional responses

    International Nuclear Information System (INIS)

    Centner, Terence J.

    2016-01-01

    While the public and governments debate the advisability of engaging in shale gas production, the United States has proceeded to develop its resources with an accompanying remarkable increase in natural gas production. The development of shale gas has not been without problems, and some countries have decided that shale gas production should not proceed until more is known about the accompanying health issues and environmental damages. From experiences in the United States, careful consideration of five critical points relating to shale gas production can form the basis for developing strategies for reducing discharges of pollutants: (1) casing and cementing, (2) handling wastewater, (3) venting and flaring, (4) equipment with air emissions, and (5) seismic events. For each strategy, institutional responses to markedly reduce the risks of harm to people and the environment are identified. These responses offer state and local governments ideas for enabling shale gas resources to be developed without sacrificing public health and environmental quality. - Highlights: •Shale gas development involves releases of unnecessary pollutants. •Major sources of unnecessary pollutants can be identified. •For major pollutant sources, strategies can be developed to reduce releases of contaminants. •Alternative strategies can offer firms and governments ways to reduce pollutant releases.

  11. [Advantages and disadvantages of direct-to-consumer genetic tests].

    Science.gov (United States)

    Christiansen, Camilla Worm; Gerdes, Anne-Marie Axø

    2017-03-13

    Direct-to-consumer genetic tests are sold over the internet to consumers all over the world - including Denmark. No regulation of these tests has been introduced neither in Denmark nor in Europe, even though they have been on the market since 2007. Such tests have several advantages, but indeed also a long list of potential disadvantages, which are most often ignored, and among these is insufficient training of general practitioners in performing the necessary counselling but also the risk of increased expenses to unnecessary follow-up consultations.

  12. Risk-based inservice testing program modifications at Palo Verde nuclear generating station

    Energy Technology Data Exchange (ETDEWEB)

    Knauf, S.; Lindenlaub, B.; Linthicum, R.

    1996-12-01

    Arizona Public Service Company (APS) is investigating changes to the Palo Verde Inservice Testing (IST) Program that are intended to result in the reduction of the required test frequency for various valves in the American Society of Mechanical Engineers (ASME) Section XI IST program. The analytical techniques employed to select candidate valves and to demonstrate that these frequency reductions are acceptable are risk based. The results of the Palo Verde probabilistic risk assessment (PRA), updated in June 1994, and the risk significant determination performed as part of the implementation efforts for 10 CFR 50.65 (the maintenance rule) were used to select candidate valves for extended test intervals. Additional component level evaluations were conducted by an `expert panel.` The decision to pursue these changes was facilitated by the ASME Risk-Based Inservice Testing Research Task Force for which Palo Verde is participating as a pilot plant. The NRC`s increasing acceptance of cost beneficial licensing actions and risk-based submittals also provided incentive to seek these changes. Arizona Public Service is pursuing the risk-based IST program modification in order to reduce the unnecessary regulatory burden of the IST program through qualitative and quantitative analysis consistent with maintaining a high level of plant safety. The objectives of this project at Palo Verde are as follows: (1) Apply risk-based technologies to IST components to determine their risk significance (i.e., high or low). (2) Apply a combination of deterministic and risk-based methods to determine appropriate testing requirements for IST components including improvement of testing methods and frequency intervals for high-risk significant components. (3) Apply risk-based technologies to high-risk significant components identified by the {open_quotes}expert panel{close_quotes} and outside of the IST program to determine whether additional testing requirements are appropriate.

  13. Risk-based inservice testing program modifications at Palo Verde nuclear generating station

    International Nuclear Information System (INIS)

    Knauf, S.; Lindenlaub, B.; Linthicum, R.

    1996-01-01

    Arizona Public Service Company (APS) is investigating changes to the Palo Verde Inservice Testing (IST) Program that are intended to result in the reduction of the required test frequency for various valves in the American Society of Mechanical Engineers (ASME) Section XI IST program. The analytical techniques employed to select candidate valves and to demonstrate that these frequency reductions are acceptable are risk based. The results of the Palo Verde probabilistic risk assessment (PRA), updated in June 1994, and the risk significant determination performed as part of the implementation efforts for 10 CFR 50.65 (the maintenance rule) were used to select candidate valves for extended test intervals. Additional component level evaluations were conducted by an 'expert panel.' The decision to pursue these changes was facilitated by the ASME Risk-Based Inservice Testing Research Task Force for which Palo Verde is participating as a pilot plant. The NRC's increasing acceptance of cost beneficial licensing actions and risk-based submittals also provided incentive to seek these changes. Arizona Public Service is pursuing the risk-based IST program modification in order to reduce the unnecessary regulatory burden of the IST program through qualitative and quantitative analysis consistent with maintaining a high level of plant safety. The objectives of this project at Palo Verde are as follows: (1) Apply risk-based technologies to IST components to determine their risk significance (i.e., high or low). (2) Apply a combination of deterministic and risk-based methods to determine appropriate testing requirements for IST components including improvement of testing methods and frequency intervals for high-risk significant components. (3) Apply risk-based technologies to high-risk significant components identified by the open-quotes expert panelclose quotes and outside of the IST program to determine whether additional testing requirements are appropriate

  14. Excitation power quantities in phase resonance testing of nonlinear systems with phase-locked-loop excitation

    Science.gov (United States)

    Peter, Simon; Leine, Remco I.

    2017-11-01

    Phase resonance testing is one method for the experimental extraction of nonlinear normal modes. This paper proposes a novel method for nonlinear phase resonance testing. Firstly, the issue of appropriate excitation is approached on the basis of excitation power considerations. Therefore, power quantities known from nonlinear systems theory in electrical engineering are transferred to nonlinear structural dynamics applications. A new power-based nonlinear mode indicator function is derived, which is generally applicable, reliable and easy to implement in experiments. Secondly, the tuning of the excitation phase is automated by the use of a Phase-Locked-Loop controller. This method provides a very user-friendly and fast way for obtaining the backbone curve. Furthermore, the method allows to exploit specific advantages of phase control such as the robustness for lightly damped systems and the stabilization of unstable branches of the frequency response. The reduced tuning time for the excitation makes the commonly used free-decay measurements for the extraction of backbone curves unnecessary. Instead, steady-state measurements for every point of the curve are obtained. In conjunction with the new mode indicator function, the correlation of every measured point with the associated nonlinear normal mode of the underlying conservative system can be evaluated. Moreover, it is shown that the analysis of the excitation power helps to locate sources of inaccuracies in the force appropriation process. The method is illustrated by a numerical example and its functionality in experiments is demonstrated on a benchmark beam structure.

  15. Alternative approaches to vertebrate ecotoxicity tests in the 21st century: A review of developments over the last 2 decades and current status

    Science.gov (United States)

    Lillicrap, Adam; Belanger, Scott; Burden, Natalie; Du Pasquier, David; Embry, Michelle; Halder, Marlies; Lampi, Mark; Lee, Lucy; Norberg-King, Teresa J.; Rattner, Barnett A.; Schirmer, Kristin; Thomas, Paul

    2016-01-01

    The need for alternative approaches to the use of vertebrate animals for hazard assessment of chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimized wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments has been banned; in other situations, the number of organisms tested has been dramatically reduced or the severity of the procedure refined. However, there is still a long way to go to achieve a complete replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is based not just on ethical considerations but also on reducing the cost of performing vertebrate ecotoxicity tests and in some cases on providing better information aimed at improving environmental risk assessments. The present Focus article provides an overview of the considerable advances that have been made toward alternative approaches for ecotoxicity assessments over the last few decades.

  16. Alternative approaches to vertebrate ecotoxicity tests in the 21st century: A review of developments over the last 2 decades and current status.

    Science.gov (United States)

    Lillicrap, Adam; Belanger, Scott; Burden, Natalie; Pasquier, David Du; Embry, Michelle R; Halder, Marlies; Lampi, Mark A; Lee, Lucy; Norberg-King, Teresa; Rattner, Barnett A; Schirmer, Kristin; Thomas, Paul

    2016-11-01

    The need for alternative approaches to the use of vertebrate animals for hazard assessment of chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimized wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments has been banned; in other situations, the number of organisms tested has been dramatically reduced or the severity of the procedure refined. However, there is still a long way to go to achieve a complete replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is based not just on ethical considerations but also on reducing the cost of performing vertebrate ecotoxicity tests and in some cases on providing better information aimed at improving environmental risk assessments. The present Focus article provides an overview of the considerable advances that have been made toward alternative approaches for ecotoxicity assessments over the last few decades. Environ Toxicol Chem 2016;35:2637-2646. © 2016 SETAC. © 2016 SETAC.

  17. Technology-assisted self-testing and management of oral anticoagulation therapy: a qualitative patient-focused study.

    Science.gov (United States)

    Kuljis, Jasna; Money, Arthur G; Perry, Mark; Barnett, Julie; Young, Terry

    2017-09-01

    Oral anticoagulation therapy requires regular blood testing to ensure therapeutic levels are maintained and excessive bleeding/clotting is avoided. Technology-assisted self-testing and management is seen as one of the key areas in which quality of care can be improved whilst reducing costs. Nevertheless, levels of patient engagement in self-testing and management remain low. To date, little research emphasis has been placed on understanding the patients' perspectives for low engagement. The typical approach adopted by healthcare providers is to provide patient education programmes, with the expectation that individual patients will change their behaviour and adopt new self-care strategies. However, if levels of patient engagement are to be increased, healthcare providers must also develop a better understanding of how their clinical service provision is perceived by patients and make adaptations. To explore patient views, needs and expectations of an anticoagulation service and the self-testing and management services provided. Interviews were conducted with 17 patients who currently engage in international normalised ratio (INR) self-testing and management. Thematic coding and analysis were carried out on the interview transcripts. Four high-level themes emerged from interviews: (i) role of clinic, (ii) motivations for self-testing, (iii) managing INR and (iv) trust. The clinic was seen as adding value in terms of specifying testing frequency, dosage profiles and calibrating equipment. Prompt communication from clinic to patient was also valued, although more personalised/real-time communication would help avoid feelings of isolation. Patients felt more in control as self-tester/managers and often took decisions about treatment adjustments themselves. However, some also manipulated their own test results to avoid 'unnecessary' interventions. More personalised/real-time communication, pragmatic and collaborative patient-clinician partnerships and recognition of

  18. Automatic test pattern generation for stuck-at and delay faults in combinational circuits

    International Nuclear Information System (INIS)

    Kim, Dae Sik

    1998-02-01

    The present studies are developed to propose the automatic test pattern generation (ATG) algorithms for combinational circuits. These ATG algorithms are realized in two ATG programs: One is the ATG program for stuck-at fault and the other one for delay faults. In order to accelerate the ATG process, these two ATG programs have a common feature (the search method based on the concept of the degree of freedom), whereas only ATG program for the delay fault utilizes the 19-valued logic, a type of composite valued logic. This difference between two ATG programs results from the difference of the target fault. Accelerating the ATG process is indispensable for improving the ATG algorithms. This acceleration is mainly achieved by reducing the number of the unnecessary backtrackings, making the earlier detection of the conflicts, and shortening the computation time between the implication. Because of this purpose, the developed ATG programs include the new search method based on the concept of the degree of freedom (DF). The DF concept, computed directly and easily from the system descriptions such as types of gates and their interconnections, is the criterion to decide which, among several alternate lines' logic values required along each path, promises to be the most effective in order to accelerate and improve the ATG process. This DF concept is utilized to develop and improve both of ATG programs for stuck-at and delay faults in combinational circuits. In addition to improving the ATG process, reducing number of test pattern is indispensable for testing the delay faults because the size of the delay faults grows rapidly as increasing the size of the circuit. In order to improve the compactness of the test set, 19-valued logic are derived. Unlike other TG logic systems, 19-valued logic is utilized to generate the robustly hazard-free test pattern. This is achieved by using the basic 5-valued logic, proposed in this work, where the transition with no hazard is

  19. Toxicity testing of polymer materials for dialysis equipment: reconsidering in vivo testing.

    Science.gov (United States)

    Sauer, U G; Liebsch, M; Kolar, R

    2000-01-01

    In fulfilment of the aims of the European Union Biocidal Directive (Directive 98/8/EC), Technical Guidance Documents are currently being compiled. Part I of these Technical Guidance Documents covers data requirements for active substances and biocidal products. The Three Rs principle has been applied in certain parts of the toxicity and ecotoxicity testing scheme for pesticides, such as testing for acute oral toxicity, skin and eye irritation, skin sensitisation, and dermal absorption. Further recommendations on how to proceed with regard to the continuing replacement, reduction and refinement of animal experiments in this field of regulatory testing are included for consideration. In this context, besides stressing the necessity to validate and accept further alternatives, emphasis is placed on providing the possibility of waiving unnecessary tests and on the continuous evaluation of whether certain tests are needed at all. 2000 FRAME.

  20. Reduced Rank Regression

    DEFF Research Database (Denmark)

    Johansen, Søren

    2008-01-01

    The reduced rank regression model is a multivariate regression model with a coefficient matrix with reduced rank. The reduced rank regression algorithm is an estimation procedure, which estimates the reduced rank regression model. It is related to canonical correlations and involves calculating...

  1. Lean manufacturing implementation in reducing waste for electronic assembly line

    Directory of Open Access Journals (Sweden)

    Zakaria Nurul Husna

    2017-01-01

    Full Text Available Lean manufacturing is the most convenient way to eliminate unnecessary waste and can provide what customers demand. This paper presents possibilities and sustainability of application of lean manufacturing method by using a virtual simulation of the workers performance in a line production of small and medium industry. Actual case study and Witness simulation were used in this study to find the waste that exists in the production and identified the performance of workers in the production line. Lean manufacturing concept has identified and rectified problems related to low productivity in the assembly line. The case study is involved a line production for electronic part assembly. The result of this preliminary study should illustrate the relationship of worker’s performance by lean manufacturing method as well as the productivity improvements which help to reduce cost for manufacturer. Lean manufacturing method has been used during the study to reduce the cost when waste is eliminated by reducing the workstation without reducing the performance of the production. The performance of the production is increased when allocating the labor in a needed working area. Lastly, the study also proves that the new layout has improved the process to be used for future production process.

  2. Inappropriate emergency laboratory test ordering: defensive or peer evidence shared based medicine?

    Directory of Open Access Journals (Sweden)

    C. Descovich

    2013-05-01

    , defining the “best – locally applicable – standard of care”, are suitable tools to facilitate communication for reducing inappropriate test-ordering. CONCLUSIONS Excessive ordering increases the use of technology and adds unnecessary costs to the delivery of health care. Hospitals with growing health care costs can improve their resource utilization through peer management of testing behaviours by using evidence based medicine for clinical audit. A basic, homogeneous and shared panel of critical tests may be adopted even in complex health organizations, including several hospitals too.

  3. Alternative approaches for vertebrate ecotoxicity tests in the 21st century: A review of developments over the last 2 decades and current status

    Science.gov (United States)

    The need for alternative approaches to the use of vertebrate animals for hazard assessing chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate or...

  4. Effects of reducing exposure to air pollution on submaximal cardiopulmonary test in patients with heart failure: Analysis of the randomized, double-blind and controlled FILTER-HF trial.

    Science.gov (United States)

    Vieira, Jefferson L; Guimaraes, Guilherme V; de Andre, Paulo A; Saldiva, Paulo H Nascimento; Bocchi, Edimar A

    2016-07-15

    Air pollution exposure could mitigate the health benefits of exercise in patients with heart failure (HF). We tested the effects of a respiratory filter on HF patients exposed to air pollution during exercise. Ancillary analysis of the FILTER-HF trial, focused on the exercise outcomes. In a randomized, double-blind, 3-way crossover design, 26 HF patients and 15 control volunteers were exposed to clean air, unfiltered dilute diesel engine exhaust (DE), or filtered DE for 6min during a submaximal cardiopulmonary testing in a controlled-exposure facility. Prospectively collected data included six-minute walking test [6mwt], VO2, VE/VCO2 Slope, O2Pulse, pulmonary ventilation [VE], tidal volume, VD/Vt, oxyhemoglobin saturation and CO2-rebreathing. Compared to clean air, DE adversely affected VO2 (11.0±3.9 vs. 8.4±2.8ml/kg/min; preduced the particulate concentration from 325±31 to 25±6μg/m(3), and was associated with an increase in VO2 (10.4±3.8ml/kg/min; preduce the adverse effects of pollution on VO2 and O2Pulse. Given the worldwide prevalence of exposure to traffic-related air pollution, these findings are relevant for public health especially in this highly susceptible population. The filter intervention holds great promise that needs to be tested in future studies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Sleep can reduce proactive interference.

    Science.gov (United States)

    Abel, Magdalena; Bäuml, Karl-Heinz T

    2014-01-01

    Sleep has repeatedly been connected to processes of memory consolidation. While extensive research indeed documents beneficial effects of sleep on memory, little is yet known about the role of sleep for interference effects in episodic memory. Although two prior studies reported sleep to reduce retroactive interference, no sleep effect has previously been found for proactive interference. Here we applied a study format differing from that employed by the prior studies to induce a high degree of proactive interference, and asked participants to encode a single list or two interfering lists of paired associates via pure study cycles. Testing occurred after 12 hours of diurnal wakefulness or nocturnal sleep. Consistent with the prior work, we found sleep in comparison to wake did not affect memory for the single list, but reduced retroactive interference. In addition we found sleep reduced proactive interference, and reduced retroactive and proactive interference to the same extent. The finding is consistent with the view that arising benefits of sleep are caused by the reactivation of memory contents during sleep, which has been suggested to strengthen and stabilise memories. Such stabilisation may make memories less susceptible to competition from interfering memories at test and thus reduce interference effects.

  6. What do Cochrane systematic reviews say about the clinical effectiveness of screening and diagnostic tests for cancer?

    Directory of Open Access Journals (Sweden)

    André Tito Pereira Bueno

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: The purpose of screening tests for cancer is to detect it at an early stage in order to increase the chances of treatment. However, their unrestrained use may lead to unnecessary examinations, overdiagnosis and higher costs. It is thus necessary to evaluate their clinical effects in terms of benefits and harm. DESIGN AND SETTING: Review of Cochrane systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on the clinical effectiveness of cancer screening procedures were included. Study titles and abstracts were independently assessed by two authors. Conflicts were resolved by another two authors. Findings were summarized and discussed. RESULTS: Seventeen reviews were selected: fifteen on screening for specific cancers (bladder, breast, colorectal, hepatic, lung, nasopharyngeal, esophageal, oral, prostate, testicular and uterine and two others on cancer in general. The quality of evidence of the findings varied among the reviews. Only two reviews resulted in high-quality evidence: screening using low-dose computed tomography scans for high-risk individuals seems to reduce lung cancer mortality; and screening using flexible sigmoidoscopy and fecal occult blood tests seems to reduce colorectal cancer mortality. CONCLUSION: The evidence found through Cochrane reviews did not support most of the commonly used screening tests for cancer. It is recommended that patients should be informed of the possibilities of false positives and false negatives before they undergo the tests. Further studies to fully assess the effectiveness of cancer screening tests and adverse outcomes are required.

  7. Comparing diagnostic tests on benefit-risk.

    Science.gov (United States)

    Pennello, Gene; Pantoja-Galicia, Norberto; Evans, Scott

    2016-01-01

    Comparing diagnostic tests on accuracy alone can be inconclusive. For example, a test may have better sensitivity than another test yet worse specificity. Comparing tests on benefit risk may be more conclusive because clinical consequences of diagnostic error are considered. For benefit-risk evaluation, we propose diagnostic yield, the expected distribution of subjects with true positive, false positive, true negative, and false negative test results in a hypothetical population. We construct a table of diagnostic yield that includes the number of false positive subjects experiencing adverse consequences from unnecessary work-up. We then develop a decision theory for evaluating tests. The theory provides additional interpretation to quantities in the diagnostic yield table. It also indicates that the expected utility of a test relative to a perfect test is a weighted accuracy measure, the average of sensitivity and specificity weighted for prevalence and relative importance of false positive and false negative testing errors, also interpretable as the cost-benefit ratio of treating non-diseased and diseased subjects. We propose plots of diagnostic yield, weighted accuracy, and relative net benefit of tests as functions of prevalence or cost-benefit ratio. Concepts are illustrated with hypothetical screening tests for colorectal cancer with test positive subjects being referred to colonoscopy.

  8. Reduced abrasion drilling fluid

    NARCIS (Netherlands)

    2010-01-01

    A reduced abrasion drilling fluid system and method of drilling a borehole by circulating the reduced abrasion drilling fluid through the borehole is disclosed. The reduced abrasion drilling fluid comprises a drilling fluid, a first additive and a weighting agent, wherein the weighting agent has a

  9. Reduced abrasion drilling fluid

    NARCIS (Netherlands)

    2012-01-01

    A reduced abrasion drilling fluid system and method of drilling a borehole by circulating the reduced abrasion drilling fluid through the borehole is disclosed. The reduced abrasion drilling fluid comprises a drilling fluid, a first additive and a weighting agent, wherein the weighting agent has a

  10. Multiplex molecular testing for management of infectious gastroenteritis in a hospital setting: a comparative diagnostic and clinical utility study.

    Science.gov (United States)

    Halligan, E; Edgeworth, J; Bisnauthsing, K; Bible, J; Cliff, P; Aarons, E; Klein, J; Patel, A; Goldenberg, S

    2014-08-01

    Laboratory diagnosis and clinical management of inpatients with diarrhoea is complex and time consuming. Tests are often requested sequentially and undertaken in different laboratories. This causes prolonged unnecessary presumptive isolation of patients, because most cases are non-infectious. A molecular multiplex test (Luminex(®) Gastrointestinal Pathogen Panel (GPP)) was compared with conventional testing over 8 months to determine diagnostic accuracy, turnaround times, laboratory costs, use of isolation facilities and user acceptability. A total of 262 (12%) patients had a pathogen detected by conventional methods compared with 483 (22.1%) by GPP. Most additional cases were detected in patients developing symptoms in the first 4 days of admission. Additional cases were detected because of presumed improved diagnostic sensitivity but also because clinicians had not requested the correct pathogen. Turnaround time (41.8 h) was faster than bacterial culture (66.5 h) and parasite investigation (66.5 h) but slower than conventional testing for Clostridium difficile (17.3 h) and viruses (27 h). The test could allow simplified requesting by clinicians and a consolidated laboratory workflow, reducing the overall number of specimens received by the laboratory. A total of 154 isolation days were saved at an estimated cost of £30 800. Consumables and labour were estimated at £150 641 compared with £63 431 for conventional testing. Multiplex molecular testing using a panel of targets allowed enhanced detection and a consolidated laboratory workflow. This is likely to be of greater benefit to cases that present within the first 4 days of hospital admission. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  11. National Aeronautics Research, Development, Test and Evaluation (RDT&E) Infrastructure Plan

    Science.gov (United States)

    2011-01-01

    addressed in the National Aeronautics R&D Plan, identi- fying unnecessary redundancy solely on the basis of infrastructure required to support H H13 ...near, mid, and far terms, and impact not only scramjet propulsion systems, but potential turbine-based combined cycle systems as well. Turbine Engine...Icing Test Facilities A greater understanding of the impact that icing conditions have on turbine engine opera- tions is needed to develop enhanced

  12. Evaluation of Transition Untestable Faults Using a Multi-Cycle Capture Test Generation Method

    OpenAIRE

    Yoshimura, Masayoshi; Ogawa, Hiroshi; Hosokawa, Toshinori; Yamazaki, Koji

    2010-01-01

    Overtesting induces unnecessary yield loss. Untestable faults have no effect on normal functions of circuits. However, in scan testing, untestable faults may be detected through scan chains. Detected untestable faults cause overtesting. Untestable faults consist of uncontrollable faults, unobservable faults, and uncontrollable and unobservable faults. Uncontrollable faults may be detected under invalid states through scan chains by shift-in operations. Unobservable faults cannot be observed ...

  13. Prototyping and Testing a New Volumetric Curvature Tool for Modeling Reservoir Compartments and Leakage Pathways in the Arbuckle Saline Aquifer: Reducing Uncertainty in CO2 Storage and Permanence

    Energy Technology Data Exchange (ETDEWEB)

    Rush, Jason [Univ. of Kansas and Kansas Geological Survey, Lawrence, KS (United States); Holubnyak, Yevhen [Univ. of Kansas and Kansas Geological Survey, Lawrence, KS (United States); Watney, Willard [Univ. of Kansas and Kansas Geological Survey, Lawrence, KS (United States)

    2016-12-09

    This DOE-funded project evaluates the utility of seismic volumetric curvature (VC) for predicting stratal and structural architecture diagnostic of paleokarst reservoirs. Of special interest are applications geared toward carbon capture, utilization, and storage (CCUS). VC has been championed for identifying faults (offset <¼ λ) that cannot be imaged by conventional 3-D seismic attributes such as coherence. The objective of this research was to evaluate VC-techniques for reducing uncertainties in reservoir compartmentalization studies and seal risk assessments especially for saline aquifers. A 2000-ft horizontal lateral was purposefully drilled across VC-imaged lineaments—interpreted to record a fractured and a fault-bounded doline—to physically confirm their presence. The 15-mi² study area is located in southeastern Bemis-Shutts Field, which is situated along the crest of the Central Kansas Uplift (CKU) in Ellis County, Kansas. The uppermost Arbuckle (200+ ft) has extensive paleokarst including collapsed paleocaverns and dolines related to exceedingly prolonged pre-Simpson (Sauk–Tippecanoe) and/or pre-Pennsylvanian subaerial exposure. A lateral borehole was successfully drilled across the full extent (~1100 ft) of a VC-inferred paleokarst doline. Triple combo (GR-neutron/density-resistivity), full-wave sonic, and borehole micro-imager logs were successfully run to TD on drill-pipe. Results from the formation evaluation reveal breccias (e.g., crackle, mosaic, chaotic), fractures, faults, vugs (1-6"), and unaffected host strata consistent with the pre-spud interpretation. Well-rounded pebbles were also observed on the image log. VC-inferred lineaments coincide with 20–80-ft wide intervals of high GR values (100+ API), matrix-rich breccias, and faults. To further demonstrate their utility, VC attributes are integrated into a geocellular modeling workflow: 1) to constrain the structural model; 2) to generate facies probability grids, and; 3) to collocate

  14. A randomized controlled trial to evaluate the relative efficacy of adding voluntary counseling and testing (VCT) to information dissemination in reducing HIV-related risk behaviors among Hong Kong male cross-border truck drivers.

    Science.gov (United States)

    Lau, Joseph T F; Tsui, Hi Yi; Cheng, Shannon; Pang, Margaret

    2010-01-01

    Mobile populations are vulnerable to contracting HIV. The present study aims to evaluate the relative efficacy of the voluntary counseling and testing plus information dissemination (VCT-ID) approach versus the information dissemination (ID) approach for promoting HIV preventive behaviors in a mobile population, cross-border truck drivers. A total of 301 adult male cross-border truck drivers who self-reported having had sex with female sex workers (FSW) or non-regular sex partners (NRPs) in mainland China in the last 12 months were recruited and randomized into the VCT-ID intervention group (Group I) or ID control group (Group C). Anonymous structured questionnaires, administered through a computer-assisted method, were used to collect data. At the follow-up survey (about 8-9 weeks since the baseline survey), Group I participants, as compared to Group C participants, were more likely to be consistent condom users when having sex with FSW (85.5% versus 68.5%, p<0.05) and with NRP (54.8% versus 36.4%, p<0.1), more knowledgeable about HIV, and were less likely to have contracted sexually transmitted diseases (STD) in the last two months. The VCT-ID approach is shown to be more efficacious than the ID approach in promoting safer sex and HIV-related knowledge among local cross-border truck drivers. Feasibility of providing voluntary counseling and testing (VCT) services at locations which are convenient to the target population is demonstrated. It also shows that VCT services can be used as a means of HIV prevention. The findings of this study resulted in up-scaled VCT services for the local target population.

  15. An Audit of Repeat Testing at an Academic Medical Center: Consistency of Order Patterns With Recommendations and Potential Cost Savings.

    Science.gov (United States)

    Hueth, Kyle D; Jackson, Brian R; Schmidt, Robert L

    2018-05-31

    To evaluate the prevalence of potentially unnecessary repeat testing (PURT) and the associated economic burden for an inpatient population at a large academic medical facility. We evaluated all inpatient test orders during 2016 for PURT by comparing the intertest times to published recommendations. Potential cost savings were estimated using the Centers for Medicare & Medicaid Services maximum allowable reimbursement rate. We evaluated result positivity as a determinant of PURT through logistic regression. Of the evaluated 4,242 repeated target tests, 1,849 (44%) were identified as PURT, representing an estimated cost-savings opportunity of $37,376. Collectively, the association of result positivity and PURT was statistically significant (relative risk, 1.2; 95% confidence interval, 1.1-1.3; P < .001). PURT contributes to unnecessary health care costs. We found that a small percentage of providers account for the majority of PURT, and PURT is positively associated with result positivity.

  16. Test Architecture, Test Retrofit

    Science.gov (United States)

    Fulcher, Glenn; Davidson, Fred

    2009-01-01

    Just like buildings, tests are designed and built for specific purposes, people, and uses. However, both buildings and tests grow and change over time as the needs of their users change. Sometimes, they are also both used for purposes other than those intended in the original designs. This paper explores architecture as a metaphor for language…

  17. A comparative clinical study investigating the efficacy of a test dentifrice containing 8% strontium acetate and 1040 ppm sodium fluoride versus a marketed control dentifrice containing 8% arginine, calcium carbonate, and 1450 ppm sodium monofluorophosphate in reducing dentinal hypersensitivity.

    Science.gov (United States)

    Hughes, Nathan; Mason, Stephen; Jeffery, Peter; Welton, Helen; Tobin, Maira; O'Shea, Caoimhe; Browne, Mairead

    2010-01-01

    The objective of this clinical study was to evaluate and compare the efficacy in reducing dentin hypersensitivity of an 8% strontium acetate, 1040 ppm sodium fluoride dentifrice to a marketed control 8% arginine, calcium carbonate, 1450 ppm sodium monofluorophosphate dentifrice after twice-daily brushing for two, four, and eight weeks. This was a randomized, examiner-blind, two-arm parallel group, eight-week longitudinal clinical study with seventy-nine subjects, stratified based on baseline tooth sensitivity (Schiff score, Yeaple). Subjects brushed with either an 8% strontium acetate-based dentifrice or a marketed 8% arginine calcium carbonate dentifrice twice daily for approximately one minute. At screening, baseline, weeks two, four, and eight, subjects' tooth sensitivity was determined through both evaporative (Schiff and Visual Analogue Scale [VAS]) and tactile stimuli (Yeaple probe). Subject assessments using each stimulus were performed by the same examiner throughout the study. Seventy-seven subjects completed this clinical study. Both subject groups exhibited significant cumulative reductions from baseline to Days 14, 28, and 56 in dentin hypersensitivity as measured by Schiff, Yeaple, and VAS (for the 8% strontium acetate group, p carbonate group, p = 0.0031 for Yeaple at Day 14, p = 0.0015 for VAS at Day 14, and p 0.05) were observed between treatments for any of the time points and measures except for tactile sensitivity at Day 56, for which the 8% strontium acetate-based dentifrice was statistically superior (p = 0.0391) to the control 8% arginine calcium carbonate dentifrice. The 8% strontium acetate, 1040 ppm sodium fluoride dentifrice provided significant reductions in dentin hypersensitivity (p carbonate dentifrice showed no significant differences (p > 0.05) apart from tactile (Yeaple) sensitivity at week 8, where the 8% strontium acetate-based dentifrice showed significant improvement over the control (p = 0.0391).

  18. Reducible oxide based catalysts

    Science.gov (United States)

    Thompson, Levi T.; Kim, Chang Hwan; Bej, Shyamal K.

    2010-04-06

    A catalyst is disclosed herein. The catalyst includes a reducible oxide support and at least one noble metal fixed on the reducible oxide support. The noble metal(s) is loaded on the support at a substantially constant temperature and pH.

  19. Parallelize Automated Tests in a Build and Test Environment

    OpenAIRE

    Durairaj, Selva Ganesh

    2016-01-01

    This thesis investigates the possibilities of finding solutions, in order to reduce the total time spent for testing and waiting times for running multiple automated test cases in a test framework. The “Automated Test Framework”, developed by Axis Communications AB, is used to write the functional tests to test both hardware and software of a resource. The functional tests that tests the software is considered in this thesis work. In the current infrastructure, tests are executed sequentially...

  20. Direct oxide reducing method

    International Nuclear Information System (INIS)

    Tokiwai, Moriyasu.

    1995-01-01

    Calcium oxides and magnetic oxides as wastes generated upon direct reduction are subjected to molten salt electrolysis, and reduced metallic calcium and magnesium are separated and recovered. Then calcium and magnesium are used recyclically as the reducing agent upon conducting direct oxide reduction. Even calcium oxides and magnesium oxides, which have high melting points and difficult to be melted usually, can be melted in molten salts of mixed fluorides or chlorides by molten-salt electrolysis. Oxides are decomposed by electrolysis, and oxygen is removed in the form of carbon monoxide, while the reduced metallic calcium and magnesium rise above the molten salts on the side of a cathode, and then separated. Since only carbon monoxide is generated as radioactive wastes upon molten salt electrolysis, the amount of radioactive wastes can be greatly reduced, and the amount of the reducing agent used can also be decreased remarkably. (N.H.)

  1. Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine (sCr) for acute kidney injury (AKI) diagnosis.

    Science.gov (United States)

    Parikh, Amay; Rizzo, John A; Canetta, Pietro; Forster, Catherine; Sise, Meghan; Maarouf, Omar; Singer, Eugenia; Elger, Antje; Elitok, Saban; Schmidt-Ott, Kai; Barasch, Jonathon; Nickolas, Thomas L

    2017-01-01

    Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a sensitive and specific diagnostic test for acute kidney injury (AKI) in the Emergency Department (ED), but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr) would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone. A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr). A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007-8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated. For a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp) in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts) at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients). Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs. Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.

  2. Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL & serum creatinine (sCr for acute kidney injury (AKI diagnosis.

    Directory of Open Access Journals (Sweden)

    Amay Parikh

    Full Text Available Urine neutrophil gelatinase-associated lipocalin (uNGAL is a sensitive and specific diagnostic test for acute kidney injury (AKI in the Emergency Department (ED, but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone.A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr. A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007-8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated.For a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients. Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs.Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.

  3. Pipeline Drag Reducers

    International Nuclear Information System (INIS)

    Marawan, H.

    2004-01-01

    Pipeline drag reducers have proven to be an extremely powerful tool in fluid transportation. High molecular weight polymers are used to reduce the frictional pressure loss ratio in crude oil pipelines, refined fuel and aqueous pipelines. Chemical structure of the main used pipeline drag reducers is one of the following polymers and copolymers classified according to the type of fluid to ; low density polyethylene, copolymer of I-hexane cross linked with divinyl benzene, polyacrylamide, polyalkylene oxide polymers and their copolymers, fluorocarbons, polyalkyl methacrylates and terpolymer of styrene, alkyl acrylate and acrylic acid. Drag reduction is the increase in pump ability of a fluid caused by the addition of small amounts of an additive to the fluid. The effectiveness of a drag reducer is normally expressed in terms of percent drag reduction. Frictional pressure loss in a pipeline system is a waste of energy and it costly. The drag reducing additive minimizes the flow turbulence, increases throughput and reduces the energy costs. The Flow can be increased by more than 80 % with existing assets. The effectiveness of the injected drag reducer in Mostorod to Tanta crude oil pipeline achieved 35.4 % drag reduction and 23.2 % flow increase of the actual performance The experimental application of DRA on Arab Petroleum Pipeline Company (Summed) achieved a flow increase ranging from 9-32 %

  4. Prevalence of the use of cancer related self-tests by members of the public: a community survey

    Directory of Open Access Journals (Sweden)

    Marriott John

    2006-08-01

    Full Text Available Abstract Background Self-tests are those where an individual can obtain a result without recourse to a health professional, by getting a result immediately or by sending a sample to a laboratory that returns the result directly. Self-tests can be diagnostic, for disease monitoring, or both. There are currently tests for more than 20 different conditions available to the UK public, and self-testing is marketed as a way of alerting people to serious health problems so they can seek medical help. Almost nothing is known about the extent to which people self-test for cancer or why they do this. Self-tests for cancer could alter perceptions of risk and health behaviour, cause psychological morbidity and have a significant impact on the demand for healthcare. This study aims to gain an understanding of the frequency of self-testing for cancer and characteristics of users. Methods Cross-sectional survey. Adults registered in participating general practices in the West Midlands Region, will be asked to complete a questionnaire that will collect socio-demographic information and basic data regarding previous and potential future use of self-test kits. The only exclusions will be people who the GP feels it would be inappropriate to send a questionnaire, for example because they are unable to give informed consent. Freepost envelopes will be included and non-responders will receive one reminder. Standardised prevalence rates will be estimated. Discussion Cancer related self-tests, currently available from pharmacies or over the Internet, include faecal occult blood tests (related to bowel cancer, prostate specific antigen tests (related to prostate cancer, breast cancer kits (self examination guide and haematuria tests (related to urinary tract cancers. The effect of an increase in self-testing for cancer is unknown but may be considerable: it may affect the delivery of population based screening programmes; empower patients or cause unnecessary anxiety

  5. SU-E-P-46: Clinical Acceptance Testing and Implementation of a Portable CT Unit

    International Nuclear Information System (INIS)

    LaFrance, M; Marsh, S; Hicks, R; O’Donnell-Moran, G

    2015-01-01

    Purpose: Planning for the first installation in New England of a new portable CT unit to be used in the Operating Room required the integration of many departments including Surgery, Neurosurgery, Information Services, Clinical Engineering, Radiology and Medical Physics/Radiation Safety. Acceptance testing and the quality assurance procedures were designed to optimize image quality and patient and personnel radiation exposure. Methods: The vendor’s protocols were tested using the CT Dosimetry phantoms. The system displayed the CTDIw instead of the CTDIvol while testing the unit. Radiation exposure was compared to existing CT scanners from installed CT units throughout the facility. Brainlab measures all 4 periphery slots on the CT Dosimetry phantom. The ACR measures only the superior slot for the periphery measurement. A comprehensive radiation survey was also performed for several locations. Results: The CTDIvol measurements were comparable for the following studies: brain, C-Spine, and sinuses. However, the mobile CT measurements were slightly higher than other CT units but within acceptable tolerance if measured using the ACR method.Based on scatter measurements, it was determined if any personnel were to stay in the OR Suite during image acquisition that the appropriate lead apron and thyroid shields had to be worn.In addition, to reduce unnecessary scatter, there were two mobile 6 foot wide shields (1/16″ lead equivalent) available to protect personnel in the room and adjacent areas. Conclusion: Intraoperative CT provides the physician new opportunities for evaluation of the progression of surgical resections and device placement at the cost of increasing the amount of trained personnel required to perform this procedure. It also brings with it challenges to keep the radiation exposure to the patients and staff within reasonable limits

  6. Acceptance sampling for attributes via hypothesis testing and the hypergeometric distribution

    Science.gov (United States)

    Samohyl, Robert Wayne

    2017-10-01

    This paper questions some aspects of attribute acceptance sampling in light of the original concepts of hypothesis testing from Neyman and Pearson (NP). Attribute acceptance sampling in industry, as developed by Dodge and Romig (DR), generally follows the international standards of ISO 2859, and similarly the Brazilian standards NBR 5425 to NBR 5427 and the United States Standards ANSI/ASQC Z1.4. The paper evaluates and extends the area of acceptance sampling in two directions. First, by suggesting the use of the hypergeometric distribution to calculate the parameters of sampling plans avoiding the unnecessary use of approximations such as the binomial or Poisson distributions. We show that, under usual conditions, discrepancies can be large. The conclusion is that the hypergeometric distribution, ubiquitously available in commonly used software, is more appropriate than other distributions for acceptance sampling. Second, and more importantly, we elaborate the theory of acceptance sampling in terms of hypothesis testing rigorously following the original concepts of NP. By offering a common theoretical structure, hypothesis testing from NP can produce a better understanding of applications even beyond the usual areas of industry and commerce such as public health and political polling. With the new procedures, both sample size and sample error can be reduced. What is unclear in traditional acceptance sampling is the necessity of linking the acceptable quality limit (AQL) exclusively to the producer and the lot quality percent defective (LTPD) exclusively to the consumer. In reality, the consumer should also be preoccupied with a value of AQL, as should the producer with LTPD. Furthermore, we can also question why type I error is always uniquely associated with the producer as producer risk, and likewise, the same question arises with consumer risk which is necessarily associated with type II error. The resolution of these questions is new to the literature. The

  7. SU-E-P-46: Clinical Acceptance Testing and Implementation of a Portable CT Unit

    Energy Technology Data Exchange (ETDEWEB)

    LaFrance, M; Marsh, S; Hicks, R; O’Donnell-Moran, G [Baystate Health Systems, Inc., Springfield, MA (United States)

    2015-06-15

    Purpose: Planning for the first installation in New England of a new portable CT unit to be used in the Operating Room required the integration of many departments including Surgery, Neurosurgery, Information Services, Clinical Engineering, Radiology and Medical Physics/Radiation Safety. Acceptance testing and the quality assurance procedures were designed to optimize image quality and patient and personnel radiation exposure. Methods: The vendor’s protocols were tested using the CT Dosimetry phantoms. The system displayed the CTDIw instead of the CTDIvol while testing the unit. Radiation exposure was compared to existing CT scanners from installed CT units throughout the facility. Brainlab measures all 4 periphery slots on the CT Dosimetry phantom. The ACR measures only the superior slot for the periphery measurement. A comprehensive radiation survey was also performed for several locations. Results: The CTDIvol measurements were comparable for the following studies: brain, C-Spine, and sinuses. However, the mobile CT measurements were slightly higher than other CT units but within acceptable tolerance if measured using the ACR method.Based on scatter measurements, it was determined if any personnel were to stay in the OR Suite during image acquisition that the appropriate lead apron and thyroid shields had to be worn.In addition, to reduce unnecessary scatter, there were two mobile 6 foot wide shields (1/16″ lead equivalent) available to protect personnel in the room and adjacent areas. Conclusion: Intraoperative CT provides the physician new opportunities for evaluation of the progression of surgical resections and device placement at the cost of increasing the amount of trained personnel required to perform this procedure. It also brings with it challenges to keep the radiation exposure to the patients and staff within reasonable limits.

  8. Dairy heifer manure management, dietary phosphorus, and soil test P effects on runoff phosphorus.

    Science.gov (United States)

    Jokela, William E; Coblentz, Wayne K; Hoffman, Patrick C

    2012-01-01

    Manure application to cropland can contribute to runoff losses of P and eutrophication of surface waters. We conducted a series of three rainfall simulation experiments to assess the effects of dairy heifer dietary P, manure application method, application rate, and soil test P on runoff P losses from two successive simulated rainfall events. Bedded manure (18-21% solids) from dairy heifers fed diets with or without supplemental P was applied on a silt loam soil packed into 1- by 0.2-m sheet metal pans. Manure was either surface-applied or incorporated (Experiment 1) or surface-applied at two rates (Experiment 2) to supply 26 to 63 kg P ha. Experiment 3 evaluated runoff P from four similar nonmanured soils with average Bray P1-extractable P levels of 11, 29, 51, and 75 mg kg. We measured runoff quantity, total P (TP), dissolved reactive P (DRP), and total and volatile solids in runoff collected for 30 min after runoff initiation from two simulated rain events (70 mm h) 3 or 4 d apart. Manure incorporation reduced TP and DRP concentrations and load by 85 to 90% compared with surface application. Doubling the manure rate increased runoff DRP and TP concentrations an average of 36%. In the same experiment, P diet supplementation increased water-extractable P in manure by 100% and increased runoff DRP concentration threefold. Concentrations of solids, TP, and DRP in runoff from Rain 2 were 25 to 75% lower than from Rain 1 in Experiments 1 and 2