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Sample records for relapse rate observed

  1. Resistance to Change and Relapse of Observing

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    Thrailkill, Eric A.; Shahan, Timothy A.

    2012-01-01

    Four experiments examined relapse of extinguished observing behavior of pigeons using a two-component multiple schedule of observing-response procedures. In both components, unsignaled periods of variable-interval (VI) food reinforcement alternated with extinction and observing responses produced stimuli associated with the availability of the VI…

  2. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis.

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    Kalinina Ayuso, Viera; van de Winkel, Evelyne Leonce; Rothova, Aniki; de Boer, Joke Helena

    2011-02-01

    To evaluate the efficacy of methotrexate (MTX) and the effect of its withdrawal on relapse rate of uveitis associated with juvenile idiopathic arthritis (JIA). Retrospective case series. Data of 22 pediatric JIA patients who were being treated with MTX for active uveitis were studied retrospectively. Relapse rate after the withdrawal of MTX was established. Anterior chamber (AC) inflammation, topical steroid use during the first year of MTX treatment, and associations of relapses after the withdrawal were evaluated statistically. Duration of MTX treatment and its withdrawal was determined individually in collaboration with a rheumatologist with an intention to continue the treatment for at least 1 year and to withdraw in case of inactivity of uveitis and arthritis. Inactivity of uveitis was defined as the presence of ≤0.5+ cells in the AC. Eighteen patients (18/22; 82%) showed improvement of their uveitis with a significant decrease in activity of AC inflammation after a minimal period of 3 months of MTX treatment. A topical steroid-sparing effect was observed when MTX was administered for a period of 3 to 9 months. MTX was discontinued because of inactive uveitis in 13 patients. In 9 patients (8/13; 69%) a relapse of uveitis was observed after a mean time of 7.5 months (± SD 7.3). Six patients (6/13; 46%) had a relapse within the first year after the withdrawal. Relapse-free survival after withdrawal of MTX was significantly longer in patients who had been treated with MTX for more than 3 years (P = .009), children who were older than 8 years at the moment of withdrawal (P = .003), and patients who had an inactivity of uveitis of longer than 2 years before withdrawal of MTX (P = .033). Longer inactivity under MTX therapy was independently protective for relapses after the withdrawal (hazard ratio = 0.07; 95% confidence interval 0.01-0.86; P = .038), which means that 1-year increase of duration of inactive uveitis before the withdrawal of MTX results in a

  3. ANALYSIS OF RELAPSE RATE AND METASTASES OF HIGH DIFFERENTIATED THYROID CANCER

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    E. V. Savenok

    2015-01-01

    Full Text Available  Analysis of rate of relapses and metastases with well-differentiated thyroid cancer was performed for patients in 2009 to 2013. The study involved 189 patients with thyroid cancer including 98 (51.9 % patients suffering from papillary thyroid cancer, 77 (40.7 % patients suffering from follicular thyroid cancer, and 14 (7.4 % patients suffering from medullary thyroid cancer. 2.04 % of the 98 patients suffering from papillary thyroid cancer manifested a relapse, and lymphogenic metastases of cancer were revealed with 1.0 % of patients. With follicular thyroid cancer (n = 77, lymphogenic metastases were registered in 7.8 % of cases, relapses were revealed in 1.3 % of cases. This analysis demonstrated that observation of patients for 5 years revealed a higher percentage of metastases with patients that suffered from follicular thyroid cancer.

  4. Relapse rates after psychotherapy for depression - stable long-term effects? A meta-analysis.

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    Steinert, Christiane; Hofmann, Mareike; Kruse, Johannes; Leichsenring, Falk

    2014-10-01

    Depression is the most common mental disorder. Effective psychotherapeutic treatments for depression exist; however, data on their long-term effectiveness beyond a time span of two years is still scarce. Our aim was to perform a meta-analysis, investigating (a) overall rates of relapse more than two years after psychotherapy (meta-analysis 1), and (b) if psychotherapy has more enduring effects than non-psychotherapeutic comparison conditions (e.g. pharmacotherapy, treatment as usual), again beyond a time span of two years post-therapy (meta-analysis 2). We searched electronic databases Medline, PsycINFO and the COCHRANE Library. Main selection criteria were (i) RCT of psychotherapy with follow-up interval of more than 2 years, (ii) primary diagnosis of depression, assessed by observer ratings, (iii) report of relapse at follow-up. We identified 11 studies, 6 of which included a non-psychotherapeutic comparison condition. Together they comprised long-term data of 966 patients. Mean follow-up duration was 4.4 years. The overall relapse rate at long-term follow-up was 0.39 (95% CI 0.29, 0.50). Psychotherapy resulted in significantly less relapses (53.1% vs. 71.1%, OR 0.51; 95% CI 0.32, 0.82, p=0.005) than comparison treatments. This finding corresponded to a number needed to treat (NNT) of 5.55. Results can only be preliminary as data was sparse and studies differed methodologically. Heterogeneity in the first meta-analysis was high (I(2)=82%). Results indicated publication bias. The relapse rate more than two years after psychotherapy is relatively high, but significantly lower compared to non-psychotherapeutic treatments. Multiannual follow-ups should routinely be included in future psychotherapy RCTs. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Observed Barium Emission Rates

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    Stenbaek-Nielsen, H. C.; Wescott, E. M.; Hallinan, T. J.

    1993-01-01

    The barium releases from the CRRES satellite have provided an opportunity for verifying theoretically calculated barium ion and neutral emission rates. Spectra of the five Caribbean releases in the summer of 1991 were taken with a spectrograph on board a U.S. Air Force jet aircraft. Because the line of sight release densities are not known, only relative rates could be obtained. The observed relative rates agree well with the theoretically calculated rates and, together with other observations, confirm the earlier detailed theoretical emission rates. The calculated emission rates can thus with good accuracy be used with photometric observations. It has been postulated that charge exchange between neutral barium and oxygen ions represents a significant source for ionization. If so. it should be associated with emissions at 4957.15 A and 5013.00 A, but these emissions were not detected.

  6. Relapse rate following antithyroid drug therapy of immunogenic and non-immunogenic hyperthyroidism

    International Nuclear Information System (INIS)

    Voth, E.; Dickmann, N.; Schicha, H.; Emrich, D.

    1990-01-01

    Data of 196 patients treated for hyperthyroidism exclusively with anthyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogenic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p [de

  7. IIVP salvage regimen induces high response rates in patients with relapsed lymphoma before autologous stem cell transplantation.

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    Abali, Huseyin; Oyan, Basak; Koc, Yener; Kars, Ayse; Barista, Ibrahim; Uner, Aysegul; Turker, Alev; Demirkazik, Figen; Tekin, Fatma; Tekuzman, Gulten; Kansu, Emin

    2005-06-01

    Patients with relapsed lymphoma can be cured with high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT). New therapeutic approaches with better cytoreductive capacity are needed for relapsed patients to keep their chance for cure with transplantation. We report 30 patients with relapsed lymphoma, median age 43 years, treated with IIVP salvage regimen consisting of ifosfamide, mesna, idarubicin, and etoposide for 2 or 3 cycles. Seventeen patients had non-Hodgkin lymphoma (NHL) and 13 patients had Hodgkin disease (HD). Fourteen (47%) patients were at their first relapse. Overall response rate was 86.6% (n = 26) with 19 patients (63.3%) achieving complete response. Overall response rate was 92% in patients with HD and 82% in NHL. The most frequent side effects observed were grade III-IV neutropenia (87%) and thrombocytopenia (73%). IIVP regimen is a highly effective salvage therapy for patients with relapsed HD or NHL who are candidates for autologous HSCT. Close follow up is necessary because of the high incidence of grade III-IV hematologic toxicity.

  8. The mortality and response rate after FLANG regimen in patients with refractory/relapsed acute leukemia

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    Vali A Mehrzad

    2012-01-01

    Full Text Available Background: Oncologists today are greatly concerned about the treatment of relapsed/refractory acute leukemia. FLANG regimen, combination of novantron, cytarabine, fludarabine, and granulocyte-colony stimulating factor, has been used in treatment of refractory/relapsed acute leukemia since 1990s. The present study has evaluated mortality and response rate of this regimen. Materials and Methods: In this study, 25 patients with refractory/relapsed acute leukemia aged 15-55 years underwent FLANG regimen at Seyed-Al-Shohada Hospital, Isfahan, Iran during 2008-2009. One month later, bone marrow samples were taken to evaluate the responsiveness to treatment. Participants were followed for a year. The data was analyzed by student-t and chi-square tests, logistic, and Cox regression analysis, and Kaplan-Meier curves in SPSS 19. Results: Out of the 25 patients, 8 patients (32% had acute lymphoblastic leukemia (5 refractory and 3 relapsed cases and 17 subjects had acute myeloid leukemia (7 refractory and 10 relapsed cases. According to the bone marrow biopsies taken one month after FLANG regimen, 10 patients (40% had responded to treatment. Five patients of the 10 responders underwent successful bone marrow transplantation (BMT. On the other hand, 13 patients (52%, who had not entered the CR period, died during the follow-up. Logistic regression analysis did not reveal any significant associations between disease type and responsiveness to treatment. Conclusion: This study indicated higher rates of unresponsiveness to treatment while its mortality rate was comparable with other studies. Overall, according to limitations for BMT (as the only chance for cure in Iran, it seems that FLANG therapy is an acceptable choice for these patients.

  9. Italian real life experience with ibrutinib: results of a large observational study on 77 relapsed/refractory mantle cell lymphoma.

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    Broccoli, Alessandro; Casadei, Beatrice; Morigi, Alice; Sottotetti, Federico; Gotti, Manuel; Spina, Michele; Volpetti, Stefano; Ferrero, Simone; Spina, Francesco; Pisani, Francesco; Merli, Michele; Visco, Carlo; Paolini, Rossella; Zilioli, Vittorio Ruggero; Baldini, Luca; Di Renzo, Nicola; Tosi, Patrizia; Cascavilla, Nicola; Molica, Stefano; Ilariucci, Fiorella; Rigolin, Gian Matteo; D'Alò, Francesco; Vanazzi, Anna; Santambrogio, Elisa; Marasca, Roberto; Mastrullo, Lucia; Castellino, Claudia; Desabbata, Giovanni; Scortechini, Ilaria; Trentin, Livio; Morello, Lucia; Argnani, Lisa; Zinzani, Pier Luigi

    2018-05-04

    Although sometimes presenting as an indolent lymphoma, mantle cell lymphoma (MCL) is an aggressive disease, hardly curable with standard chemo-immunotherapy. Current approaches have greatly improved patients' outcomes, nevertheless the disease is still characterized by high relapse rates. Before approval by EMA, Italian patients with relapsed/refractory MCL were granted ibrutinib early access through a Named Patient Program (NPP). An observational, retrospective, multicenter study was conducted. Seventy-seven heavily pretreated patients were enrolled. At the end of therapy there were 14 complete responses and 14 partial responses, leading to an overall response rate of 36.4%. At 40 months overall survival was 37.8% and progression free survival was 30%; disease free survival was 78.6% at 4 years: 11/14 patients are in continuous complete response with a median of 36 months of follow up. Hematological toxicities were manageable, and main extra-hematological toxicities were diarrhea (9.4%) and lung infections (9.0%). Overall, 4 (5.2%) atrial fibrillations and 3 (3.9%) hemorrhagic syndromes occurred. In conclusions, thrombocytopenia, diarrhea and lung infections are the relevant adverse events to be clinically focused on; regarding effectiveness, ibrutinib is confirmed to be a valid option for refractory/relapsed MCL also in a clinical setting mimicking the real world.

  10. A randomized controlled trial to compare cure and relapse rate of paucibacillary multidrug therapy with monthly rifampicin, ofloxacin, and minocycline among paucibacillary leprosy patients in Agra District, India

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    Anil Kumar

    2015-01-01

    Full Text Available Objectives: To study cure rate and relapse rate of standard World Health Organization paucibacillary multidrug therapy (PB-MDT with monthly rifampicin, ofloxacin, and minocycline for six months (ROM-6 among paucibacillary leprosy patients. Methods: A total of 268 patients, detected during active search in Agra district during 2001-2004, who had paucibacillary (PB leprosy having 1-5 skin lesions and/or one nerve thickening/tenderness, were allocated, using random number tables, to two treatment groups; PB-MDT and ROM-6. On the first day of the month, dose of PB-MDT and of the ROM were given under supervision for 6 months. After completion of drug therapy, patients were followed every 6 months for first 5 years and later annually for next 3 years for monitoring disease status, cure rates, reactions and relapses. Cηi σθuαρε test was used to compare relapse rates. Results: The cure rate at 2 years was 99% in ROM-6 and 97.0% in PB-MDT group, of those who completed treatment and the difference was statistically not significant. At 5 years, only 88 patients in PB-MDT group and 90 patients in ROM-6 group could be followed; all were observed to be cured. However, during the period of 5-8 years, 3 of 67 patients in PB-MDT group and 1 of 73 in ROM-6 group were observed to have relapsed. In all, 10 relapses were noted (3 in ROM-6 and 7 in PB-MDT group giving a relapse rate of 1.10/100 person years in PB-MDT and 0.435/100 person years in ROM groups (P = 0.053 ; statistically not significant. Of the 10 relapses, 5 occurred within 5 years (3 in PB-MDT group and 2 in ROM-6, 4 during 5-8 years (3 in PB-MDT and 1 in ROM-6, and 1 occurred in MDT group after 8 years. Limitation: A number of patients were lost to follow up after release from treatment and thus actual number of relapses in the study could not be assessed. Additionally, diagnosis was purely clinical and histology could not be done for reasons related to functional difficulties in the field

  11. Incidence and risk factors for relapses in HIV-associated non-Hodgkin lymphoma as observed in the German HIV-related lymphoma cohort study.

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    Schommers, Philipp; Gillor, Daniel; Hentrich, Marcus; Wyen, Christoph; Wolf, Timo; Oette, Mark; Zoufaly, Alexander; Wasmuth, Jan-Christian; Bogner, Johannes R; Müller, Markus; Esser, Stefan; Schleicher, Alisa; Jensen, Björn; Stoehr, Albrecht; Behrens, Georg; Schultze, Alexander; Siehl, Jan; Thoden, Jan; Taylor, Ninon; Hoffmann, Christian

    2018-05-01

    Outcome of HIV-infected patients with AIDS-related lymphomas has improved during recent years. However, data on incidence, risk factors, and outcome of relapses in AIDS-related lymphomas after achieving complete remission are still limited. This prospective observational multicenter study includes HIV-infected patients with biopsy- or cytology-proven malignant lymphomas since 2005. Data on HIV infection and lymphoma characteristics, treatment and outcome were recorded. For this analysis, AIDS-related lymphomas patients in complete remission were analyzed in terms of their relapse- free survival and potential risk factors for relapses. In total, 254 of 399 (63.7%) patients with AIDS-related lymphomas reached a complete remission with their first-line chemotherapy. After a median follow up of 4.6 years, 5-year overall survival of the 254 patients was 87.8% (Standard Error 3.1%). Twenty-nine patients relapsed (11.4%). Several factors were independently associated with a higher relapse rate, including an unclassifiable histology, a stage III or IV according to the Ann Arbor Staging System, no concomitant combined antiretroviral therapy during chemotherapy and R-CHOP-based compared to more intensive chemotherapy regimens in Burkitt lymphomas. In conclusion, complete remission and relapse rates observed in our study are similar to those reported in HIV-negative non-Hodgkin lymphomas. These data provide further evidence for the use of concomitant combined antiretroviral therapy during chemotherapy and a benefit from more intensive chemotherapy regimens in Burkitt lymphomas. Modifications to the chemotherapy regimen appear to have only a limited impact on relapse rate. Copyright © 2018 Ferrata Storti Foundation.

  12. Fingolimod Treatment in Relapsing-Remitting Multiple Sclerosis Patients: A Prospective Observational Multicenter Postmarketing Study

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    Rocco Totaro

    2015-01-01

    Full Text Available Objective. The aim of this prospective observational multicenter postmarketing study was to evaluate fingolimod efficacy in a real world clinical setting. Methods. One hundred forty-two subjects with relapsing-remitting multiple sclerosis (RRMS were enrolled in three multiple sclerosis centers throughout Central and Southern Italy between January 2011 and September 2013. After enrollment, regular visits and EDSS assessment were scheduled every 3 months, and MRI scan was obtained every 12 months. Patients were followed up from 1 to 33 months (mean 14.95 ± 9.15 months. The main efficacy endpoints included the proportion of patients free from clinical relapses, from disability progression, from magnetic resonance imaging activity, and from any disease activity. Results. Out of 142 patients enrolled in the study, 88.1% were free from clinical relapse and 69.0% were free from disability progression; 68.5% of patients remained free from new or newly enlarging T2 lesions and 81.7% of patients were free from gadolinium enhancing lesions. Overall the proportion of patients free from any disease activity was 41.9%. Conclusions. Our data in a real world cohort are consistent with previous findings that yield convincing evidence for the efficacy of fingolimod in patients with RRMS.

  13. Multimodal Hazard Rate for Relapse in Breast Cancer: Quality of Data and Calibration of Computer Simulation

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    Michael Retsky

    2014-11-01

    Full Text Available Much has occurred since our 2010 report in Cancers. In the past few years we published several extensive reviews of our research so a brief review is all that will be provided here. We proposed in the earlier reports that most relapses in breast cancer occur within 5 years of surgery and seem to be associated with some unspecified manner of surgery-induced metastatic initiation. These events can be identified in relapse data and are correlated with clinical data. In the last few years an unexpected mechanism has become apparent. Retrospective analysis of relapse events by a Brussels anesthesiology group reported that a perioperative NSAID analgesic seems to reduce early relapses five-fold. We then proposed that primary surgery produces a transient period of systemic inflammation. This has now been identified by inflammatory markers in serum post mastectomy. That could explain the early relapses. It is possible that an inexpensive and non-toxic NSAID can reduce breast cancer relapses significantly. We want to take this opportunity to discuss database quality issues and our relapse hazard data in some detail. We also present a demonstration that the computer simulation can be calibrated with Adjuvant-on-line, an often used clinical tool for prognosis in breast cancer.

  14. Extending supplementary feeding for children younger than 5 years with moderate acute malnutrition leads to lower relapse rates

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    Children with moderate acute malnutrition (MAM) have a high rate of relapse and death in the year following recovery. In this pilot study, we evaluate the long-term benefits of an extended course of nutritional therapy for children with MAM. Rural Malawian children 6 to 59 months old with MAM, defin...

  15. High rates of relapse in adolescents crack users after inpatient clinic discharge

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    Rosemeri Siqueira Pedroso

    Full Text Available ABSTRACT Objective The objective of the present study was to evaluate 88 adolescent crack users referred to hospitalization and to follow them up after discharge to investigate relapse and factors associated with treatment. Methods Cohort (30 and 90 days after discharge from a psychiatric hospital and a rehab clinic for treatment for chemical dependency in Porto Alegre between 2011 and 2012. Instruments: Semi-structured interview, conducted to evaluate the sociodemographic profile of the sample and describe the pattern of psychoactive substance use; Crack Use Relapse Scale/CURS; Questionnaire Tracking Users to Crack/QTUC; K-SADS-PL. Results In the first follow-up period (30 days after discharge, 65.9% of participants had relapsed. In the second follow-up period (90 days after discharge, 86.4% of participants had relapsed. Conclusion This is one of the first studies that show the extremely high prevalence of early relapse in adolescent crack users after discharge, questioning the cost/benefit of inpatient treatment for this population. Moreover, these results corroborate studies which suggested, young psychostimulants users might need tailored intensive outpatient treatment with contingency management and other behavioral strategies, in order to increase compliance and reduce drug or crime relapse, but this specific therapeutic modality is still scarce and must be developed in Brazil.

  16. Relapsing polychondritis in childhood: a rare observation studied by CT and MRI

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    Oddone, M. (Dept. of Radiology, G. Gaslini Children' s Research Inst., Genoa (Italy)); Toma, P. (Dept. of Radiology, G. Gaslini Children' s Research Inst., Genoa (Italy)); Taccone, A. (Dept. of Radiology, G. Gaslini Children' s Research Inst., Genoa (Italy)); Hanau, G. (Dept. of Auxology, Genoa Univ. (Italy)); Delogu, A. (Dept. of Auxology, Genoa Univ. (Italy)); Gemme, G. (Dept. of Auxology, Genoa Univ. (Italy))

    1992-11-01

    Relapsing polychondritis is very rare in children. The diagnosis must be based on a combination of clinical and pathologic features. CT is very useful for an accurate and rapid assessment of laryngo-tracheo-bronchial involvement and the typical finding is lumen narrowing by wall thickening and collapse of the supporting cartilaginous structures. The role of MR imaging should be complementary to CT. (orig.)

  17. Effect of Preserving the Pituitary Stalk During Resection of Craniopharyngioma in Children on the Diabetes Insipidus and Relapse Rates and Long-Term Outcomes.

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    Cheng, Jing; Fan, Yanqin; Cen, Bo

    2017-09-01

    The objective of this study was to investigate the effect of preserving an infiltrated pituitary stalk during the resection of craniopharyngioma of pituitary stalk origin on postoperative outcomes and thus provide a theoretical basis for microsurgical treatment and prognosis. We screened the clinical data of all 103 pediatric patients with craniopharyngioma undergoing surgical treatment at our department between January 2006 and January 2013 and conducted a retrospective analysis of 82 patients with craniopharyngioma originating in the pituitary stalk. The patients were followed up from 12 months to 8 years. We analyzed the effect of preserving the pituitary stalk on the early and persistent diabetes insipidus rates, postoperative relapse rate, and mortality. In the total resection group (n = 67), the early and persistent diabetes insipidus rates were significantly lower in the 46 patients (68.7%) with a pituitary stalk than in those whose pituitary stalk was removed (P  0.05). In the subtotal resection group (n = 15), a significant difference was observed in the early and persistent diabetes insipidus rates (P  0.05). For children with craniopharyngioma of pituitary stalk origin, preserving the pituitary stalk has a significant effect on the early and persistent diabetes insipidus rates. When intraoperative exploration showed excessive adhesion between the tumor and pituitary stalk, we opted to preserve the pituitary stalk, which significantly reduced the early and persistent postoperative diabetes insipidus rates, without significantly increasing the relapse or mortality rate.

  18. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: A quality improvement project

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    Mitra, Sujata; Muthu, Sonai G

    2012-01-01

    Introduction: Radioiodine (I-131) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after I-131 therapy. The present study was undertaken to reduce treatment failure rate of I-131 therapy in TMNG patients. Materials and Methods: Multiple causes may have lead to treatment failure of I-131 in TMNG patients making it difficult to establish a direct cause?effect relationship and take corrective action. Therefore, the JURAN methodology...

  19. Radioiodine therapy in toxic multinodular goiter- the influence of carbimazole therapy and dietary iodine on relapse rates

    International Nuclear Information System (INIS)

    Mitra, S.; Muthu, G.S.

    2007-01-01

    Full text: The relapse rate of radioiodine therapy in toxic multinodular goiter (TMNG) is reported to be around 34% at one year. The effect of antithyroid drugs on the response rate is controversial with studies reporting a higher relapse rate in patients pretreated with antithyroid drugs. Other studies report no influence of pretreatment with antithyroid drugs. The thyroid clinic at Tata Main Hospital is a referral center for thyroid disorders in Jamshedpur. 63 patients of TMNG (Group A) were treated with Radioiodine between 1995-2003. The demographic profile of these patients was as follows: M/F- 38%: 62%, 76% of patients were above 40 years, 85% had been on anti-thyroid drugs for more than 18 months. Fixed dose radioiodine in an oral dose varying from 5-10 mCi was given in all patients of Group A. 32.4 % of patients continued to be toxic or relapsed after a period of euthyroid status within 1 year of Radioiodine therapy. A change in protocol for radioiodine therapy was introduced in 2003. This included withdrawal of antithyroid drugs for one month before radioiodine therapy and the use of noniodized salt and abstinence from seafood in diet during this period. 33 TMN Goiter patients (Group B) followed this protocol before receiving Radioiodine. The dose of Radioiodine remained 5-10 mCi. The age and sex profile of Group A and B were comparable. However, Group B patients had been on antithyroid drugs for a shorter period (p< 0.001). The dose of Radioiodine in 94% of Group B patients was between 7-10mCi, whereas this was 63.4% in Group A. The rest of the patients had received a dose between 5-7 mCi. The relapse rate in Group B was 9.1% compared to 32.4% in Group A. Improvement in response rates with increase in Radioiodine dose remains controversial.P PThe better response rate in Group B patients may be attributed to the withdrawal of antithyroid drugs for one month before therapy and the reduction in dietary intake of Iodine for a month before therapy. However, a

  20. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project

    International Nuclear Information System (INIS)

    Mitra, Sujata; Muthu, Sonai G.

    2012-01-01

    Radioiodine ( 131 I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after 131 I therapy. The present study was undertaken to reduce treatment failure rate of 131 I therapy in TMNG patients. Multiple causes may have lead to treatment failure of 131 I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with 131 I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with 131 I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to 131 I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to include patient preparation and implemented after standardization. The post- 131 I relapse rate in patients treated after implementation of the new protocol from 2007 to 2009 was 18% which further reduced to 16% in 2011 after modification of the protocol. The failure rate of 131 I therapy in TMNG reduced from 29% to 16% through standardization of the treatment procedure achieved by the use of Juran Methodology that helped to identify process-related defects. (author)

  1. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project

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    Mitra, Sujata; Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com [Department of Nuclear Medicine, Tata Main Hospital, Jamshedpur (India)

    2012-01-15

    Radioiodine ({sup 131}I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after {sup 131}I therapy. The present study was undertaken to reduce treatment failure rate of {sup 131}I therapy in TMNG patients. Multiple causes may have lead to treatment failure of {sup 131}I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with {sup 131}I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with {sup 131}I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to {sup 131}I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to include patient preparation and implemented after standardization. The post-{sup 131}I relapse rate in patients treated after implementation of the new protocol from 2007 to 2009 was 18% which further reduced to 16% in 2011 after modification of the protocol. The failure rate of {sup 131}I therapy in TMNG reduced from 29% to 16% through standardization of the treatment procedure achieved by the use of Juran Methodology that helped to identify process-related defects. (author)

  2. Therapeutic Community Effectiveness on Self-Esteem and Relapse Rate among Drug Users

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    Mosayyeb Yarmohammadi-Vasel

    2012-04-01

    Full Text Available Objective: In recent years, the Therapeutic Community(TC has become a widespread treatment alternative for drug addicts. TC have been widely studied with emphasis on thair effectiveness. The aims of the present study was to examined effectiveness of TC on self esteem and decrease of relapse. Materials & Methods: Research Statistics universe constitutes of all the substance abusers who have come to the TC centers of Tehran and Mashad. samples is chosen as stratified sampling of the cities of Tehran & Mashad. This study conducted among 165 substance abuser, examined their drug use 2 years. The study utilized a quasi-experimental design with one group, clients were tested at 3 points in time pretest (at admission time, posttest (3-6 months after treatment and 1-year Follo-up (1-year after treatment using the self esteem questionnaire. Results: The findings show that (a about half (50% the clients were clean at follow-up (b significant linear increases on self esteem After 3 to 6 months of treatment(P<0.05. Conclusion: This study provides evidence that TC could effective approach to increases on self esteem and decrease of relapse.

  3. Vaginal HDR-afterloading in the treatment of endometrial carcinoma - analysis of side effects and relapse rates

    International Nuclear Information System (INIS)

    Weiss, E.; Arnold-Bofinger, H.; Weidner, N.; Hirnle, P.; Bamberg, M.

    1996-01-01

    Introduction: In a retrospective analysis side effects, relapse rates and the value of in vivo dosimetry for vaginal HDR-brachytherapy (BT) in women with endometrial carcinoma are evaluated. Material and Methods: From 1987 to 1993 124 women received vaginal HDR-BT (Ir-192) only for adjuvant treatment of early endometrial carcinoma. The usual fractionation was 1x7 Gy per week applied to the surface of the vaginal cylinder to a total dose of 21 Gy. During BT we performed in vivo dosimetry using bladder and rectal probes. The measured doses per patient in the bladder ranged from 1.5 to 9.8 Gy, 6.7 Gy in the mean. In the rectum the mean dose was 8.2 Gy (1.7 to 13.8 Gy). Results: The analysis of side effects shows that only 23 of 124 women (18 %) reported any problems at all. 13 women (10 %) noticed dysuria or pollakisuria for a maximum of 6 weeks. The average measured bladder dose in those patients was 5.3 Gy, (below the average bladder dose of 6.7 Gy). Diarrhea was reported in 3 patients (2 %), in those the average measured rectal dose was 6.8 Gy (lower than the average rectal dose of 8.2 Gy). 6 women (5 %) received antibiotic treatment because of bacteriuria. Of all patients 10 (8%) had a pelvic relapse, 3 in the vagina only. 5 women showed distant metastases during follow-up (3 of those having also a local relapse). Discussion and Conclusion: With only 2 % vaginal relapses HDR-BT is a save method to reduce the probability of vaginal metastases of endometrial carcinoma in an adjuvant setting. Moreover the incidence of acute side effects is low, no lasting complications were seen in our patients. There existed no correlation between the incidence of side effects and the measured in vivo doses in bladder and rectum, questioning the future usage in the era of well advanced BT-planning systems

  4. The effects of duration of glucocorticoid therapy on relapse rate in anti-neutrophil cytoplasm antibody associated vasculitis: A meta-analysis

    Science.gov (United States)

    Walsh, Michael; Merkel, Peter A.; Mahr, Alfred; Jayne, David

    2010-01-01

    Objective Disease relapses are common for patients with anti-neutrophil cytoplasm antibody associated vasculitis (AAV). The role of low-dose glucocorticoids (GC) in relapse prevention is controversial. We undertook a systematic review and meta-analysis to determine if GC target doses influence relapses of AAV. Methods Medline, EMBASE and Cochrane databases were searched for observational studies and randomized controlled trials of treatment of AAV that included a predefined GC treatment plan. The association of GC target dose with the proportion of relapses in studies was assessed using meta-regression and multi-level generalized linear modeling. Results Thirteen studies (983 patients) were identified for inclusion. There were no studies directly comparing GC regimens. We classified 288 patients as having a non-zero GC target dose by study end and 695 patients as having a zero GC target dose by study end. The pooled proportion of patients with a relapse was 36% (95% confidence interval [CI] 25 to 47%). GC regimen was the most significant variable explaining the variability between the proportions of patients with relapses. The proportion of patients with a relapse was 14% (95% CI 10 to 19%) in non-zero GC target dose and 43% (95% CI 33 to 52%) in zero GC target dose studies. Differences other than GC regimens exist between studies that complicate the comparability of trials and isolation of the variability in relapses due to GC target alone. Conclusions Studies with longer courses of GC in AAV are associated with fewer relapses. These results have implications for study design and outcome assessment in clinical trials of AAV. PMID:20235186

  5. Observational study of lenalidomide in patients with mantle cell lymphoma who relapsed/progressed after or were refractory/intolerant to ibrutinib (MCL-004

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    Michael Wang

    2017-11-01

    Full Text Available Abstract Background The observational MCL-004 study evaluated outcomes in patients with relapsed/refractory mantle cell lymphoma who received lenalidomide-based therapy after ibrutinib failure or intolerance. Methods The primary endpoint was investigator-assessed overall response rate based on the 2007 International Working Group criteria. Results Of 58 enrolled patients (median age, 71 years; range, 50–89, 13 received lenalidomide monotherapy, 11 lenalidomide plus rituximab, and 34 lenalidomide plus other treatment. Most patients (88% had received ≥ 3 prior therapies (median 4; range, 1–13. Median time from last dose of ibrutinib to the start of lenalidomide was 1.3 weeks (range, 0.1–21.7; 45% of patients had partial responses or better to prior ibrutinib. Primary reasons for ibrutinib discontinuation were lack of efficacy (88% and ibrutinib toxicity (9%. After a median of two cycles (range, 0–11 of lenalidomide-based treatment, 17 patients responded (8 complete responses, 9 partial responses, for a 29% overall response rate (95% confidence interval, 18–43% and a median duration of response of 20 weeks (95% confidence interval, 2.9 to not available. Overall response rate to lenalidomide-based therapy was similar for patients with relapsed/progressive disease after previous response to ibrutinib (i.e., ≥PR versus ibrutinib-refractory (i.e., ≤SD patients (30 versus 32%, respectively. The most common all-grade treatment-emergent adverse events after lenalidomide-containing therapy (n = 58 were fatigue (38% and cough, dizziness, dyspnea, nausea, and peripheral edema (19% each. At data cutoff, 28 patients have died, primarily due to mantle cell lymphoma. Conclusion Lenalidomide-based treatment showed clinical activity, with no unexpected toxicities, in patients with relapsed/refractory mantle cell lymphoma who previously failed ibrutinib therapy. Trial registration Clinicaltrials.gov identifier NCT02341781 . Date of

  6. Effects of repeated withdrawal from alcohol on recovery of cognitive impairment under abstinence and rate of relapse.

    Science.gov (United States)

    Loeber, Sabine; Duka, Theodora; Welzel Márquez, Helga; Nakovics, Helmut; Heinz, Andreas; Mann, Karl; Flor, Herta

    2010-01-01

    Several authors suggest that withdrawal from alcohol could cause neurotoxic lesions in the frontal lobe and thereby affect cognitive function. In line with this, previous studies have demonstrated greater cognitive impairment of alcohol-dependent patients with two or more previous detoxifications (Hi-detox) compared with patients with less than two detoxifications (Lo-detox). The aim of the present study was to investigate whether repeated withdrawal from alcohol affects recovery of cognitive function and is related to relapse. Forty-eight alcohol-dependent patients (Hi-detox: n = 31, Lo-detox: n = 17) and 36 healthy controls underwent a comprehensive neuropsychological test-battery. Patients were tested after completion of detoxification (T1) and 3 (T2, n = 35) and 6 (T3, n = 28) months after discharge. Healthy controls were tested at T1 (n = 36) and T2 (n = 16). Drinking behaviour was assessed at all times. Patients performed significantly worse than controls at T1 as well as T2 with regard to attention/executive function. Recovery of attention/executive function was observed within the second 3 months after discharge, but the Hi-detox group performed worse than the Lo-detox group. No association with relapse was observed. This study provides first evidence, that repeated withdrawal from alcohol might be associated with reduced brain plasticity as indicated by a delay of recovery from impairment of attention/executive function. However, little evidence was found for a direct influence of cognitive impairment on treatment success.

  7. Cytomegalovirus reactivation is associated with a lower rate of early relapse in myeloid malignancies independent of in-vivo T cell depletion strategy.

    Science.gov (United States)

    Hilal, Talal; Slone, Stacey; Peterson, Shawn; Bodine, Charles; Gul, Zartash

    2017-06-01

    The association between cytomegalovirus (CMV) reactivation and relapse risk has not been evaluated in relation to T cell depletion strategies. We evaluated 93 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and analyzed the association between T cell depletion strategies with the cumulative incidence of relapse and CMV reactivation. A total of 33% of patients who received ATG vs. 34% who received alemtuzumab developed CMV reactivation. The cumulative incidence of relapse was 3% at 1year and 20% at 3 years in patients with CMV reactivation vs. 30% at 1year and 38% at 3 years in patients without CMV reactivation (p=0.02). When analyzed separately, this effect persisted in the myeloid, but not the lymphoid group. There was a numerical trend towards increased non-relapse mortality (NRM) in patients with CMV reactivation, especially in the myeloid group. The choice of T cell depleting agent and the rate of CMV reactivation were not associated with different overall survival (OS) rates. These results suggest that the choice of T cell depletion strategy may have similar effects on rates of CMV reactivation, disease relapse, and survival. Further studies examining these variables in patients not exposed to in-vivo T cell depleting agents may be of interest. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Pharmacometric Analysis of the Relationship Between Absolute Lymphocyte Count and Expanded Disability Status Scale and Relapse Rate, Efficacy End Points, in Multiple Sclerosis Trials.

    Science.gov (United States)

    Novakovic, A M; Thorsted, A; Schindler, E; Jönsson, S; Munafo, A; Karlsson, M O

    2018-05-10

    The aim of this work was to assess the relationship between the absolute lymphocyte count (ALC), and disability (as measured by the Expanded Disability Status Scale [EDSS]) and occurrence of relapses, 2 efficacy endpoints, respectively, in patients with remitting-relasping multiple sclerosis. Data for ALC, EDSS, and relapse rate were available from 1319 patients receiving placebo and/or cladribine tablets. Pharmacodynamic models were developed to characterize the time course of the endpoints. ALC-related measures were then evaluated as predictors of the efficacy endpoints. EDSS data were best fitted by a model where the logit-linear disease progression is affected by the dynamics of ALC change from baseline. Relapse rate data were best described by the Weibull hazard function, and the ALC change from baseline was also found to be a significant predictor of time to relapse. Presented models have shown that once cladribine exposure driven ALC-derived measures are included in the model, the need for drug effect components is of less importance (EDSS) or disappears (relapse rate). This simplifies the models and theoretically makes them mechanism specific rather than drug specific. Having a reliable mechanism-specific model would allow leveraging historical data across compounds, to support decision making in drug development and possibly shorten the time to market. © 2018, The American College of Clinical Pharmacology.

  9. Long Term Clinical Prognostic Factors in Relapsing-Remitting Multiple Sclerosis: Insights from a 10-Year Observational Study.

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    Gabriel Bsteh

    Full Text Available Multiple sclerosis (MS has a highly heterogenic course making prediction of long term outcome very difficult.The objective was to evaluate current and identify additional clinical factors that are linked to long term outcome of relapsing-remitting MS assessed by disability status 10 years after disease onset.This observational study included 793 patients with relapsing-remitting MS. Clinical factors hypothesized to influence long term outcome measured by EDSS scores 10 years after disease onset were analysed by Kaplan-Meier-estimates. Multinomial logistic regression models regarding mild (EDSS ≤2.5, moderate (EDSS 3.0-5.5 or severe (EDSS ≥6.0 disability were calculated to correct for confounders.Secondary progression was the strongest predictor of severe disability (Hazard ratio [HR] 503.8, 95% confidence interval [CI] 160.0-1580.1; p<0.001. Complete remission of neurological symptoms at onset reduced the risk of moderate disability (HR 0.42; CI 0.23-0.77; p = 0.005, while depression (HR 3.59; CI 1.14-11.24; p = 0.028 and cognitive dysfunction (HR 4.64; CI 1.11-19.50; p = 0.036 10 years after disease onset were associated with severe disability. Oligoclonal bands and pregnancy were not correlated with disability.We were able to identify clinically apparent chronic depression and cognitive dysfunction to be associated with adverse long term outcome in MS and to confirm that pregnancy has no negative impact. Additionally, we emphasize the positive predictive value of complete remission of initial symptoms.

  10. Evaluating Teacher Preparation Using Graduates' Observational Ratings

    Science.gov (United States)

    Ronfeldt, Matthew; Campbell, Shanyce L.

    2016-01-01

    Despite growing calls for more accountability of teacher education programs (TEPs), there is little consensus about how to evaluate them. This study investigates the potential for using observational ratings of program completers to evaluate TEPs. Drawing on statewide data on almost 9,500 program completers, representing 44 providers (183…

  11. [Research and control of relapse tuberculosis cases].

    Science.gov (United States)

    Yamagishi, Fumio; Toyota, Makoto

    2009-12-01

    were recognized more significantly in male cases aged 70's. In the cases that deviated from the standard treatment and that became impossible to use rifampicin, it should be careful to emergence of isoniazid resistance. 3. The current status of the recurrence tuberculosis cases in Tokyo: Michiko NAGAMINE (Specific Disease Control Section, Tokyo Metropolitan Government Bureau of Social Welfare and Public Health). As for the background of the patient whose disease has relapsed, unstable elements are observed. After any symptom, more patients are diagnosed as a relapse case rather than finding by a medical check up. And more than half are related to homeless or life without fixed address. Their status of insurance is the livelihood protection, no insurance or the national health insurance. By RFLP analysis in Shinjuku city, some clusters have recurrent cases, one of clusters has both a relapse and exogenous reinfection. This is able to elucidate an infectious state. Like this, the analysis of each cluster can help effective countermeasures. 4. Recurrence of tuberculosis in the City of Yokohama between 2004 and 2008: Michihiko YOSHIDA (Shinagawa Public Health Center), Takahiro TOYOZAWA (Yokohama Public Health Center). To identify the TB recurrence rate, we studied a cohort of 40 cases (treatment completion 36 cases, interruption 4 cases) of whom had a previous history of TB treatment including isoniazid and rifampicin. The time for relapse was 7.9 +/- 8.6 years and the overall relapse rate was 0.6% (0.47-0.7%). Our study suggested the relapse was almost equal to the low incident countries but the long-term follow-up and surveillance data should be carefully evaluated. 5. Comparison of the retreatment cases of pulmonary tuberculosis: Yuka SASAKI (National Hospital Organization Chiba-East National Hospital). To investigate the factors of the retreatment of pulmonary tuberculosis, 134 retreatment cases were studied. The factors leading to retreatment were cavitary and large

  12. Rates and Durability of Response to Salvage Radiation Therapy Among Patients With Refractory or Relapsed Aggressive Non-Hodgkin Lymphoma

    International Nuclear Information System (INIS)

    Tseng, Yolanda D.; Chen, Yu-Hui; Catalano, Paul J.; Ng, Andrea

    2015-01-01

    Purpose: To evaluate the response rate (RR) and time to local recurrence (TTLR) among patients who received salvage radiation therapy for relapsed or refractory aggressive non-Hodgkin lymphoma (NHL) and investigate whether RR and TTLR differed according to disease characteristics. Methods and Materials: A retrospective review was performed for all patients who completed a course of salvage radiation therapy between January 2001 and May 2011 at Brigham and Women's Hospital/Dana-Farber Cancer Institute. Separate analyses were conducted for patients treated with palliative and curative intent. Predictors of RR for each subgroup were assessed using a generalized estimating equation model. For patients treated with curative intent, local control (LC) and progression-free survival were estimated with the Kaplan-Meier method; predictors for TTLR were evaluated using a Cox proportional hazards regression model. Results: Salvage radiation therapy was used to treat 110 patients to 121 sites (76 curative, 45 palliative). Salvage radiation therapy was given as part of consolidation in 18% of patients treated with curative intent. Median dose was 37.8 Gy, with 58% and 36% of curative and palliative patients, respectively, receiving 39.6 Gy or higher. The RR was high (86% curative, 84% palliative). With a median follow-up of 4.8 years among living patients, 5-year LC and progression-free survival for curative patients were 66% and 34%, respectively. Refractory disease (hazard ratio 3.3; P=.024) and lack of response to initial chemotherapy (hazard ratio 4.3; P=.007) but not dose (P=.93) were associated with shorter TTLR. Despite doses of 39.6 Gy or higher, 2-year LC was only 61% for definitive patients with refractory disease or disease that did not respond to initial chemotherapy. Conclusions: Relapsed or refractory aggressive NHL is responsive to salvage radiation therapy, and durable LC can be achieved in some cases. However, refractory disease is associated with a

  13. Enhancing Brain Lesions during Acute Optic Neuritis and/or Longitudinally Extensive Transverse Myelitis May Portend a Higher Relapse Rate in Neuromyelitis Optica Spectrum Disorders.

    Science.gov (United States)

    Orman, G; Wang, K Y; Pekcevik, Y; Thompson, C B; Mealy, M; Levy, M; Izbudak, I

    2017-05-01

    Neuromyelitis optica spectrum disorders are inflammatory demyelinating disorders with optic neuritis and/or longitudinally extensive transverse myelitis episodes. We now know that neuromyelitis optica spectrum disorders are associated with antibodies to aquaporin-4, which are highly concentrated on astrocytic end-feet at the blood-brain barrier. Immune-mediated disruption of the blood-brain barrier may manifest as contrast enhancement on brain MR imaging. We aimed to delineate the extent and frequency of contrast enhancement on brain MR imaging within 1 month of optic neuritis and/or longitudinally extensive transverse myelitis attacks and to correlate contrast enhancement with outcome measures. Brain MRIs of patients with neuromyelitis optica spectrum disorders were evaluated for patterns of contrast enhancement (periependymal, cloudlike, leptomeningeal, and so forth). The Fisher exact test was used to evaluate differences between the proportion of contrast enhancement in patients who were seropositive and seronegative for aquaporin-4 antibodies. The Mann-Whitney test was used to compare the annualized relapse rate and disease duration between patients with and without contrast enhancement and with and without seropositivity. Brain MRIs of 77 patients were evaluated; 59 patients (10 males, 49 females) were scanned within 1 month of optic neuritis and/or longitudinally extensive transverse myelitis attacks and were included in the analysis. Forty-eight patients were seropositive, 9 were seronegative, and 2 were not tested for aquaporin-4 antibodies. Having brain contrast enhancement of any type during an acute attack was significantly associated with higher annualized relapse rates ( P = .03) and marginally associated with shorter disease duration ( P = .05). Having periependymal contrast enhancement was significantly associated with higher annualized relapse rates ( P = .03). Brain MRIs of patients with neuromyelitis optica spectrum disorders with contrast

  14. The Effectiveness of Marlaat’s Cognitive Behavior Intervention and Group Treatment Based on Change Stages for Recovery and Relapse Prevention Rates in Male Heroin Crack Addicts

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    S Khodadust

    2014-11-01

    Full Text Available Objective: The aim of this study was the Study of effectiveness of Marlaat’s cognitive behavior intervention and group treatment based on change stages for recovery and relapse rates in male heroin crack addictions. Method: In a experimental research design, 45 men addictions, who were diagnosed as the dependence of the heroin crack on the basis of DSM-IV-TR criteria, were chosen after successfully detoxified. They were divided two experimental groups (30 participants and a control group (15 participants that have been selected by random sampling. The first experimental group was undergone group treatment based on change stages underwent 16 sessions of 1.5 hours, totally 24 hours and the second experimental groups who were undergone Marlaat’s cognitive behavior intervention has been held 15 sessions of 2 hours, totally 24 hours. The control group were just received MMT without any psychotherapy. All participants were assessed by structured interview, urine test, before treatment, after treatment and after 3 months follow up. Results: Results showed that both psychotherapy treatments were affected on recovery and relapse rates. Conclusion: It seems that psychological problems and conflicts before addiction and after addiction could be caused for individuals’ tendency to narcotics consumption. Therefore, applying of psychotherapy could be useful in relapse prevention.

  15. Effects of needs-assessment-based psycho-education of schizophrenic patients' families on the severity of symptoms and relapse rate of patients.

    Science.gov (United States)

    Kheirabadi, Gholam Reza; Rafizadeh, Mahnaz; Omranifard, Victoria; Yari, Azam; Maracy, Mohammad Reza; Mehrabi, Tayebe; Sadri, Sima

    2014-11-01

    Family psycho-education is one of the most effective interventions for preventing relapse in patients with schizophrenia. We evaluated the efficacy of a needs-assessment-based educational program in comparison with a current program (textbook based) in the treatment of schizophrenia. Patients with schizophrenia and their families (N = 60) were allocated to needs-assessment-based education (treatment) and textbook-based (control) programs; both included 10 sessions of education within about 6 months. Symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS) prior to intervention and every 3 months for a total of 18 months. A 25% decrease or increase in total PANSS score was considered as response or relapse, respectively. Forty-two cases completed the study. The total PANSS score was significantly decreased in both groups with more reduction in the treatment group. Positive and negative scale scores were reduced in the treatment group, but not significantly in the control group. Response rate was higher in the treatment group and relapse rate was lower (15% vs. 27.2%, P = 0.279). In logistic regression analysis, needs-assessment-based psycho-education was associated with more treatment response. Needs-assessment-based psycho-education is more effective than textbook-based education for treating schizophrenia. We recommend psychiatric care centers to conduct needs-assessment and develop their own program for family psycho-education.

  16. The Effects of Family-Centered Problem-Solving Education on Relapse Rate, Self Efficacy and Self Esteem Among Substance Abusers.

    Science.gov (United States)

    Habibi, Rahim; Nikbakht Nasrabadi, Alireza; Shabany Hamedan, Maryam; Saleh Moqadam, Amirreza

    2016-03-01

    The success of drug abuse treatment and relapse prevention methods depends widely on not only pharmaceutical and non-pharmaceutical therapies but also self efficacy and self esteem promotion. The current study attempted to clarify the effects of Problem Solving Education (PSE) on relapse rate, self efficacy and self esteem among drug abusers. This non-controlled clinical trial (quasi-experimental) assessed 60 opium and heroin abusers who were willing to quit and were referred to the Mehr Center of Addiction Treatment and Rehabilitation Facility. The patients were allocated to two groups of 30 (intervention and control groups). While both groups received the routine care of the clinic, the intervention group also attended eight 45-minute family-centered PSE sessions. The Coopersmith Self esteem Inventory and Quit Addiction Self efficacy Questionnaire were filled out for all subjects before and after the intervention. Drug relapse was investigated four times with two-week intervals. The two groups were compared using chi-square and Student's-t tests. Logistic regression analysis was applied to determine factors affecting drug relapse. A total of 45 individuals (21 and 24 in the intervention and control groups, respectively) completed the study. At baseline, the two groups had no significant difference regarding their mean scores of self esteem and self efficacy (P = 0.692 and 0.329, respectively). After the intervention, however, the mean changes of self esteem scores were 20.10 ± 3.75 for the intervention group and 4.50 for the control group (P self efficacy scores in the mentioned groups were 34 34.17 ± 5.19 and 9.03± 2.04, respectively (P self efficacy and self esteem among patients.

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

    Science.gov (United States)

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

    2015-01-01

    This study analyzed the anti-myeloma effect of zoledronic acid monotherapy by investigating patients at the time of asymptomatic biochemical relapse. One hundred patients were randomized to receive either zoledronic acid (4 mg iv/4 weeks, 12 doses) (n=51) or not (n=49). Experimental and control groups were well balanced for disease and prognostic features. Zoledronic acid did not show an antitumor effect according to changes in M-component. However, there were fewer symptomatic progressions in the experimental group than in the control group (34 versus 41, respectively; P=0.05) resulting in a median time to symptoms of 16 versus 10 months (P=0.161). The median time to next therapy was also slightly longer for the treated group than the untreated, control group (13.4 versus 10.1 months), although the difference was not statistically significant (P=0.360). The pattern of relapses was different for treated versus control patients: progressive bone disease (8 versus 20), anemia (24 versus 18), renal dysfunction (1 versus 2), and plasmacytomas (1 versus 1, respectively). This concurred with fewer skeletal-related events in the treated group than in the control group (2 versus 14), with a projected 4-year event proportion of 6% versus 40% (P<0.001). In summary, zoledronic acid monotherapy does not show an antitumor effect on biochemical relapses in multiple myeloma, but does reduce the risk of progression with symptomatic bone disease and skeletal complications. This trial was registered in the ClinicalTrials.gov database with code NCT01087008 PMID:26069291

  18. Recurrence and Relapse in Bipolar Mood Disorder

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    S Gh Mousavi

    2004-06-01

    Full Text Available Background: Despite the effectiveness of pharmacotherapy in acute phase of bipolar mood disorder, patients often experience relapses or recurrent episodes. Hospitalization of patients need a great deal of financial and humanistic resources which can be saved through understanding more about the rate of relapse and factors affecting this rate. Methods: In a descriptive analytical study, 380 patients with bipolar disorder who were hospitalized in psychiatric emergency ward of Noor hospital, Isfahan, Iran, were followed. Each patient was considered for; the frequency of relapse and recurrence, kind of pharmachotherapy, presence of psychotherapeutic treatments, frequency of visits by psychiatrist and the rank of present episode. Results: The overall prevalence of recurrence was 42.2%. Recurrence was lower in patients using lithium carbonate or sodium valproate or combined therapy (about 40%, compared to those using carbamazepine (80%. Recurrence was higher in patients treated with only pharmacotherapy (44.5% compared to those treated with both pharmacotherapy and psychotherapy (22.2%. Patients who were visited monthy by psychiatrist had lower rate of recurrence compared to those who had irregular visits. Conclusion: The higher rate of recurrence observed in carbamazepine therapy may be due to its adverse reactions and consequently poor compliance to this drug. Lower rates of recurrence with psychotherapy and regular visits may be related to the preventive effects of these procedures and especially to the effective management of stress. Keywords: Bipolar Mood Disorder, Recurrence, Relapse.

  19. JUVENILE MYOCLONIC EPILEPSY: A FOCUS ON THE EFFICACY OF THERAPY AND THE RATE OF RELAPSES ACCORDING TO LONG-TERM FOLLOW-UP DATA

    Directory of Open Access Journals (Sweden)

    K. Yu. Mukhin

    2015-01-01

    Full Text Available Juvenile myoclonic epilepsy (JME is a type of adolescent-onset idiopathic generalized epilepsy with the appearance of massive myoclonic seizures and, in most cases, generalized convulsions occurring chiefly in the period after awakening. It is assumed that there is a two-locus (dominant and recessive model of inheritance of JME; moreover, the dominant gene is located on the short arm of chromosome 6. JME is one of the most common types of epilepsy and most frequent among idiopathic generalized epilepsies. Its rate is 5 to 11 % of all types of epilepsy with some female predominance. The diagnosis of JME creates no problems in typical cases. The disease is generally manifested by a concurrence of myoclonic (usually in the hands and generalized clonic-tonic-clonic seizures occurring during waking. Typical absences and epileptic myoclonus of the eyelid are rarer. Seizures are clearly provoked by sleep deprivation. As in other types of idiopathic epilepsy, the patients’ neurological status is normal; no intellectual disabilities are observed. This type of epilepsy is well treatable and, when initial monotherapy is correctly used, sustainable remission occurs immediately in the vast majority (75–85 % of the patients with JME. However, the problem of these patients, unlike that of patients with many forms of idiopathic epilepsy, is that sleep pattern disturbance, missing a dose of antiepileptic drugs (AED, or therapy refusal give rise to relapse of seizures in the vast majority of patients even in long-term remission.Due to the fact that the data available in the literature on the efficacy of therapy in patients with JME and particularly on the results of its discontinuation are contradictory, the authors of the paper conducted an investigation to determine therapeutic effectiveness and the frequency of relapse of seizures in patients with JME during a long-term follow-up.The study enrolled 106 JME patients who had been regularly followed up at

  20. Long-term persistence with injectable therapy in relapsing-remitting multiple sclerosis: an 18-year observational cohort study.

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    Simon Zhornitsky

    Full Text Available Disease modifying therapies (DMTs reduce the frequency of relapses and accumulation of disability in multiple sclerosis (MS. Long-term persistence with treatment is important to optimize treatment benefit. This long-term, cohort study was conducted at the Calgary MS Clinic. All consenting adults with relapsing-remitting MS who started either glatiramer acetate (GA or interferon-β 1a/1b (IFN-β between January 1st, 1996 and July 1st, 2011 were included. Follow-up continued to February 1st, 2014. Time-to-discontinuation of the initial and subsequently-prescribed DMTs (switches was analysed using Kaplan-Meier survival analyses. Group differences were compared using log-rank tests and multivariable Cox regression models. Analysis included 1471 participants; 906 were initially prescribed GA and 565 were initially prescribed IFN-β. Follow-up information was available for 87%; 29 (2% were lost to follow-up and 160 (11% moved from Southern Alberta while still using DMT. Median time-to-discontinuation of all injectable DMTs was 11.1 years. Participants with greater disability at treatment initiation, those who started treatment before age 30, and those who started between 2006 and 2011 were more likely to discontinue use of all injectable DMTs. Median time-to-discontinuation of the initial DMT was 8.6 years. Those initially prescribed GA remained on treatment longer. Of 610 participants who discontinued injectable DMT, 331 (54% started an oral DMT, or a second-line DMT, or resumed injectable DMT after 90 days. Persistence with injectable DMTs was high in this long-term population-based study. Most participants who discontinued injectable DMT did not remain untreated. Further research is required to understand treatment outcomes and outcomes after stopping DMT.

  1. Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study.

    Science.gov (United States)

    Wegman, Martin P; Altice, Frederick L; Kaur, Sangeeth; Rajandaran, Vanesa; Osornprasop, Sutayut; Wilson, David; Wilson, David P; Kamarulzaman, Adeeba

    2017-02-01

    Detention of people who use drugs into compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Evidence-based pharmacological therapies for treating substance use disorders, such as opioid agonist treatments with methadone, are generally unavailable in these settings. We used a unique opportunity where CDDCs coexisted with voluntary drug treatment centres (VTCs) providing methadone in Malaysia to compare the timing and occurrence of opioid relapse (measured using urine drug testing) in individuals transitioning from CDDCs versus methadone maintenance in VTCs. We did a parallel, two-arm, prospective observational study of opioid-dependent individuals aged 18 years and older who were treated in Malaysia in the Klang Valley in two settings: CDDCs and VTCs. We used sequential sampling to recruit individuals. Assessed individuals in CDDCs were required to participate in services such as counselling sessions and manual labour. Assessed individuals in VTCs could voluntarily access many of the components available in CDDCs, in addition to methadone therapy. We undertook urinary drug tests and behavioural interviews to assess individuals at baseline and at 1, 3, 6, 9, and 12 months post-release. The primary outcome was time to opioid relapse post-release in the community confirmed by urinary drug testing in individuals who had undergone baseline interviewing and at least one urine drug test (our analytic sample). Relapse rates between the groups were compared using time-to-event methods. This study is registered at ClinicalTrials.gov (NCT02698098). Between July 17, 2012, and August 21, 2014, we screened 168 CDDC attendees and 113 VTC inpatients; of these, 89 from CDDCs and 95 from VTCs were included in our analytic sample. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants (median time to relapse

  2. The MS@Work study: a 3-year prospective observational study on factors involved with work participation in patients with relapsing-remitting Multiple Sclerosis.

    Science.gov (United States)

    van der Hiele, Karin; van Gorp, Dennis A M; Heerings, Marco A P; van Lieshout, Irma; Jongen, Peter J; Reneman, Michiel F; van der Klink, Jac J L; Vosman, Frans; Middelkoop, Huub A M; Visser, Leo H

    2015-08-12

    Multiple Sclerosis (MS) is the most common cause of neurological disability in young and middle-aged adults. At this stage in life most people are in the midst of their working career. The majority of MS patients are unable to retain employment within 10 years from disease onset. Leading up to unemployment, many may experience a reduction in hours or work responsibilities and increased time missed from work. The MS@Work study examines various factors that may influence work participation in relapsing-remitting MS patients, including disease-related factors, the working environment and personal factors. The MS@Work study is a multicenter, 3-year prospective observational study on work participation in patients with relapsing-remitting MS. We aim to include 350 patients through 15-18 MS outpatient clinics in the Netherlands. Eligible participants are 18 years and older, and either currently employed or within three years since their last employment. At baseline and after 1, 2 and 3 years, the participants are asked to complete online questionnaires (including questions on work participation, work problems and accommodations, cognitive and physical ability, anxiety, depression, psychosocial stress, quality of life, fatigue, empathy, personality traits and coping strategies) and undergo cognitive and neurological examinations. After six months, patients are requested to only complete online questionnaires. Patient perspectives on maintaining and improving work participation and reasons to stop working are gathered through semi-structured interviews in a sub-group of patients. Prospective studies with long-term follow-up on work participation in MS are rare, or take into account a limited number of factors. The MS@Work study provides a 3-year follow-up on various factors that may influence work participation in patients with relapsing-remitting MS. We aim to identify factors that relate to job loss and to provide information about preventative measures for physicians

  3. Clinical features and relapse rates after surgery in type 1 autoimmune pancreatitis differ from type 2: a study of 114 surgically treated European patients.

    Science.gov (United States)

    Detlefsen, Sönke; Zamboni, Giuseppe; Frulloni, Luca; Feyerabend, Bernd; Braun, Felix; Gerke, Oke; Schlitter, Anna Melissa; Esposito, Irene; Klöppel, Günter

    2012-01-01

    At the recent consensus conference on autoimmune pancreatitis (AIP) in Honolulu, we presented preliminary data from our study of surgically treated AIP patients. Our data strongly supported the separation of AIP into type 1 and type 2. Our study is based on a total of 114 surgically treated European AIP patients. Our aims were to elucidate serum IgG4 elevation, other organ involvement, relapse of disease, steroid treatment and diabetes after surgery in 114 surgically treated European AIP patients. 88 pancreaticoduodenectomies, 22 left-sided resections and 4 total pancreatectomies were examined. All cases were graded for granulocytic epithelial lesions, IgG4-positive cells, storiform fibrosis, phlebitis and eosinophilic granulocytes. Follow-up data were obtained from 102/114 patients, mean follow-up was 5.3 years. Histologically, 63 (55.3%) of the 114 patients fulfilled the criteria of type 1 AIP, while 51 (44.7%) patients fulfilled the criteria of type 2 AIP. Type 1 AIP patients were older and more often males than type 2 AIP patients. Elevation of serum IgG4, involvement of extrapancreatic organs, disease relapse, systemic steroid treatment and diabetes after surgery were noted more often in type 1 AIP, while inflammatory bowel disease (IBD) was observed mainly in type 2 AIP. Histological typing of AIP is clinically important because type 1 AIP is part of the IgG4-related disease and type 2 AIP is associated with IBD. Our data also show that relapse of disease and steroid treatment after surgery occur more frequently in type 1 than in type 2 AIP. Copyright © 2012 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  4. Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

    International Nuclear Information System (INIS)

    Gujral, Dorothy M.; Sumo, Georges; Owen, John R.; Ashton, Anita; Bliss, Judith M.; Haviland, Joanne; Yarnold, John R.

    2011-01-01

    Purpose: The justification for partial breast radiotherapy after breast conservation surgery assumes that ipsilateral breast tumor relapses (IBTR) outside the index quadrant are mostly new primary (NP) tumors that develop despite radiotherapy. We tested the hypothesis that whole-breast radiotherapy (WBRT) is ineffective in preventing NP by comparing development rates in irradiated and contralateral breasts after tumor excision and WBRT. Methods and Materials: We retrospectively reviewed 1,410 women with breast cancer who were entered into a prospective randomized trial of radiotherapy fractionation and monitored annually for ipsilateral breast tumor relapses (IBTR) and contralateral breast cancer (CLBC). Cases of IBTR were classified into local recurrence (LR) or NP tumors based on location and histology and were subdivided as definite or likely depending on clinical data. Rates of ipsilateral NP and CLBC were compared over a 15-year period of follow-up. Results: At a median follow-up of 10.1 years, there were 150 documented cases of IBTR: 118 (79%) cases were definite or likely LR; 27 (18%) cases were definite or likely NP; and 5 (3%) cases could not be classified. There were 71 cases of CLBC. The crude proportion of definite-plus-likely NP was 1.9% (27/1,410) patients compared with 5% (71/1,410) CLBC patients. Cumulative incidence rates at 5, 10, and 15 years were 0.8%, 2.0%, and 3.5%, respectively, for definite-plus-likely NP and 2.4%, 5.8%, and 7.9%, respectively for CLBC, suggesting a difference in the rates of NP and CLBC. Conclusions: This analysis suggests that WBRT reduces the rate of ipsilateral NP tumors. The late presentation of NP has implications for the reporting of trials that are testing partial breast radiotherapy.

  5. [Attributable risk of co-morbid substance use disorder in poor observance to pharmacological treatment and the occurrence of relapse in schizophrenia].

    Science.gov (United States)

    Ameller, A; Gorwood, P

    2015-04-01

    There are numerous risk factors involved in poor (incomplete) compliance to pharmacological treatment, and the associated relapse risk, for patients with schizophrenia. Comorbid substance use disorders are considered as among the most important ones, although how much their presence increase the risk of poorer observance (and higher risk of relapse) has not been yet assessed. This measure would be important, especially if the published literature on the topic provides sufficient material to perform a meta-analysis and to assess different potential biases such as those related to time (new studies are easier to publish when positive) or sample size (small samples might drive the global positive conclusion). A PubMed(®) search was made, screening the following terms between 1996 and august 2014 "Addiction AND (Observance OR Adherence) AND schizophrenia AND (French OR English [Language])" and "(Substance Abuse OR substance dependance) AND Outcome AND schizophrenia AND (French OR English [Language])". Studies were included if they describe two patients groups (schizophrenia with and without present substance use disorder) and assess the studied outcome. MetaWin(®) version 2 was used for the meta-analysis, while publication time bias relied on non-parametric correlation and the one linked to sample size was assessed through normal quantile plots. An attributable risk was also computered, on the basis of the odds-ratio derived from the meta-analysis and the prevalence of the analyzed trait (associated substance use disorder). Eight studies could be included in the meta-analysis, showing that the presence of a substance use disorder significantly increases the risk of poor observance to pharmacological treatment (OR=2.18 [1.84-2.58]), no significant bias being detected, either linked to time (rho=0.287, P=0.490) or sample size (Kendall's Tau=-0.286, P=0.322). The related attributable risk is 18.50%. Only three studies could be used for the meta-analysis of the risk of

  6. Low-dose-rate brachytherapy for the treatment of localised prostate cancer in men with a high risk of disease relapse.

    Science.gov (United States)

    Laing, Robert; Uribe, Jennifer; Uribe-Lewis, Santiago; Money-Kyrle, Julian; Perna, Carla; Chintzoglou, Stylianos; Khaksar, Sara; Langley, Stephen E M

    2018-04-01

    To report clinical outcomes of 125 I low-dose-rate prostate brachytherapy (LDR-PB) as monotherapy or combined with androgen-deprivation therapy (ADT) and/or external beam radiotherapy (EBRT) in high-risk localised prostate cancer. Analysis of clinical outcomes from a prospective cohort of patients treated with LDR-PB alone or combined treatment in a single institution. Men with a high risk of disease relapse were identified by the National Institute for Health and Care Excellence (NICE) criteria or by the National Comprehensive Cancer Network (NCCN) criteria. Relapse-free survival (RFS), overall survival (OS), prostate cancer-specific survival (PCSS), and metastases-free survival (MFS), were analysed together with patient-reported symptom scores and physician-reported adverse events. The NICE and NCCN criteria identified 267 and 202 high-risk patients, respectively. NICE-defined patients had significantly lower pre-treatment PSA levels, Gleason scores LDR-PB monotherapy. At 9 years after implantation RFS was 89% and 87% in the NICE and NCCN groups, respectively (log-rank P = 0.637), and OS 93% and 94%, respectively (log-rank P = 0.481). All of the survival estimates were similar between LDR-PB monotherapy and combined therapies. Cox proportional hazards regression confirmed RFS was similar between the treatment types. Treatment-related toxicity was also similar between the treatment methods. LDR-PB is effective at controlling localised prostate cancer in patients with a high risk of disease relapse. As the present study was not randomised, it is not possible to define those patients who need the addition of ADT and/or EBRT. However, the NICE criteria appear suitable to define treatment options where patients could benefit from LDR-PB as monotherapy or combined treatment. This choice should be discussed with the patient taking into account comorbidities and presence of multiple high-risk factors. © 2018 The Authors BJU International © 2018 BJU International

  7. Preliminary observation of genital secretions, growth rate and ...

    African Journals Online (AJOL)

    Cane rats are large terrestial rodents which have the potential to increase animal protein intake. There is paucity of information on the genital secretions and growth rate of caged cane rats. This study observed the genital secretions, growth rate, feeds, feeding and the behaviour of caged cane rats. When animals adjusted to ...

  8. High rate of complete responses to immune checkpoint inhibitors in patients with relapsed or refractory Hodgkin lymphoma previously exposed to epigenetic therapy

    Directory of Open Access Journals (Sweden)

    Lorenzo Falchi

    2016-11-01

    Full Text Available Abstract Options for patients with relapsed or refractory (R/R classical Hodgkin lymphoma (cHL after brentuximab vedotin (Bv and autologous stem cell transplantation (ASCT are limited. Immune checkpoint inhibitors (ICI are active in this population but rarely induce complete response (CR. Ten patients with R/R cHL after ASCT and Bv received pembrolizumab (n = 8 or nivolumab (n = 2. Five had been previously exposed to 5-azacitidine on a phase 1 study. Among nine evaluable patients, seven (78% achieved CR, one partial response, and one reduction of tumor burden. All five patients who had received 5-azacitidine prior to ICI achieved CR, while only two of four who did not receive prior 5-azacitidine achieved CR. At a median follow-up of 9.9 months [0.5–14.3], eight patients are alive and five are still receiving treatment. We documented an unprecedented CR rate after ICI in patients with R/R cHL. We hypothesize that hypomethylating agents might have an immune priming effect and enhance the efficacy of ICI.

  9. Beyond student ratings: peer observation of classroom and clinical teaching.

    Science.gov (United States)

    Berk, Ronald A; Naumann, Phyllis L; Appling, Susan E

    2004-01-01

    Peer observation of classroom and clinical teaching has received increased attention over the past decade in schools of nursing to augment student ratings of teaching effectiveness. One essential ingredient is the scale used to evaluate performance. A five-step systematic procedure for adapting, writing, and building any peer observation scale is described. The differences between the development of a classroom observation scale and an appraisal scale to observe clinical instructors are examined. Psychometric issues peculiar to observation scales are discussed in terms of content validity, eight types of response bias, and interobserver reliability. The applications of the scales in one school of nursing as part of the triangulation of methods with student ratings and the teaching portfolio are illustrated. Copies of the scales are also provided.

  10. Gender differences in alcohol and substance use relapse.

    Science.gov (United States)

    Walitzer, Kimberly S; Dearing, Ronda L

    2006-03-01

    This review explores gender differences in relapse and characteristics of relapse events in alcohol and substance use. For alcohol, relapse rates were similar across gender. Although negative mood, childhood sexual abuse, alcohol-related self-efficacy, and poorer coping strategies predicted alcohol relapse, gender did not moderate these effects. Gender did moderate the association between marriage and alcohol relapse. For women, marriage and marital stress were risk factors for alcohol relapse; among men, marriage lowered relapse risk. This gender difference in the role of marriage in relapse may be a result of partner differences in problem drinking. Alcoholic women are more likely to be married to heavy drinking partners than are alcoholic men; thus, alcoholic women may be put at risk of relapse by marriage and alcoholic men may be protected by marriage. There are fewer studies documenting gender differences in substance abuse relapse so conclusions are limited and tentative. In contrast to the lack of gender differences in alcohol relapse rates, women appear less likely to experience relapse to substance use, relative to men. Women relapsing to substance use appear to be more sensitive to negative affect and interpersonal problems. Men, in contrast, may be more likely to have positive experiences prior to relapse.

  11. Depression relapse and ethological measures

    NARCIS (Netherlands)

    Hale, WWH; Jansen, JHC; Bouhuys, AL; vandenHoofdakker, RH

    1997-01-01

    Within the framework of interactional theories on depression, the question is raised whether depression relapse can be predicted by observable behavior of remitted patients and their interviewer during an interaction (i.e. discharge interview). Thirty-four patients were interviewed at hospital

  12. Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012.

    Directory of Open Access Journals (Sweden)

    Claire M Italiano

    2014-05-01

    Full Text Available BACKGROUND: From the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak. METHODOLOGY/PRINCIPAL FINDINGS: All retreat participants were identified, and clinical and epidemiological information was obtained via clinical review and self-reported answers to a structured questionnaire. Laboratory, imaging and muscle biopsy results were evaluated and possible sources of exposure, in particular water supply, were investigated. At an average of 9-11 days upon return from the retreat, 89 (97% of the participants became ill. A vast majority of 94% had fever with 57% of these persons experiencing relapsing fever. Myalgia was present in 91% of patients. Facial swelling from myositis of jaw muscles occurred in 9 (10% patients. The median duration of symptoms was 17 days (IQR 7 to 30 days; range 3 to 112. Out of 4 muscle biopsies, sarcocysts were identified in 3. S. nesbitti was identified by PCR in 3 of the 4 biopsies including one biopsy without observed sarcocyst. Non-Malaysians had a median duration of symptoms longer than that of Malaysians (27.5 days vs. 14 days, p = 0.001 and were more likely to experience moderate or severe myalgia compared to mild myalgia (83.3% vs. 40.0%, p = 0.002. CONCLUSIONS/SIGNIFICANCE: The similarity of the symptoms and clustered time of onset suggests that all affected persons had muscular sarcocystosis. This is the largest human outbreak of sarcocystosis ever reported, with the specific Sarcocystis species identified. The largely non-specific clinical features of this illness suggest that S. nesbitti may be an under diagnosed infection in the tropics.

  13. Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012.

    Science.gov (United States)

    Italiano, Claire M; Wong, Kum Thong; AbuBakar, Sazaly; Lau, Yee Ling; Ramli, Norlisah; Syed Omar, Sharifah Faridah; Kahar Bador, Maria; Tan, Chong Tin

    2014-05-01

    From the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak. All retreat participants were identified, and clinical and epidemiological information was obtained via clinical review and self-reported answers to a structured questionnaire. Laboratory, imaging and muscle biopsy results were evaluated and possible sources of exposure, in particular water supply, were investigated. At an average of 9-11 days upon return from the retreat, 89 (97%) of the participants became ill. A vast majority of 94% had fever with 57% of these persons experiencing relapsing fever. Myalgia was present in 91% of patients. Facial swelling from myositis of jaw muscles occurred in 9 (10%) patients. The median duration of symptoms was 17 days (IQR 7 to 30 days; range 3 to 112). Out of 4 muscle biopsies, sarcocysts were identified in 3. S. nesbitti was identified by PCR in 3 of the 4 biopsies including one biopsy without observed sarcocyst. Non-Malaysians had a median duration of symptoms longer than that of Malaysians (27.5 days vs. 14 days, p = 0.001) and were more likely to experience moderate or severe myalgia compared to mild myalgia (83.3% vs. 40.0%, p = 0.002). The similarity of the symptoms and clustered time of onset suggests that all affected persons had muscular sarcocystosis. This is the largest human outbreak of sarcocystosis ever reported, with the specific Sarcocystis species identified. The largely non-specific clinical features of this illness suggest that S. nesbitti may be an under diagnosed infection in the tropics.

  14. Significance of definitions of relapse after discontinuation of oral antivirals in HBeAg-negative chronic hepatitis B.

    Science.gov (United States)

    Papatheodoridis, George V; Manolakopoulos, Spilios; Su, Tung-Hung; Siakavellas, Spyros; Liu, Chun-Jen; Kourikou, Anastasia; Yang, Hung-Chih; Kao, Jia-Horng

    2017-08-31

    Relapses are observed in most hepatitis B e antigen (HBeAg)-negative chronic hepatitis B patients who discontinue treatment with nucleos(t)ide analogues (NAs); however, the rates of relapse vary widely among studies, and whether all patients with relapse need retreatment is unclear. The aim of this study was to assess the impact of different definitions on the rates of posttreatment relapse and therefore on the probability of retreatment in patients who have discontinued effective long-term NA therapy. In total, 130 HBeAg-negative chronic hepatitis B patients without cirrhosis and before NA treatment were included. All had on-therapy virological remission for ≥24 months and close follow-up for ≥12 months after stopping NA treatment or until retreatment, which started on stringent predefined criteria. Relapses rates based on several predetermined definitions of virological and perhaps biochemical criteria were assessed. The median duration of therapy was 60 months and the median duration of on-therapy virological remission was 43 months. During a median off-NAs follow-up of 15 months, no patient experienced liver decompensation or died. Cumulative relapse rates were 2%-49%, 4%-73%, 11%-82%, and 16%-90% at 3, 6, 12, and 24 months, respectively, whereas cumulative retreatment rates were 15%, 22%, and 40% at 6, 12, and 24 months, respectively, after discontinuation of NA therapy. No patient characteristic was independently associated with the probability of relapse based on at least two definitions or of retreatment. In HBeAg-negative chronic hepatitis B patients who discontinue NA therapy, the definition of relapse has a great impact on off-NAs relapse rates and potentially on the probability of retreatment. Regardless of definition, off-NAs relapses cannot be easily predicted by patient characteristics. A substantial proportion of such patients may not require retreatment if stringent criteria are adopted. (Hepatology 2017). © 2017 by the American Association

  15. Factors associated with relapse in schizophrenia

    African Journals Online (AJOL)

    increases the economic burden on health care systems because of its associated morbidity .... Depression in schizophrenia has been associated with higher rates of relapse ... The researchers approached the psychiatric nursing staff of mental.

  16. Pro-Inflammatory Cytokines Predict Relapse-Free Survival after One Month of Interferon-α but Not Observation in Intermediate Risk Melanoma Patients.

    Directory of Open Access Journals (Sweden)

    Ahmad A Tarhini

    Full Text Available E1697 was a phase III trial of adjuvant interferon (IFN-α2b for one month (Arm B versus observation (Arm A in patients with resected melanoma at intermediate risk. We evaluated the levels of candidate serum cytokines, the HLA genotype, polymorphisms of CTLA4 and FOXP3 genes and the development of autoantibodies for their association with relapse free survival (RFS in Arm A and Arm B among 268 patients with banked biospecimens.ELISA was used to test 5 autoantibodies. Luminex/One Lambda LABTypeRSSO was used for HLA Genotyping. Selected CTLA4 and FOXP3 Single nucleotide polymorphisms (SNPs and microsatellites were tested for by polymerase chain reaction (PCR. Sixteen serum cytokines were tested at baseline and one month by Luminex xMAP multiplex technology. Cox Proportional Hazards model was applied and the Wald test was used to test the marginal association of each individual marker and RFS. We used the Lasso approach to select the markers to be included in a multi-marker Cox Proportional Hazards model. The ability of the resulting models to predict one year RFS was evaluated by the time-dependent ROC curve. The leave-one-out method of cross validation (LOOCV was used to avoid over-fitting of the data.In the multi-marker modeling analysis conducted in Arm B, one month serum IL2Rα, IL-12p40 and IFNα levels predicted one year RFS with LOOCV AUC = 82%. Among the three markers selected, IL2Rα and IFNα were the most stable (selected in all the cross validation cycles. The risk score (linear combination of the 3 markers separated the RFS curves of low and high risk groups well (p = 0.05. This model did not hold for Arm A, indicating a differential marker profile in Arm B linked to the intervention (adjuvant therapy.Early on-treatment proinflammatory serum markers (IL2Rα, IL-12p40, IFNα significantly predict RFS in our cohort of patients treated with adjuvant IFN-α2b and warrant further study.

  17. Multiple-clone activation of hypnozoites is the leading cause of relapse in Plasmodium vivax infection.

    Directory of Open Access Journals (Sweden)

    Flávia Carolina F de Araujo

    Full Text Available BACKGROUND: Plasmodium vivax infection is characterized by a dormant hepatic stage, the hypnozoite that is activated at varying periods of time after clearance of the primary acute blood-stage, resulting in relapse. Differentiation between treatment failure and new infections requires characterization of initial infections, relapses, and clone multiplicity in vivax malaria infections. METHODOLOGY/PRINCIPAL FINDINGS: Parasite DNA obtained from primary/relapse paired blood samples of 30 patients with P. vivax infection in Brazil was analyzed using 10 molecular markers (8 microsatellites and MSP-1 blocks 2 and 10. Cloning of PCR products and genotyping was used to identify low-frequency clones of parasites. We demonstrated a high frequency of multiple-clone infections in both primary and relapse infections. Few alleles were identified per locus, but the combination of these alleles produced many haplotypes. Consequently, the majority of parasites involved in relapse showed haplotypes that were distinct from those of primary infections. Plasmodium vivax relapse was characterized by temporal variations in the predominant parasite clones. CONCLUSIONS/SIGNIFICANCE: The high rate of low frequency alleles observed in both primary and relapse infections, along with temporal variation in the predominant alleles, might be the source of reported heterologous hypnozoite activation. Our findings complicate the concept of heterologous activation, suggesting the involvement of undetermined mechanisms based on host or environmental factors in the simultaneous activation of multiple clones of hypnozoites.

  18. Daily corticosteroids reduce infection-associated relapses in frequently relapsing nephrotic syndrome: a randomized controlled trial.

    Science.gov (United States)

    Gulati, Ashima; Sinha, Aditi; Sreenivas, Vishnubhatla; Math, Aparna; Hari, Pankaj; Bagga, Arvind

    2011-01-01

    Relapses of nephrotic syndrome often follow minor infections, commonly of the upper respiratory tract. Daily administration of maintenance prednisolone during intercurrent infections was examined to determine whether the treatment reduces relapse rates in children with frequently relapsing nephrotic syndrome. In a randomized controlled trial (nonblind, parallel group, tertiary-care hospital), 100 patients with idiopathic, frequently relapsing nephrotic syndrome eligible for therapy with prolonged low-dose, alternate-day prednisolone with or without levamisole were randomized to either receive their usual dose of alternate-day prednisolone daily for 7 days during intercurrent infections (intervention group) or continue alternate-day prednisolone (controls). Primary outcome was assessed by comparing the rates of infection-associated relapses at 12-month follow-up. Secondary outcomes were the frequency of infections and the cumulative amount of prednisolone received in both groups. Patients in the intervention group showed significantly lower infection-associated (rate difference, 0.7 episodes/patient per year; 95% confidence intervals [CI] 0.3, 1.1) and lower total relapse rates (0.9 episodes/patient per year, 95% CI 0.4, 1.4) without increase in steroid toxicity. Poisson regression, adjusted for occurrence of infections, showed that daily administration of prednisolone during infections independently resulted in 59% reduction in frequency of relapses (rate ratio, 0.41; 95% CI 0.3, 0.6). For every six patients receiving this intervention, one showed a reduction of relapse frequency to less than three per year. Daily administration of maintenance doses of prednisolone, during intercurrent infections, significantly reduces relapse rates and the proportion of children with frequently relapsing nephrotic syndrome.

  19. Fast radio burst event rate counts - I. Interpreting the observations

    Science.gov (United States)

    Macquart, J.-P.; Ekers, R. D.

    2018-02-01

    The fluence distribution of the fast radio burst (FRB) population (the `source count' distribution, N (>F) ∝Fα), is a crucial diagnostic of its distance distribution, and hence the progenitor evolutionary history. We critically reanalyse current estimates of the FRB source count distribution. We demonstrate that the Lorimer burst (FRB 010724) is subject to discovery bias, and should be excluded from all statistical studies of the population. We re-examine the evidence for flat, α > -1, source count estimates based on the ratio of single-beam to multiple-beam detections with the Parkes multibeam receiver, and show that current data imply only a very weak constraint of α ≲ -1.3. A maximum-likelihood analysis applied to the portion of the Parkes FRB population detected above the observational completeness fluence of 2 Jy ms yields α = -2.6_{-1.3}^{+0.7 }. Uncertainties in the location of each FRB within the Parkes beam render estimates of the Parkes event rate uncertain in both normalizing survey area and the estimated post-beam-corrected completeness fluence; this uncertainty needs to be accounted for when comparing the event rate against event rates measured at other telescopes.

  20. Observational Test of the Dayside Magnetopause Reconnection Rate

    Science.gov (United States)

    Wang, S.; Kistler, L. M.; Mouikis, C.

    2014-12-01

    In asymmetric reconnection, the reconnection rate (R) is expected to follow the Cassak-Shay formula with an aspect ratio of around 0.1. At the magnetopause, reconnection is asymmetric, with the dense shocked solar wind population on the magnetosheath side, and a normally hot and tenuous population on the magnetospheric side. However, the hot magnetospheric population can contain a significant O+ component that increases the mass density, and the magnetospheric population may also include a cold dense population of plasmaspheric origin. We perform a statistical study of 13 magnetopause reconnection events observed by Cluster to determine how the reconnection rate depends on these different populations. The events are mainly at high latitudes, due to the Cluster orbit. Our results show that the measured R generally follows the Cassak-Shay prediction when all populations are included. However, the predicted rate only considering the magnetosheath contribution also correlates well with the measured R. For individual events, cold ions can make a comparable contribution to the magnetosheath H+ when there are plasmaspheric drainage plumes; the contribution of the magnetospheric hot O+ can be up to ~30%. However, the variation of solar wind conditions has a larger effect on the variation in the reconnection rate. The aspect ratio does not vary systematically with the O+ content, and 0.1 is a reasonable estimation. The outflow velocity is around the hybrid Alfven speed, but there is not a strong correlation. This may be due to motion of the x-line, or effects of the magnetosheath shear flow.

  1. [Relapse: causes and consequences].

    Science.gov (United States)

    Thomas, P

    2013-09-01

    Relapse after a first episode of schizophrenia is the recurrence of acute symptoms after a period of partial or complete remission. Due to its variable aspects, there is no operational definition of relapse able to modelise the outcome of schizophrenia and measure how the treatment modifies the disease. Follow-up studies based on proxys such as hospital admission revealed that 7 of 10 patients relapsed after a first episode of schizophrenia. The effectiveness of antipsychotic medications on relapse prevention has been widely demonstrated. Recent studies claim for the advantages of atypical over first generation antipsychotic medication. Non-adherence to antipsychotic represents with addictions the main causes of relapse long before some non-consensual factors such as premorbid functioning, duration of untreated psychosis and associated personality disorders. The consequences of relapse are multiple, psychological, biological and social. Pharmaco-clinical studies have demonstrated that the treatment response decreases with each relapse. Relapse, even the first one, will contribute to worsen the outcome of the disease and reduce the capacity in general functionning. Accepting the idea of continuing treatment is a complex decision in which the psychiatrist plays a central role besides patients and their families. The development of integrated actions on modifiable risk factors such as psychosocial support, addictive comorbidities, access to care and the therapeutic alliance should be promoted. Relapse prevention is a major goal of the treatment of first-episode schizophrenia. It is based on adherence to the maintenance treatment, identification of prodromes, family active information and patient therapeutical education. Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  2. Intensive social cognitive treatment (can do treatment) with participation of support partners in persons with relapsing remitting multiple sclerosis: observation of improved self-efficacy, quality of life, anxiety and depression 1 year later.

    Science.gov (United States)

    Jongen, Peter Joseph; Heerings, Marco; Ruimschotel, Rob; Hussaarts, Astrid; Duyverman, Lotte; van der Zande, Anneke; Valkenburg-Vissers, Joyce; van Droffelaar, Maarten; Lemmens, Wim; Donders, Rogier; Visser, Leo H

    2016-07-29

    In persons with multiple sclerosis (MS) self-efficacy positively affects health-related quality of life (HRQoL) and physical activity. In a previous study we observed that 6 months after an intensive 3-day social cognitive treatment (Can Do treatment) with the participation of support partners, self-efficacy and HRQoL had improved in persons with relapsing remitting MS (RRMS). Given the chronic nature of the disease, it is important to know whether these beneficial changes may last. Can Do treatment was given to 60 persons with MS and their support partners. At baseline and 12 months after treatment self-efficacy control, self-efficacy function, physical and mental HRQoL, anxiety, depression and fatigue were assessed via self-report questionnaires. Differences were tested via a paired t test. Of the 57 persons with MS that completed the baseline assessment and the 3-day treatment, 38 filled in the 12th month questionnaires (response rate 66.7 %), 22 with RRMS and 14 with progressive MS. In the RR group self-efficacy control had increased by 20.2 % and physical HRQoL by 15.0 %, and depression and anxiety had decreased by 29.8 and 25.9 %, respectively (all P treatment (Can Do treatment) with the participation of support partners may have long lasting beneficial effects on the self-efficacy and HRQoL in persons with RRMS; and that improvements in anxiety and depression, not seen in the 6-month study, may yet develop at 12 months.

  3. Clinical factors related to schizophrenia relapse.

    Science.gov (United States)

    Porcelli, Stefano; Bianchini, Oriana; De Girolamo, Giovanni; Aguglia, Eugenio; Crea, Luciana; Serretti, Alessandro

    2016-01-01

    Relapses represent one of the main problems of schizophrenia management. This article reviews the clinical factors associated with schizophrenia relapse. A research of the last 22 years of literature data was performed. Two-hundred nineteen studies have been included. Three main groups of factors are related to relapse: factors associated with pharmacological treatment, add-on psychotherapeutic treatments and general risk factors. Overall, the absence of a maintenance therapy and treatment with first generation antipsychotics has been associated with higher risk of relapse. Further, psychotherapy add-on, particularly with cognitive behaviour therapy and psycho-education for both patients and relatives, has shown a good efficacy for reducing the relapse rate. Among general risk factors, some could be modified, such as the duration of untreated psychosis or the substance misuse, while others could not be modified as male gender or low pre-morbid level of functioning. Several classes of risk factors have been proved to be relevant in the risk of relapse. Thus, a careful assessment of the risk factors here identified should be performed in daily clinical practice in order to individualise the relapse risk for each patient and to provide a targeted treatment in high-risk subjects.

  4. Estimation of human core temperature from sequential heart rate observations

    International Nuclear Information System (INIS)

    Buller, Mark J; Tharion, William J; Cheuvront, Samuel N; Montain, Scott J; Kenefick, Robert W; Castellani, John; Latzka, William A; Hoyt, Reed W; Roberts, Warren S; Richter, Mark; Jenkins, Odest Chadwicke

    2013-01-01

    Core temperature (CT) in combination with heart rate (HR) can be a good indicator of impending heat exhaustion for occupations involving exposure to heat, heavy workloads, and wearing protective clothing. However, continuously measuring CT in an ambulatory environment is difficult. To address this problem we developed a model to estimate the time course of CT using a series of HR measurements as a leading indicator using a Kalman filter. The model was trained using data from 17 volunteers engaged in a 24 h military field exercise (air temperatures 24–36 °C, and 42%–97% relative humidity and CTs ranging from 36.0–40.0 °C). Validation data from laboratory and field studies (N = 83) encompassing various combinations of temperature, hydration, clothing, and acclimation state were examined using the Bland–Altman limits of agreement (LoA) method. We found our model had an overall bias of −0.03 ± 0.32 °C and that 95% of all CT estimates fall within ±0.63 °C (>52 000 total observations). While the model for estimating CT is not a replacement for direct measurement of CT (literature comparisons of esophageal and rectal methods average LoAs of ±0.58 °C) our results suggest it is accurate enough to provide practical indication of thermal work strain for use in the work place. (paper)

  5. Estimation of human core temperature from sequential heart rate observations.

    Science.gov (United States)

    Buller, Mark J; Tharion, William J; Cheuvront, Samuel N; Montain, Scott J; Kenefick, Robert W; Castellani, John; Latzka, William A; Roberts, Warren S; Richter, Mark; Jenkins, Odest Chadwicke; Hoyt, Reed W

    2013-07-01

    Core temperature (CT) in combination with heart rate (HR) can be a good indicator of impending heat exhaustion for occupations involving exposure to heat, heavy workloads, and wearing protective clothing. However, continuously measuring CT in an ambulatory environment is difficult. To address this problem we developed a model to estimate the time course of CT using a series of HR measurements as a leading indicator using a Kalman filter. The model was trained using data from 17 volunteers engaged in a 24 h military field exercise (air temperatures 24-36 °C, and 42%-97% relative humidity and CTs ranging from 36.0-40.0 °C). Validation data from laboratory and field studies (N = 83) encompassing various combinations of temperature, hydration, clothing, and acclimation state were examined using the Bland-Altman limits of agreement (LoA) method. We found our model had an overall bias of -0.03 ± 0.32 °C and that 95% of all CT estimates fall within ±0.63 °C (>52 000 total observations). While the model for estimating CT is not a replacement for direct measurement of CT (literature comparisons of esophageal and rectal methods average LoAs of ±0.58 °C) our results suggest it is accurate enough to provide practical indication of thermal work strain for use in the work place.

  6. Clinical observation of relapsing polychondritis: a report of 23 patients%复发性多软骨炎23例临床观察

    Institute of Scientific and Technical Information of China (English)

    高岭; 娄卫华; 程秀莲

    2012-01-01

    Objective To explore the clinical characteristics of relapsing polychondritis (RP) for its early diagnosis and treatment.Methods A retrospective analysis was performed for the clinical data and prognoses for 23 RP patients from April 1996 to October 2011 at Departments of Respiratory Medicine,Rheumatism and Otorhinolaryngology,First Affiliated Hospital,Zhengzhou University. Results Lesion locations included auricle (n =19),joints (n =17),nose (n =14),respiratory tract (n =10 ),eyes ( n =6 ),inner ear ( n =4),costal cartilage ( n =3 ) and kidney ( n =1 ).Laboratory examinations revealed elevated erythrocyte sedimentation rate (ESR) ( n =18 ),elevated C-reactive protein (CRP) ( n =16 ) andpositive rheumatoid factor (n =2).Laryngeal mucosa was edematous and the vocal cords were paralyzed in the cases with airway involvement under laryngofiberscopy. Tracheal mucosa was highly edematous and tracheal lumen narrowed in the cases examined under bronchofibroscope. Laryngeal mucosa was swollen,glottic chink narrowed,laryngeal cartilage partially absorbed and deformed in the cases examined with neck computed tomography (CT). Tracheal mucosa was thickened,tracheal lumen narrowed and tracheal cartilage was deformed and calcified in the cases on chest CT.Pathological examination on tracheal cartilage showed that cartilage tissue was degenerative and fibrotic.And the proliferation of granulation tissue and the infiltration of inflammatory cells were present around cartilage tissue.Twenty-three RP patients received the therapies of antibiotics, glucocorticosteroid, immunosuppressive agent, tracheotomy or tracheal stent implantation.Two cases died of asphyxia.One casc died of myocardial infarct.The symptoms of other 20 cases improved in different degrees.Conclusion The clinical manifestations are diverse in RP patients.The prognoses of patients with airway involvement are worse and may be improved by an early diagnosis and correct treatment.%目的 研究复发性多软骨炎(RP)

  7. Inverse modelling of radionuclide release rates using gamma dose rate observations

    Science.gov (United States)

    Hamburger, Thomas; Evangeliou, Nikolaos; Stohl, Andreas; von Haustein, Christoph; Thummerer, Severin; Wallner, Christian

    2015-04-01

    Severe accidents in nuclear power plants such as the historical accident in Chernobyl 1986 or the more recent disaster in the Fukushima Dai-ichi nuclear power plant in 2011 have drastic impacts on the population and environment. Observations and dispersion modelling of the released radionuclides help to assess the regional impact of such nuclear accidents. Modelling the increase of regional radionuclide activity concentrations, which results from nuclear accidents, underlies a multiplicity of uncertainties. One of the most significant uncertainties is the estimation of the source term. That is, the time dependent quantification of the released spectrum of radionuclides during the course of the nuclear accident. The quantification of the source term may either remain uncertain (e.g. Chernobyl, Devell et al., 1995) or rely on estimates given by the operators of the nuclear power plant. Precise measurements are mostly missing due to practical limitations during the accident. The release rates of radionuclides at the accident site can be estimated using inverse modelling (Davoine and Bocquet, 2007). The accuracy of the method depends amongst others on the availability, reliability and the resolution in time and space of the used observations. Radionuclide activity concentrations are observed on a relatively sparse grid and the temporal resolution of available data may be low within the order of hours or a day. Gamma dose rates, on the other hand, are observed routinely on a much denser grid and higher temporal resolution and provide therefore a wider basis for inverse modelling (Saunier et al., 2013). We present a new inversion approach, which combines an atmospheric dispersion model and observations of radionuclide activity concentrations and gamma dose rates to obtain the source term of radionuclides. We use the Lagrangian particle dispersion model FLEXPART (Stohl et al., 1998; Stohl et al., 2005) to model the atmospheric transport of the released radionuclides. The

  8. Relapse risk assessment of transplantation for patients with chronic myeloid leukaemia

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective To analyse the risk factors of relapse before bone marrow transplantation (BMT) and to present the prognostic information as good as possible.Methods A total of 3142 patients, who underwent the allogeneic blood or bone marrow tran splantation between 1989 and 1997 and were documented in the European Group for Blood and Marrow transplantation (EBMT), were included. Six possible risk factors including type of donor, stage of disease, age, gender, donor@#-recipient sex co mbination and the waiting time from diagnosis to transplation of relapse were co nsidered. The time to relapse was analysed by Kaplan-Meier curves and Coxregre ssion with stratification on prognostic factors that did not satisfy the Proport ional Hazard Assumption.Results An amount of 447 patients relapsed out of all 3142 patients. The relapse rate was 14.2%. Type of donor and stage of disease showed a clear prognostic effect, but failed the proportional hazard assumption. Therefore, the data were stratified on the combination of type of donor and stage of disease. Within these strata a n additional significant effect of age could be observed. Relative risk of age ≥40 vs age <40 was 1.32 (95% confidence interval 1.09-1.59). The prognostic model is summarized graphically.Conclusions The combination of type of donor, stage of disease and age of recipient at transplantation are important prognostic factors for relapse after BMT.

  9. High risk of postpartum relapses in neuromyelitis optica spectrum disorder.

    Science.gov (United States)

    Klawiter, Eric C; Bove, Riley; Elsone, Liene; Alvarez, Enrique; Borisow, Nadja; Cortez, Melissa; Mateen, Farrah; Mealy, Maureen A; Sorum, Jaime; Mutch, Kerry; Tobyne, Sean M; Ruprecht, Klemens; Buckle, Guy; Levy, Michael; Wingerchuk, Dean; Paul, Friedemann; Cross, Anne H; Jacobs, Anu; Chitnis, Tanuja; Weinshenker, Brian

    2017-11-28

    To study the effect of pregnancy on the frequency of neuromyelitis optica spectrum disorder (NMOSD) relapse and evaluate rates of pregnancy-related complications in an international multicenter setting. We administered a standardized survey to 217 women with NMOSD from 7 medical centers and reviewed their medical records. We compared the annualized relapse rate (ARR) during a baseline period 2 years prior to a participant's first pregnancy to that during pregnancy and to the 9 months postpartum. We also assessed pregnancy-related complications. There were 46 informative pregnancies following symptom onset in 31 women with NMOSD. Compared to baseline (0.17), ARR was increased both during pregnancy (0.44; p = 0.035) and during the postpartum period (0.69; p = 0.009). The highest ARR occurred during the first 3 months postpartum (ARR 1.33). A total of 8 of 76 (10.5%) with onset of NMOSD prior to age 40 experienced their initial symptom during the 3 months postpartum, 2.9 times higher than expected. The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery. © 2017 American Academy of Neurology.

  10. Health-related quality of life in relapsing remitting multiple sclerosis patients during treatment with glatiramer acetate: a prospective, observational, international, multi-centre study

    Directory of Open Access Journals (Sweden)

    Fredrikson Sten

    2010-11-01

    Full Text Available Abstract Background Glatiramer acetate (GA and interferon-beta (INFb are first-line disease modifying drugs for relapsing remitting multiple sclerosis (RRMS. Treatment with INFb is associated with a significant increase in health-related quality of life (HR-QoL in the first 12 months. It is not known whether HR-QoL increases during treatment with GA. Methods 197 RRMS patients, 106 without and 91 with prior immunomodulation/immunosuppression, were studied for HR-QoL (Leeds Multiple Sclerosis-QoL [LMS-QoL] scale, score range 0 - 32, fatigue (Fatigue Impact Scale [FIS] and depressed mood (Beck Depression Inventory-Short Form [BDI-SF] at baseline and 6 and 12 months after start of GA treatment. Results At 6 and 12 months mean LMS-QoL scores were significantly increased in the treatment-naive patient group (p Conclusions In RRMS patients without prior immunomodulation/immunosuppression treatment with GA was associated with an increase in HR-QoL in the first 6 months, that was sustained at 12 months. In 4 out of 10 patients HR-QoL improved. Increase in HR-QoL was associated with decrease in fatigue.

  11. Relapsing polychondritis: commentary

    Directory of Open Access Journals (Sweden)

    R.D. Altman

    2011-09-01

    Full Text Available Relapsing Polychondritis (RP is a multisystem disease of unknown etiology characterized by episodic inflammation of cartilage and potentially progressive degeneration of cartilaginous tissue, such as auricular, nasal and laryngotracheobronchial cartilage. However, many other proteoglycan- rich structures may be involved, such as inner ear, eyes, blood vessels, heart and kidneys (1- 4. RP was first described by Jacksh-Wartenhorst in 1923, who named it “polychondropathia” (5. Pearson et al. (6 introduced the term “relapsing polychondritis” in 1960...

  12. Inter-Observer Agreement in Measuring Respiratory Rate

    DEFF Research Database (Denmark)

    Nielsen, Louise Gramstrup; Folkestad, Lars; Brodersen, Jacob Broder

    2015-01-01

    BACKGROUND: Respiratory rate (RR) is an important vital sign which is strongly correlated with in-hospital mortality. At the same time, RR is the most likely vital sign to be omitted when assessing a patient. We believe that one reason for this could be the difficulty in measure the RR, since...

  13. Mass loss rates of OB stars derived from infrared observations

    International Nuclear Information System (INIS)

    Tanzi, E.G.; Tarenghi, M.; Panagia, N.

    1981-01-01

    In this paper the authors report briefly on a study of the mass loss of early type stars in the infrared. Up to now near infrared (1.25 - 4.8 μ) broad band photometry of 70 southern OB stars of various luminosity class has been secured. Program stars have been selected, among those bright enough in the infrared to give a suitable photometric accuracy, in order to cover a wide range of spectral types. 37 stars are found to exhibit emission in excess over a blackbody photospheric continuum, which is interpreted in terms of gas ejected in the form of an accelerated wind. By means of model calculations the corresponding mass loss rates are derived. The obtained values compare well with those determined independently by various authors for stars in common. Their data show that mass loss rates increase with luminosity and are a decreasing function of surface gravity. (Auth.)

  14. Observing the tabarru' rate in a family takaful

    Science.gov (United States)

    Ismail, Hamizun bin

    2013-04-01

    Takaful system has a built-in mechanism to counter any over-pricing policies of the insurance companies because whatever may be the premium charged, the surplus would normally go back to the participants in proportion to their contributions. In contrast to a conventional insurance company, insurance surplus is not supposed to be a source of return for a takaful company. Any surplus that is a result of overpricing or over-charging is required to be returned back to takaful participants. Similarly, in case of under-pricing, policyholders may be asked to meet any deficit or negative difference between the policyholders' contribution and the actual claims, benefits and compensation. The objective of this study is to measure the efficacy of a family takaful contract through a simple actuarial model based on deterministic survival assumption. In addition, a linear tabarru' rate is introduced. The results show that the linear assumption on the tabarru' rate has an advantage over the flat rate as far as the risk of the prospective loss is concerned.

  15. Exchange rate behavior with negative interest rates: Some early negative observations

    OpenAIRE

    Hameed, Allaudeen S.; Rose, Andrew

    2017-01-01

    This paper examines exchange rate behavior during the recent period with negative nominal interest rates. We use a daily panel of data on 61 currencies from January 2010 through May 2016, during which five economies - Denmark, the European Economic and Monetary Union, Japan, Sweden, and Switzerland - experienced negative nominal interest rates. We examine both effective exchange rates and bilateral rates; the latter typically measured against the Swiss franc since Switzerland has had the long...

  16. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Clinicians Publications for Your Patients MS Navigator Program Programs and Services for Your Patients Contact Us Clinical Fellows ... Relapsing-remitting MS (RRMS) Relapsing-remitting ...

  17. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... for You and Your Practice Publications for Clinicians Publications for Your Patients MS Navigator Program Programs and Services for Your Patients ... Relapsing-remitting MS (RRMS) Relapsing-remitting MS ( ...

  18. Observing relationships in Finnish adoptive families: Oulu Family Rating Scale.

    Science.gov (United States)

    Tienari, Pekka; Wynne, Lyman C; Sorri, Anneli; Lahti, Ilpo; Moring, Juha; Nieminen, Pentti; Joukamaa, Matti; Naarala, Mikko; Seitamaa, Markku; Wahlberg, Karl-Erik; Miettunen, Jouko

    2005-01-01

    Adoption studies were intended to separate genetic from environmental "causal" factors. In earlier adoption studies, psychiatric diagnostic labels for the adoptive parents were used as a proxy for the multiple dimensions of the family rearing environment. In the Finnish Adoption Study, research design provided the opportunity to study directly the adoptive family rearing environment. For this purpose 33 sub-scales were selected creating what we call Oulu Family Rating Scale (OPAS, Oulun PerheArviointiSkaala). In this paper, the manual for scoring of these sub-scales is presented.

  19. Detection rate of PET/CT in patients with biochemical relapse of prostate cancer using [{sup 68}Ga]PSMA I and T and comparison with published data of [{sup 68}Ga]PSMA HBED-CC

    Energy Technology Data Exchange (ETDEWEB)

    Berliner, Christoph; Tienken, Milena; Kobayashi, Yuske; Helberg, Annabelle; Kirchner, Uve; Klutmann, Susanne; Mester, Janos; Bannas, Peter [University Medical Center Hamburg-Eppendorf, Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg (Germany); Frenzel, Thorsten [University Medical Center Hamburg-Eppendorf, Ambulatory Center, Department for Radiation Oncology, Hamburg (Germany); Beyersdorff, Dirk [University Medical Center Hamburg-Eppendorf, Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg (Germany); University Medical Center Hamburg-Eppendorf, Martini-Klinik, Hamburg (Germany); Budaeus, Lars [University Medical Center Hamburg-Eppendorf, Martini-Klinik, Hamburg (Germany); Wester, Hans-Juergen [Technical University Munich, Pharmaceutical Radiochemistry, Garching (Germany)

    2017-04-15

    To determine the detection rate of PET/CT in biochemical relapse of prostate cancer using [{sup 68}Ga]PSMA I and T and to compare it with published detection rates of [{sup 68}Ga]PSMA HBED-CC. We performed a retrospective analysis in 83 consecutive patients with documented biochemical relapse after prostatectomy. All patients underwent whole body [{sup 68}Ga]PSMA I and T PET/CT. PET/CT images were evaluated for presence of local recurrence, lymph node metastases, and distant metastases. Proportions of positive PET/CT results were calculated for six subgroups with increasing prostate specific antigen (PSA) levels (<0.5 ng/mL, 0.5 to <1.0 ng/mL, 1.0 to <2.0 ng/mL, 2.0 to <5.0 ng/mL, 5.0 to <10.0, ≥10.0 ng/mL). Detection rates of [{sup 68}Ga]PSMA I and T were statistically compared with published detection rates of [{sup 68}Ga]PSMA HBED-CC using exact Fisher's test. Median PSA was 0.81 (range: 0.01 - 128) ng/mL. In 58/83 patients (70 %) at least one [{sup 68}Ga]PSMA I and T positive lesion was detected. Local recurrent cancer was present in 18 patients (22 %), lymph node metastases in 29 patients (35 %), and distant metastases in 15 patients (18 %). The tumor detection rate was positively correlated with PSA levels, resulting in detection rates of 52 % (<0.5 ng/mL), 55 % (0.5 to <1.0 ng/mL), 70 % (1.0 to <2.0 ng/mL), 93 % (2.0 to <5.0 ng/mL), 100 % (5.0 to <10.0 ng/mL), and 100 % (≥10.0 ng/mL). There was no significant difference between the detection rate of [{sup 68}Ga]PSMA I and T and published detection rates of [{sup 68}Ga]PSMA HBED-CC (all p>0.05). [{sup 68}Ga]PSMA I and T PET/CT has high detection rates of recurrent prostate cancer that are comparable to [{sup 68}Ga]PSMA HBED-CC. (orig.)

  20. Does a Teacher's Classroom Observation Rating Vary across Multiple Classrooms?

    Science.gov (United States)

    Lei, Xiaoxuan; Li, Hongli; Leroux, Audrey J.

    2018-01-01

    Classroom observations have been increasingly used for teacher evaluations, and it is important to examine the measurement quality and the use of observation ratings. When a teacher is observed in multiple classrooms, his or her observation ratings may vary across classrooms. In that case, using ratings from one classroom per teacher may not be…

  1. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... MS Relapsing-remitting MS (RRMS) Share this page Facebook Twitter Email Relapsing-remitting MS (RRMS) Relapsing-remitting ... Here Start Here Colophon Stay Informed Join Us Facebook Twitter LinkedIn YouTube Pinterest MS Connection About the ...

  2. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Relapsing-remitting MS (RRMS) Share this page Facebook Twitter Email Relapsing-remitting MS (RRMS) Relapsing-remitting MS ( ... Start Here Colophon Stay Informed Join Us Facebook Twitter LinkedIn YouTube Pinterest MS Connection About the Society ...

  3. Prefrontal cortex plasticity mechanisms in drug seeking and relapse

    NARCIS (Netherlands)

    van den Oever, M.C.; Spijker, S.; Smit, A.B.; de Vries, T.J.

    2010-01-01

    Development of pharmacotherapy to reduce relapse rates is one of the biggest challenges in drug addiction research. The enduring nature of relapse suggests that it is maintained by long-lasting molecular and cellular adaptations in the neuronal circuitry that mediates learning and processing of

  4. An intervention study to prevent relapse in patients with schizophrenia

    NARCIS (Netherlands)

    van Meijel, B.; Kruitwagen, C.; van der Gaag, M.; Kahn, R.S.; Grypdonck, M.H.E.

    2006-01-01

    Purpose: To determine whether the use of relapse prevention plans (RPPs) in nursing practice is an effective intervention in reducing relapse rates among patients with schizophrenia. Design and Methods: Experimental design. Patients with schizophrenia (or a related psychotic disorder) and nurses

  5. Cognitive reactivity to sad mood provocation and the prediction of depressive relapse.

    Science.gov (United States)

    Segal, Zindel V; Kennedy, Sidney; Gemar, Michael; Hood, Karyn; Pedersen, Rebecca; Buis, Tom

    2006-07-01

    Episode remission in unipolar major depression, while distinguished by minimal symptom burden, can also be a period of marked sensitivity to emotional stress as well as an increased risk of relapse. To examine whether mood-linked changes in dysfunctional thinking predict relapse in recovered patients who were depressed. In phase 1 of this study, patients with major depressive disorder were randomly assigned to receive either antidepressant medication or cognitive behavior therapy. In phase 2, patients who achieved clinical remission underwent sad mood provocation and were then observed with regular clinical assessments for 18 months. Outpatient psychiatric clinics at the Centre for Addiction and Mental Health, Toronto, Ontario. A total of 301 outpatients with major depressive disorder, aged 18 to 65 years, participated in phase 1 of this study and 99 outpatients with major depressive disorder in remission, aged 18 to 65 years, participated in phase 2. Occurrence of a relapse meeting DSM-IV criteria for a major depressive episode as assessed by the longitudinal interval follow-up evaluation and a Hamilton Depression Rating Scale score of 16 or greater. Patients who recovered through antidepressant medication showed greater cognitive reactivity following the mood provocation than those who received cognitive behavior therapy. Regardless of type of prior treatment, the magnitude of mood-linked cognitive reactivity was a significant predictor of relapse over the subsequent 18 months. Patients whose mood-linked endorsement of dysfunctional attitudes increased by a minimum of 8 points had a significantly shorter time to relapse than those whose scores were not as elevated. The vulnerability of remitted depressed patients for illness relapse may be related to the (re)activation of depressive thinking styles triggered by temporary dysphoric states. This is the first study to link such differences to prognosis following successful treatment for depression. Further

  6. Self-rated and observer-rated measures of well-being and distress in adolescence: an exploratory study.

    Science.gov (United States)

    Vescovelli, Francesca; Albieri, Elisa; Ruini, Chiara

    2014-01-01

    The evaluation of eudaimonic well-being in adolescence is hampered by the lack of specific assessment tools. Moreover, with younger populations, the assessment of positive functioning may be biased by self-report data only, and may be more accurate by adding significant adults' evaluations. The objective of this research was to measure adolescents' well-being and prosocial behaviours using self-rated and observer-rated instruments, and their pattern of associations. The sample included 150 Italian high school adolescents. Observed-evaluation was performed by their school teachers using the Strengths and Difficulties Questionnaire. Adolescents completed Ryff's Psychological Well-being Scales and Symptom Questionnaire. Pearson' r correlations and Linear regression were performed. Self-rated dimensions of psychological well-being significantly correlated with all observer-rated dimensions, but Strengths and Difficulties Emotional symptom scale. Multiple linear regression showed that the self-rated dimensions Environmental Mastery and Personal Growth, and surprisingly not Positive Relations, are related to the observer-rated dimension Prosocial Behaviour. Adolescents with higher levels of well-being in specific dimensions tend to be perceived as less problematic by their teachers. However, some dimensions of positive functioning present discrepancies between self and observer-rated instruments. Thus, the conjunct use of self-reports and observer-rated tools for a more comprehensive assessment of students' eudaimonic well-being is recommended.

  7. Isolation of Trypanosoma brucei gambiense from cured and relapsed sleeping sickness patients and adaptation to laboratory mice.

    Directory of Open Access Journals (Sweden)

    Patient Pati Pyana

    Full Text Available BACKGROUND: Sleeping sickness due to Trypanosoma brucei (T.b. gambiense is still a major public health problem in some central African countries. Historically, relapse rates around 5% have been observed for treatment with melarsoprol, widely used to treat second stage patients. Later, relapse rates of up to 50% have been recorded in some isolated foci in Angola, Sudan, Uganda and Democratic Republic of the Congo (DRC. Previous investigations are not conclusive on whether decreased sensitivity to melarsoprol is responsible for these high relapse rates. Therefore we aimed to establish a parasite collection isolated from cured as well as from relapsed patients for downstream comparative drug sensitivity profiling. A major constraint for this type of investigation is that T.b. gambiense is particularly difficult to isolate and adapt to classical laboratory rodents. METHODOLOGY/PRINCIPAL FINDINGS: From 360 patients treated in Dipumba hospital, Mbuji-Mayi, D.R. Congo, blood and cerebrospinal fluid (CSF was collected before treatment. From patients relapsing during the 24 months follow-up, the same specimens were collected. Specimens with confirmed parasite presence were frozen in liquid nitrogen in a mixture of Triladyl, egg yolk and phosphate buffered glucose solution. Isolation was achieved by inoculation of the cryopreserved specimens in Grammomys surdaster, Mastomys natalensis and SCID mice. Thus, 85 strains were isolated from blood and CSF of 55 patients. Isolation success was highest in Grammomys surdaster. Forty strains were adapted to mice. From 12 patients, matched strains were isolated before treatment and after relapse. All strains belong to T.b. gambiense type I. CONCLUSIONS AND SIGNIFICANCE: We established a unique collection of T.b. gambiense from cured and relapsed patients, isolated in the same disease focus and within a limited period. This collection is available for genotypic and phenotypic characterisation to investigate the

  8. Detection Rates of 68Ga-PSMA PET/CT in Patients with Biochemical Relapse from Prostate Cancer after Radical Prostatectomy and PSA Values < 1 ng/ml

    DEFF Research Database (Denmark)

    Nielsen, Julie Bødker; Zacho, Helle D; Dettmann, Katja

    2016-01-01

    PURPOSE: The aim of this study was to assess observer agreement on the evaluation of treatment responses of bone metastases by bone scintigraphy (BS) using different scoring methods in prostate cancer patients. PATIENTS AND METHODS: Sixty-three paired BS from 55 patients were included. BS was per...

  9. Social settings and addiction relapse.

    Science.gov (United States)

    Walton, M A; Reischl, T M; Ramanthan, C S

    1995-01-01

    Despite addiction theorists' acknowledgment of the impact of environmental factors on relapse, researchers have not adequately investigated these influences. Ninety-six substance users provided data regarding their perceived risk for relapse, exposure to substances, and involvement in reinforcing activities. These three setting attributes were assessed in their home, work, and community settings. Reuse was assessed 3 months later. When controlling for confounding variables, aspects of the home settings significantly distinguished abstainers from reusers; perceived risk for relapse was the strongest predictor of reuse. Exposure to substances and involvement in reinforcing activities were not robust reuse indicators. The work and community settings were not significant determinants of reuse. These findings offer some initial support for the utility of examining social settings to better understand addiction relapse and recovery. Identification of setting-based relapse determinants provides concrete targets for relapse prevention interventions.

  10. Azathioprine reduces the risk of audiometric relapse in immune-mediated hearing loss.

    Science.gov (United States)

    Mata-Castro, Nieves; Gavilanes-Plasencia, Javier; Ramírez-Camacho, Rafael; García-Fernández, Alfredo; García-Berrocal, José Ramón

    2018-03-01

    Current schemes for treatment of immune-mediated hearing loss with sporadic short-course, low-dose corticosteroids, are insufficient. To determine the role of azathioprine in the control of auditory impairment, a longitudinal, observational, descriptive study was performed with 20 patients treated with azathioprine (1.5-2.5mg/kg/day into two doses) for 1year. The loss of 10dB on two consecutive frequencies or 15dB on an isolated frequency was considered as relapse. The mean age of the patients was 52.50years (95%CI: 46.91-58.17), half were women. Bilateral affectation was 65%. 75% had organ specific disease and 25% had systemic autoimmune disease. The difference between baseline PTA (46.49dB; DS18.90) and PTA at 12months (45.47dB; DS18.88) did not reach statistical significance (P=.799). There was a moderate positive correlation between female sex and the presence of systemic disease (R=.577). By applying Student's t for paired data, a significant difference (P=.042) was obtained between the PTA in frequencies up to 1000 Hz (PTA125-1000Hz). The relative incidence rate of relapse per year was .52 relapses/year (95%CI: .19-1.14]). The median time to audiometric relapse-free was 9.70months (DS1.03). Azathioprine maintains the hearing threshold, decreases the risk of relapse, and slows down the rate at which patients relapse, altering the course of immune-mediated inner ear disease. Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Improved outcome after relapse in children with acute myeloid leukaemia

    DEFF Research Database (Denmark)

    Abrahamsson, Jonas; Clausen, Niels; Gustafsson, Göran

    2007-01-01

    investigated. The study included all 146 children in the Nordic countries diagnosed with AML between 1988 and 2003, who relapsed. Data on disease characteristics and relapse treatment were related to outcome. Sixty-six percentage achieved remission with survival after relapse (5 years) 34 +/- 4%. Of 122......In the Nordic Society for Paediatric Haematology and Oncology paediatric study acute myeloid leukaemia (AML) 93, event-free survival was 50% and overall survival was 66%, indicating that many patients were cured following relapse. Factors influencing outcome in children with relapsed AML were...... patients who received re-induction therapy, 77% entered remission with 40 +/- 5% survival. Remission rates were similar for different re-induction regimens but fludarabine, cytarabine, granulocyte colony-stimulating factor-based therapy had low treatment-related mortality. Prognostic factors for survival...

  12. Combination treatment with risperidone long-acting injection and psychoeducational approaches for preventing relapse in schizophrenia

    Directory of Open Access Journals (Sweden)

    Zhao Y

    2013-10-01

    Full Text Available Yueren Zhao,1–3 Taro Kishi,1 Nakao Iwata,1 Manabu Ikeda3,4 1Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; 2Department of Psychiatry, Okehazama Hospital Fujita Kokoro Care Center, Toyoake, Aichi, Japan; 3Department of Neuropsychiatry, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan; 4Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan Abstract: A recent meta-analysis showed that long-acting injectable (LAI antipsychotics were not superior to oral antipsychotics for preventing relapse in patients with schizophrenia. We therefore designed a treatment strategy combining risperidone LAI and COMPASS (COMprehensive Psycho-educational Approach and Scheme Set, an original psychoeducational program supporting treatment with risperidone LAI and evaluating subjective treatment satisfaction, transition of symptoms, and effectiveness in preventing symptomatic relapse. The aim of this study was to examine whether addition of COMPASS to risperidone LAI was more effective in preventing relapse in schizophrenia patients than risperidone LAI alone, with the latter group consisting of patients enrolled in a Phase III trial of risperidone LAI in Japan. Patients were followed up for 6 months, with COMPASS continuously implemented from the transition to the observation phase. The primary efficacy measurements were relapse rate (rates of rehospitalization and discontinuation due to inefficacy. Secondary efficacy measurements were the Brief Psychiatric Rating Scale (BPRS and Global Assessment of Functioning (GAF scores. Of the 96 patients originally enrolled, 19 (19.8% were discontinued from all causes. During the 6-month study period, ten of the 96 patients (10.4% relapsed, compared with a 12.2% relapse rate in patients enrolled in a Phase III trial of risperidone LAI in Japan. Patients showed significant improvements in BPRS total

  13. Prevention of relapse of Graves' disease by treatment with an intrathyroid injection of dexamethasone.

    Science.gov (United States)

    Mao, Xiao-Ming; Li, Hui-Qin; Li, Qian; Li, Dong-Mei; Xie, Xiao-Jing; Yin, Guo-Ping; Zhang, Peng; Xu, Xiang-Hong; Wu, Jin-Dan; Chen, Song-Wang; Wang, Shu-Kui

    2009-12-01

    Antithyroid drugs are widely used in the treatment of Graves' disease (GD), but the relapse rate is very high after therapy withdrawal. We evaluated the reduction effects of intrathyroid injection of dexamethasone (IID) on the relapse rate of hyperthyroidism in patients with newly diagnosed GD. A total of 191 patients with GD completed the study. After 6 months of treatment with methimazole (MMI), the patients were randomly assigned to receive either MMI (96 patients) alone or MMI combined with IID (MMI+IID; 95 patients) treatment for 3 months, followed by continuing a dose of MMI that would maintain euthyroidism for the next 9 months in all of the patients. After withdrawal of the medical therapy, patients were followed for 24 months, and the relapse rate of hyperthyroidism was evaluated. No statistical difference was observed in the levels of serum FT(4), TSH, or TSH receptor antibodies (TR-Ab), the thyroid volume, or the TR-Ab positive rate between the two groups at month 6. After the next 3 months of treatment with MMI+IID or MMI alone, the levels of TSH increased significantly, and the levels of serum TR-Ab, the TR-Ab positive rate, and thyroid volume decreased significantly in the MMI+IID group compared with the MMI group. Seven patients (7.4%) experienced a relapse of overt hyperthyroidism in the MMI+IID group and 49 patients (51%) in MMI group during the 2-yr follow-up period (P prevent relapse of hyperthyroidism in GD after medical therapy withdrawal.

  14. Lapse and relapse following inpatient treatment of opiate dependence.

    LENUS (Irish Health Repository)

    Smyth, B P

    2010-06-01

    We conducted a prospective follow-up study of consecutive opiate dependent patients admitted to a residential addiction treatment service for detoxification. We measured the rate of relapse following discharge, and sought to identify factors that were associated with early relapse (i.e., a return to daily opiate use). Follow-up interviews were conducted with 109 patients, of whom, 99 (91%) reported a relapse. The initial relapse occurred within one week in 64 (59%) cases. Multivariate survival analysis revealed that earlier relapse was significantly predicted by younger age, greater heroin use prior to treatment, history of injecting, and a failure to enter aftercare. Unexpectedly, those who were in a relationship with an opiate user had significantly delayed relapse. Those who completed the entire six-week inpatient treatment programme also had a significantly delayed relapse. In order to reduce relapse and the associated increased risk of fatal overdose, services providing residential opiate detoxification should prepare people for admission, strive to retain them in treatment for the full admission period and actively support their entry into planned aftercare in order to improve outcome.

  15. Dutch courage? Effects of acute alcohol consumption on self-ratings and observer ratings of foreign language skills.

    Science.gov (United States)

    Renner, Fritz; Kersbergen, Inge; Field, Matt; Werthmann, Jessica

    2018-01-01

    A popular belief is that alcohol improves the ability to speak in a foreign language. The effect of acute alcohol consumption on perceived foreign language performance and actual foreign language performance in foreign language learners has not been investigated. The aim of the current study was to test the effects of acute alcohol consumption on self-rated and observer-rated verbal foreign language performance in participants who have recently learned this language. Fifty native German speakers who had recently learned Dutch were randomized to receive either a low dose of alcohol or a control beverage that contained no alcohol. Following the experimental manipulation, participants took part in a standardized discussion in Dutch with a blinded experimenter. The discussion was audio-recorded and foreign language skills were subsequently rated by two native Dutch speakers who were blind to the experimental condition (observer-rating). Participants also rated their own individual Dutch language skills during the discussion (self-rating). Participants who consumed alcohol had significantly better observer-ratings for their Dutch language, specifically better pronunciation, compared with those who did not consume alcohol. However, alcohol had no effect on self-ratings of Dutch language skills. Acute alcohol consumption may have beneficial effects on the pronunciation of a foreign language in people who have recently learned that language.

  16. Medical chart validation of an algorithm for identifying multiple sclerosis relapse in healthcare claims.

    Science.gov (United States)

    Chastek, Benjamin J; Oleen-Burkey, Merrikay; Lopez-Bresnahan, Maria V

    2010-01-01

    Relapse is a common measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objective of this study was to test the content validity of an operational algorithm for detecting relapse in claims data. A claims-based relapse detection algorithm was tested by comparing its detection rate over a 1-year period with relapses identified based on medical chart review. According to the algorithm, MS patients in a US healthcare claims database who had either (1) a primary claim for MS during hospitalization or (2) a corticosteroid claim following a MS-related outpatient visit were designated as having a relapse. Patient charts were examined for explicit indication of relapse or care suggestive of relapse. Positive and negative predictive values were calculated. Medical charts were reviewed for 300 MS patients, half of whom had a relapse according to the algorithm. The claims-based criteria correctly classified 67.3% of patients with relapses (positive predictive value) and 70.0% of patients without relapses (negative predictive value; kappa 0.373: p value of the operational algorithm. Limitations of the algorithm include lack of differentiation between relapsing-remitting MS and other types, and that it does not incorporate measures of function and disability. The claims-based algorithm appeared to successfully detect moderate-to-severe MS relapse. This validated definition can be applied to future claims-based MS studies.

  17. Increasing Incidence in Relapsing-Remitting MS and High Rates among Young Women in Finland: A Thirty-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Marja-Liisa Sumelahti

    2014-01-01

    Full Text Available Object. Gender and disease course specific incidences were studied in high- and medium-risk regions of MS in Finland. Methods. Age- and gender-specific incidences with 95% CIs were calculated in 10-year periods from 1981 to 2010. Poser diagnostic criteria were used and compared with the McDonald criteria from 2001 to 2010. Association between age and diagnostic delay over time was assessed by using the Kruskal-Wallis test. Results. 1419 (89% RRMS and 198 (11% PPMS cases were included. RRMS incidence increased with the female to male ratio (F/M from 4,2/105 (F/M 1.9 to 9,7 (2.3, while that of PPMS decreased from 1,2 (1.6 to 0,7 (1.2. The use of McDonald criteria did not change the conclusion. The decreasing diagnostic delay and age at diagnosis in RRMS were associated within the 10-year periods and contrasted those in PPMS. Increasing female risk in RRMS was observed in the high-risk region. Conclusion. Increasing RRMS incidence and high female ratios shown in each age group indicate gender-specific influences acting already from childhood. A more precise definition of the risk factors and their action in MS is needed to provide a better understanding of underlying pathological processes and a rationale for the development of new preventive and treatment strategies.

  18. Relapsing Polychondritis Following Alopecia Areata

    Directory of Open Access Journals (Sweden)

    John C. Starr

    2010-01-01

    Full Text Available A case of alopecia areata followed by relapsing polychondritis is presented. Similar cases from the literature are reviewed and speculation about the relationship of these diseases is offered. Although the occurrence of these diseases together could be coincidental, an association seems immunologically plausible. Thus, relapsing polychondritis might be an unusual systemic manifestation of alopecia areata.

  19. Relapse May Serve as a Mediator Variable in Longitudinal Outcomes in Multiple Sclerosis.

    Science.gov (United States)

    Stone, Lael Anne; Cutter, Gary Raymond; Fisher, Elizabeth; Richert, Nancy; McCartin, Jennifer; Ohayon, Joan; Bash, Craig; McFarland, Henry

    2016-05-01

    Contrast-enhancing lesions (CEL) on magnetic resonance imaging (MRI) are believed to represent inflammatory disease activity in multiple sclerosis (MS), but their relationship to subsequent long-term disability and progression is unclear, particularly at longer time periods such as 8-10 years. Between 1989 and 1994, 111 MS patients were seen at the National Institutes of Health for clinical evaluations and 3 monthly contrast-enhanced MRI scans. Of these, 94 patients were re-evaluated a mean of 8 years later (range 6.1-10.5 years) with a single MRI scan and clinical evaluation. CEL number and volume were determined at baseline and follow-up. The number of relapses was ascertained over the follow-up period and annualized relapse rates were calculated. Other MRI parameters, such as T2 hyperintensity volume, T1 volume, and brain parenchymal fraction, were also calculated. While there was no direct correlation between CEL number or volume at baseline and disability status at follow-up, CEL measures at baseline did correlate with number of relapses observed in the subsequent years, and the number of relapses in turn correlated with subsequent disability as well as transition to progressive MS. While number and volume of CEL at baseline do not directly correlate with disability in the longer term in MS, our data suggest that 1 route to disability involves relapses as a mediator variable in the causal sequence of MS progression from CEL to disability. Further studies using relapse as a mediator variable in a larger data set may be warranted. Copyright © 2015 by the American Society of Neuroimaging.

  20. TBI parameters and relapse of acute leukemia

    International Nuclear Information System (INIS)

    Sugawara, Tadashi; Inoue, Toshihiko; Mori, Tomoyuki.

    1994-01-01

    The purpose of this study, which involved 240 acute leukemia patients (ALL: 115, ANL: 125) who received an allogeneic bone marrow transplantation (BMT) with preconditioning by total body irradiation (TBI) and chemotherapy, was to examine retrospectively the TBI factors that may have influenced a leukemic relapse. The patients were divided into two groups: 124 patients who had received their BMT within a diagnosis-transplantation period of 9 months or less (DTP9 group), and 116 patients who had received their BMT within a diagnosis-transplantation period of 10 months or more (DTP10 group). It was concluded that: (1) the higher the TBI dose, the fewer the relapse rates in DTP9 group; (2) the longer the TBI period, the greater the increase in the relapse rate in DTP10 group. It was thus speculated that an effective TBI regimen for acute leukemia patients may vary depending on the length of time that has elapsed from the diagnosis of leukemia to the BMT. (author)

  1. Time to relapse and remission of bipolar disorder: findings from a 1-year prospective study in Thailand

    Directory of Open Access Journals (Sweden)

    Leelahanaj T

    2013-08-01

    Full Text Available Thawatchai Leelahanaj,1 Ronnachai Kongsakon,2 Somrak Choovanichvong,3 Sookjaroen Tangwongchai,4 Suchat Paholpak,5 Thoranin Kongsuk,6 Manit Srisurapanont7 For the Thai Bipolar Registry Study Group 1Department of Psychiatry and Neurology, Phramongkutklao Hospital, Bangkok, Thailand; 2Department of Psychiatry, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Srithanya Hospital, Nonthaburi, Thailand; 4Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand; 5Department of Psychiatry, Khon Kaen University, Khon Kaen, Thailand; 6Prasrimahabhodi Psychiatric Hospital, Ubon Ratchathani, Thailand; 7Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand Background and methods: This study aimed to determine time to relapse and remission of mood episodes in Thai patients with bipolar disorder (BD. The Thai Bipolar Disorder Registry was a multicenter, prospective, naturalistic, observational study conducted in Thailand. Participants were adult inpatients or outpatients with Diagnostic and Statistical Manual of Mental Disorders bipolar disorder. The diagnosis of bipolar disorder, current psychiatric comorbidity, mood relapse, and mood remission were determined by using the Mini International Neuropsychiatric Interview. Relapse and remission were assessed every 2 months. Results: Of 424 BD participants, 404 (95.3% were BD I, and 258 (60.8% were female. At entry, 260 (61.3% had recovered, and 49 (11.6% were recovering. During 1-year follow-up (381.7 person-years, 92 participants (21.7% had 119 relapses or 0.31 (95% confidence interval 0.25–0.35 episodes per person-year. Among 119 relapses, 58 (48.7%, 39 (32.7%, and 21 (17.6% of them were depressive, hypomanic, and manic episodes, respectively. Using the Kaplan–Meier method, we found that 25% of the participants relapsed in 361 days. Of the 400 participants who reached remission, 113 (28.2% had mood relapses. Of 173 mood events accountable for remission analysis, the

  2. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... in RRMS; however, each person's experience with RRMS will be unique. Following a relapse, the new symptoms ... and worsening, you and your MS care provider will likely want to consider a more aggressive treatment ...

  3. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... course – is characterized by clearly defined attacks of new or increasing neurologic symptoms. These attacks – also called ... either active (with relapses and/or evidence of new MRI activity) or not active , as well as ...

  4. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... defined attacks of new or increasing neurologic symptoms. These attacks – also called relapses or exacerbations – are followed ... as well as the nerve fibers themselves. During these inflammatory attacks, activated immune cells cause small, localized ...

  5. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Treating MS Comprehensive Care Find an MS Care Provider Medications Managing Relapses Rehabilitation Complementary & Alternative Medicines For Clinicians Resources & Support Library & Education Programs Find Support Advanced Care ...

  6. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... without symptoms of which the person is aware. What happens in RRMS? Relapsing-remitting MS is defined ... a different mechanism of action in order to control the disease activity more effectively and help prevent ...

  7. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Rule Out For Clinicians Treating MS Comprehensive Care Find an MS Care Provider Medications Managing Relapses Rehabilitation ... Medicines For Clinicians Resources & Support Library & Education Programs Find Support Advanced Care Needs Resources for Specific Populations ...

  8. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... the periods of remission. At different points in time, RRMS can be further characterized as either active ( ... increase in disability over a specified period of time following a relapse) or not worsening . An increase ...

  9. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... attacks of inflammation (relapses) in the CNS, progressive forms of MS involve much less of this type ... and memory or information processing). People with progressive forms of MS are more likely to experience gradually ...

  10. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Team Make the Most of Your Doctor Visits Advance Medical Directives d Find an MS Care Provider ... in RRMS; however, each person's experience with RRMS will be unique. Following a relapse, the new symptoms ...

  11. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... as shown by the arrows, often occur as part of a relapse. However, new MRI lesions indicating ... course of your disease at different points in time helps you and your MS care provider discuss ...

  12. Natalizumab for the treatment of relapsing multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Richard A Rudick

    2008-06-01

    Full Text Available Richard A Rudick1, Michael A Panzara21Cleveland Clinic Foundation, Cleveland, OH, USA; 2Biogen Idec, Inc., Cambridge, MA, USAAbstract: Natalizumab is an α4-integrin antagonist approved as monotherapy for patients with relapsing multiple sclerosis (MS, based on demonstrated efficacy in the pivotal AFFIRM study (N = 942. Natalizumab monotherapy reduced risk of disability progression by 42%–54% and annualized relapse rate by 68% during a period of 2 years. Natalizumab was also associated with significant reductions in number of T2-hyperintense, gadolinium-enhancing, and T1-hypointense lesions and in volume of T2-hyperintense lesions (all p < 0.001 on magnetic resonance imaging. Furthermore, natalizumab-treated patients in AFFIRM experienced significant improvements from baseline in the physical and mental components of the Short Form-36 (p ≤ 0.01 and a 35% reduction in risk of clinically significant vision loss (p = 0.008 vs placebo. Natalizumab was well tolerated in phase 3 studies. Common adverse events were generally mild and included headache, fatigue, urinary tract infections, and arthralgia. Serious adverse events were similar between treatment groups. The incidence of serious hypersensitivity reactions associated with natalizumab was <1%. Progressive multifocal leukoencephalopathy was a rare complication of treatment, observed in 2 patients with MS who received natalizumab plus interferon β-1a. The robust clinical benefits of natalizumab, including benefits on patient-reported quality of life, make it an important addition to disease-modifying therapies available to patients with relapsing MS.Keywords: multiple sclerosis, natalizumab, α4-integrin antagonist

  13. Received View of Addiction, Relapse and Treatment.

    Science.gov (United States)

    Ndasauka, Yamikani; Wei, Zhengde; Zhang, Xiaochu

    2017-01-01

    It is important to highlight that attempts at understanding and explaining addiction have been made for centuries. It is, however, just five decades ago, with the growth of science and technology that more interest has been observed in this field. This chapter examines different views and theories that have been posited to understand and explain addiction. More attention will be given to prominent views that seem to draw consensus among researchers and medical practitioners. The first section of the chapter introduces the addiction debate, the different theories that have been provided to explain it from different perspectives and disciplines such as neurosciences, philosophy and psychology. Then, the chapter discusses different views on the role of relapse and what it entails in understanding addiction. The second section discusses different proposed and used forms of treating addiction. Thus, the chapter discusses the received view of addiction, the understanding of relapse as a critical element in addiction and treatments.

  14. New England observed and predicted August stream/river temperature maximum daily rate of change points

    Data.gov (United States)

    U.S. Environmental Protection Agency — The shapefile contains points with associated observed and predicted August stream/river temperature maximum negative rate of change in New England based on a...

  15. Regional homogeneity changes between heroin relapse and non-relapse patients under methadone maintenance treatment: a resting-state fMRI study.

    Science.gov (United States)

    Chang, Haifeng; Li, Wei; Li, Qiang; Chen, Jiajie; Zhu, Jia; Ye, Jianjun; Liu, Jierong; Li, Zhe; Li, Yongbin; Shi, Ming; Wang, Yarong; Wang, Wei

    2016-08-18

    Methadone maintenance treatment (MMT) is recognized as one of the most effective treatments for heroin addiction but its effect is dimmed by the high incidence of heroin relapse. However, underlying neurobiology mechanism of heroin relapse under MMT is still largely unknown. Here, we took advantage of a resting-state fMRI technique by analysis of regional homogeneity (ReHo), and tried to explore the difference of brain function between heroin relapsers and non-relapsers in MMT. Forty MMT patients were included and received a 12-month follow-up. All patients were given baseline resting-state fMRI scans by using a 3.0 T GE Signa Excite HD whole-body MRI system. Monthly self-report and urine test were used to assess heroin relapse or non-relapse. Subjective craving was measured with visual analog scale. The correlation between ReHo and the degree of heroin relapse was analyzed. Compared with the non-relapsers, ReHo values were increased in the bilateral medial orbitofrontal cortex, right caudate, and right cerebellum of the heroin relapsers while those in the left parahippocampal gyrus, left middle temporal gyrus, right lingual gyrus, and precuneus were decreased in heroin relapsers. Importantly, altered ReHo in the right caudate were positively correlated with heroin relapse rates or subjective craving response. Using the resting-state fMRI technique by analysis of ReHo, we provided the first resting-state fMRI evidence that right caudate may serve as a potential biomarker for heroin relapse prediction and also as a promising target for reducing relapse risk.

  16. Increased effects of machining damage in beryllium observed at high strain rates

    International Nuclear Information System (INIS)

    Beitscher, S.; Brewer, A.W.; Corle, R.R.

    1980-01-01

    Tensile tests at both low and high strain rates, and also impact shear tests, were performed on a weldable grade powder-source beryllium. Impact energies increased by a factor of 2 to 3 from the as-machined level after etching or annealing. Similar increases in the ductility from machining damage removal were observed from the tensile data at the higher strain rate (10 s -1 ) while an insignificant increase in elongation was measured at the lower strain rate (10 -4 s -1 ). High strain-rate tests appear to be more sensitive and reliable for evaluating machining practice and damage removal methods for beryllium components subjected to sudden loads. 2 tables

  17. An exploratory study on association between family relationship and relapse among methamphetamine users in Compulsory Treatment System of Khon Kaen and Yasothon Provinces.

    Science.gov (United States)

    Rodseeda, Pritsana; Ratanasiri, Amornrat; Kanato, Manop; Pinitsoontorn, Somdej; Chiawiriyabunya, Isara

    2010-03-01

    It was estimated that 3.5 million Thais have ever used "Yaba (methamphetamine)" at least once in their entire life. The Northeastern region had the highest number of Yaba users with a high relapse rate after treatment. The authors aimed to explore the association between relapse, among methamphetamine users in the Compulsory Treatment System of Khon Kaen and Yasothon Provinces, and family relationship as well as other contextual factors. An exploratory study was conducted from all cases of post-treatment methamphetamine users in the databases of Khon Kaen Drug Dependence Treatment Center and Yasothorn Provincial Probation Office during October 2007 and February 2008. Interviews and observations were done for data collection. Double data entry was applied. Pearson Chi-square, Fisher's exact test and odds ratio were used to assess the associations. Sixty-five users were found (13 relapses and 52 abstainers). Family relationship revealed no significant association with relapse of the methamphetamine users. Other contextual factors, however, did. They were social acceptance [acceptance by community leader (p = 0.006), acceptance for working or studying (p = 0.049)], risky community situations [using Yaba of close friend, existence of Yaba users and Yaba trading in community (p = 0.014, p agent and drinking of alcohol to reduce Yaba desire (p = 0.012 and p = 0.013)]. Effect of family relationship on relapse among post-treatment methamphetamine users could not be demonstrated in the present study. But several contextual factors had significant relationship with the relapse.

  18. Relapse prevention and smoking cessation.

    Science.gov (United States)

    Davis, J R; Glaros, A G

    1986-01-01

    A multicomponent smoking relapse prevention treatment based on Marlatt and Gordon's (1980) model of the relapse process was developed and evaluated. Behavior-analytic methods were used to develop assessment instruments, training situations, and coping responses. The prevention components were presented in the context of a basic broad-spectrum stop-smoking program, and were compared with the basic program plus discussion control, and the basic program alone. Smoking-related dependent variables generally did not differ between groups at any time from pre-treatment to 12 month follow-up. Only the subjects in the relapse prevention condition improved problem-solving and social skills needed to cope with high-risk situations. These subjects also tended to take longer to relapse and smoke fewer cigarettes at the time of relapse. Subjects above the median level of competence on measures of social skill at post-treatment remained abstinent significantly longer. Maintenance of non-smoking was found to be related to the degree of competence with which individuals deal with high-risk situations. Results are discussed in relation to models of compliance with therapeutic regimens.

  19. Entyvio lengthen dose-interval study: lengthening vedolizumab dose interval and the risk of clinical relapse in inflammatory bowel disease.

    Science.gov (United States)

    Chan, Webber; Lynch, Nicole; Bampton, Peter; Chang, Jeff; Chung, Alvin; Florin, Timothy; Hetzel, David J; Jakobovits, Simon; Moore, Gregory; Pavli, Paul; Radford-Smith, Graham; Thin, Lena; Baraty, Brandon; Haifer, Craig; Yau, Yunki; Leong, Rupert W L

    2018-07-01

    Vedolizumab (VDZ), an α4β7 anti-integrin antibody, is efficacious in the induction and maintenance of remission in ulcerative colitis (UC) and Crohn's disease (CD). In the GEMINI long-term safety study, enrolled patients received 4-weekly VDZ. Upon completion, patients were switched to 8-weekly VDZ in Australia. The clinical success rate of treatment de-escalation for patients in remission on VDZ has not been described previously. To determine the proportion of patients who relapsed after switching from 4 to 8-weekly VDZ, the mean time to relapse, and the recapture rate when switching back to 8-weekly dosing. This was a retrospective, observational, multicenter study of patients previously recruited into GEMINI long-term safety in Australia. Data on the demographics and biochemical findings were collected. There were 34 patients [23 men, mean age 49.1 (±13.1) years] and their mean disease duration was 17.6 (±8.5) years. The mean 4-weekly VDZ infusion duration was 286.5 (±48.8) weeks. A total of five (15%) patients relapsed on dose-interval increase (4/17 UC, 1/17 CD) at a median duration from dose interval lengthening to flare of 14 weeks (interquartile range=6-25). Eighty percent (4/5) of patients re-entered remission following dose-interval decrease back to 4-weekly. No clinical predictors of relapse could be determined because of the small cohort size. The risk of patients relapsing when switching from 4 to 8-weekly VDZ ∼15% and is similar between CD and UC. Dose-interval decrease recaptures 80% of patients who relapsed. Therapeutic drug monitoring of VDZ may be of clinical relevance.

  20. Discrepancies between self and observer ratings of depression. The relationship to demographic, clinical and personality variables.

    Science.gov (United States)

    Enns, M W; Larsen, D K; Cox, B J

    2000-10-01

    The observer-rated Hamilton depression scale (HamD) and the self-report Beck Depression Inventory (BDI) are among the most commonly used rating scales for depression, and both have well demonstrated reliability and validity. However, many depressed subjects have discrepant scores on these two assessment methods. The present study evaluated the ability of demographic, clinical and personality factors to account for the discrepancies observed between BDI and HamD ratings. The study group consisted of 94 SCID-diagnosed outpatients with a current major depressive disorder. Subjects were rated with the 21-item HamD and completed the BDI and the NEO-Five Factor Inventory. Younger age, higher educational attainment, and depressive subtype (atypical, non-melancholic) were predictive of higher BDI scores relative to HamD observer ratings. In addition, high neuroticism, low extraversion and low agreeableness were associated with higher endorsement of depressive symptoms on the BDI relative to the HamD. In general, these predictive variables showed a greater ability to explain discrepancies between self and observer ratings of psychological symptoms of depression compared to somatic symptoms of depression. The study does not determine which aspects of neuroticism and extraversion contribute to the observed BDI/HamD discrepancies. Depression ratings obtained with the BDI and HamD are frequently discordant and a number of patient characteristics robustly predict the discrepancy between these two rating methods. The value of multi-modal assessment in the conduct of research on depressive disorders is re-affirmed.

  1. Extramedullary Relapse Following Total Marrow and Lymphoid Irradiation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyun [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States); Stein, Anthony [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States); Tsai, Nicole [Department of Biostatistics, City of Hope National Medical Center, Duarte, California (United States); Schultheiss, Timothy E. [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States); Palmer, Joycelynne [Department of Biostatistics, City of Hope National Medical Center, Duarte, California (United States); Liu, An [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States); Rosenthal, Joseph [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States); Department of Pediatrics, City of Hope National Medical Center, Duarte, California (United States); Forman, Stephen J. [Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California (United States); Wong, Jeffrey Y.C., E-mail: jwong@coh.org [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California (United States)

    2014-05-01

    Purpose: Approximately 5% to 20% of patients who undergo total body irradiation (TBI) in preparation for hematopoietic cell transplantation (HCT) can develop extramedullary (EM) relapse. Whereas total marrow and lymphoid irradiation (TMLI) provides a more conformally targeted radiation therapy for patients, organ sparing has the potential to place the patient at a higher risk for EM relapse than TBI. This study evaluated EM relapse in patients treated with TMLI at our institution. Methods and Materials: Patients eligible for analysis had been enrolled in 1 of 3 prospective TMLI trials between 2006 and 2012. The TMLI targeted bones, major lymph node chains, liver, spleen, testes, and brain, using image-guided tomotherapy with total dose ranging from 12 to 15 Gy. Results: A total of 101 patients with a median age of 47 years were studied. The median follow-up was 12.8 months. Incidence of EM relapse and bone marrow (BM) relapse were 12.9% and 25.7%, respectively. Of the 13 patients who had EM relapse, 4 also had BM relapse, and 7 had EM disease prior to HCT. There were a total of 19 EM relapse sites as the site of initial recurrence: 11 soft tissue, 6 lymph node, 2 skin. Nine of these sites were within the target region and received ≥12 Gy. Ten initial EM relapse sites were outside of the target region: 5 sites received 10.1 to 11.4 Gy while 5 sites received <10 Gy. Pretransplantation EM was the only significant predictor of subsequent EM relapse. The cumulative incidence of EM relapse was 4% at 1 year and 11.4% at 2 years. Conclusions: EM relapse incidence was as frequent in regions receiving ≥10 Gy as those receiving <10 Gy. EM relapse rates following TMLI that included HCT regimens were comparable to published results with regimens including TBI and suggest that TMLI is not associated with an increased EM relapse risk.

  2. Extramedullary Relapse Following Total Marrow and Lymphoid Irradiation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

    International Nuclear Information System (INIS)

    Kim, Ji Hyun; Stein, Anthony; Tsai, Nicole; Schultheiss, Timothy E.; Palmer, Joycelynne; Liu, An; Rosenthal, Joseph; Forman, Stephen J.; Wong, Jeffrey Y.C.

    2014-01-01

    Purpose: Approximately 5% to 20% of patients who undergo total body irradiation (TBI) in preparation for hematopoietic cell transplantation (HCT) can develop extramedullary (EM) relapse. Whereas total marrow and lymphoid irradiation (TMLI) provides a more conformally targeted radiation therapy for patients, organ sparing has the potential to place the patient at a higher risk for EM relapse than TBI. This study evaluated EM relapse in patients treated with TMLI at our institution. Methods and Materials: Patients eligible for analysis had been enrolled in 1 of 3 prospective TMLI trials between 2006 and 2012. The TMLI targeted bones, major lymph node chains, liver, spleen, testes, and brain, using image-guided tomotherapy with total dose ranging from 12 to 15 Gy. Results: A total of 101 patients with a median age of 47 years were studied. The median follow-up was 12.8 months. Incidence of EM relapse and bone marrow (BM) relapse were 12.9% and 25.7%, respectively. Of the 13 patients who had EM relapse, 4 also had BM relapse, and 7 had EM disease prior to HCT. There were a total of 19 EM relapse sites as the site of initial recurrence: 11 soft tissue, 6 lymph node, 2 skin. Nine of these sites were within the target region and received ≥12 Gy. Ten initial EM relapse sites were outside of the target region: 5 sites received 10.1 to 11.4 Gy while 5 sites received <10 Gy. Pretransplantation EM was the only significant predictor of subsequent EM relapse. The cumulative incidence of EM relapse was 4% at 1 year and 11.4% at 2 years. Conclusions: EM relapse incidence was as frequent in regions receiving ≥10 Gy as those receiving <10 Gy. EM relapse rates following TMLI that included HCT regimens were comparable to published results with regimens including TBI and suggest that TMLI is not associated with an increased EM relapse risk

  3. Hospital differences in rates of cesarean deliveries in the Sardinian region: An observational study

    Directory of Open Access Journals (Sweden)

    Massimo Cannas

    2014-11-01

    Full Text Available Background: The rates of cesarean deliveries have been increasing steadily in several European countries in recent decades, with Italy having the second-highest rate (38% in 2010, causing concern and debate about the appropriateness of many interventions. Moreover, some recent studies suggest that rates of common obstetric interventions are not homogeneous across hospitals, maybe not only because of patient case mix but also possibly because of different hospital practices and cultures. Thus, it is important to investigate whether the variation in rates of cesarean sections can be traced back to patient characteristics or whether it depends upon context variables at the hospital level. Objective and method: Using official hospital abstracts on deliveries that occurred in Sardinia over a two-year period, we implement multilevel logistic regression models in order to assess whether the observed differences in cesarean rates across hospitals can be justified by case-mix differences across hospitals. Results: The between-hospital variation in rates of cesarean delivery is estimated to be 0.388 in the model with only the intercept and 0.382 in the model controlling for the mother’s clinical and sociodemographic characteristics. Conclusions: The results show that taking into account the individual characteristics of delivered mothers is not enough to justify the observed variation across hospital rates, suggesting the important role of unobserved variables at the hospital level in determining cesarean section rates.

  4. The Effect of a Condylar Repositioning Plate on Condylar Position and Relapse in Two-Jaw Surgery

    Directory of Open Access Journals (Sweden)

    Gyu Sik Jung

    2017-01-01

    Full Text Available BackgroundNumerous condylar repositioning methods have been reported. However, most of them are 2-dimensional or are complex procedures that require a longer operation time and a highly trained surgeon. This study aims to introduce a new technique using a condylar repositioning plate and a centric relation splint to achieve a centric relationship.MethodsWe evaluated 387 patients who had undergone surgery for skeletal jaw deformities. During the operation, a centric relation splint, intermediate splint, final centric occlusion splint, and condylar repositioning plate along with an L-type mini-plate for LeFort I osteotomy or a bicortical screw for bilateral sagittal split ramus osteotomy were utilized for rigid fixation. The evaluation included: a physical examination to detect preoperative and postoperative temporomandibular joint dysfunction, 3-dimensional computed tomography and oblique transcranial temporomandibular joint radiography to measure 3-dimensional condylar head movement, and posteroanterior and lateral cephalometric radiography to measure the preoperative and postoperative movement of the bony segment and relapse rate.ResultsA 0.3% relapse rate was observed in the coronal plane, and a 2.8% relapse rate in the sagittal plane, which is indistinguishable from the dental relapse rate in orthodontic treatment. The condylar repositioning plate could not fully prevent movement of the condylar head, but the relapse rate was minimal, implying that the movement of the condylar head was within tolerable limits.ConclusionsOur condylar repositioning method using a centric relation splint and mini-plate in orthognathic surgery was found to be simple and effective for patients suffering from skeletal jaw deformities.

  5. Neurophysiological correlates of response inhibition predict relapse in detoxified alcoholic patients: some preliminary evidence from event-related potentials

    Directory of Open Access Journals (Sweden)

    Petit G

    2014-06-01

    Full Text Available Géraldine Petit, Agnieszka Cimochowska, Charles Kornreich, Catherine Hanak, Paul Verbanck, Salvatore CampanellaLaboratory of Psychological Medicine and Addictology, ULB Neuroscience Institute (UNI, Université Libre de Bruxelles (ULB, Brussels, BelgiumBackground: Alcohol dependence is a chronic relapsing disease. The impairment of response inhibition and alcohol-cue reactivity are the main cognitive mechanisms that trigger relapse. Despite the interaction suggested between the two processes, they have long been investigated as two different lines of research. The present study aimed to investigate the interaction between response inhibition and alcohol-cue reactivity and their potential link with relapse.Materials and methods: Event-related potentials were recorded during a variant of a “go/no-go” task. Frequent and rare stimuli (to be inhibited were superimposed on neutral, nonalcohol-related, and alcohol-related contexts. The task was administered following a 3-week detoxification course. Relapse outcome was measured after 3 months, using self-reported abstinence. There were 27 controls (seven females and 27 patients (seven females, among whom 13 relapsed during the 3-month follow-up period. The no-go N2, no-go P3, and the “difference” wave (P3d were examined with the aim of linking neural correlates of response inhibition on alcohol-related contexts to the observed relapse rate.Results: Results showed that 1 at the behavioral level, alcohol-dependent patients made significantly more commission errors than controls (P<0.001, independently of context; 2 through the subtraction no-go P3 minus go P3, this inhibition deficit was neurophysiologically indexed in patients with greater P3d amplitudes (P=0.034; and 3 within the patient group, increased P3d amplitude enabled us to differentiate between future relapsers and nonrelapsers (P=0.026.Conclusion: Our findings suggest that recently detoxified alcoholics are characterized by poorer

  6. A new approach to estimate ice dynamic rates using satellite observations in East Antarctica

    Directory of Open Access Journals (Sweden)

    B. Kallenberg

    2017-05-01

    Full Text Available Mass balance changes of the Antarctic ice sheet are of significant interest due to its sensitivity to climatic changes and its contribution to changes in global sea level. While regional climate models successfully estimate mass input due to snowfall, it remains difficult to estimate the amount of mass loss due to ice dynamic processes. It has often been assumed that changes in ice dynamic rates only need to be considered when assessing long-term ice sheet mass balance; however, 2 decades of satellite altimetry observations reveal that the Antarctic ice sheet changes unexpectedly and much more dynamically than previously expected. Despite available estimates on ice dynamic rates obtained from radar altimetry, information about ice sheet changes due to changes in the ice dynamics are still limited, especially in East Antarctica. Without understanding ice dynamic rates, it is not possible to properly assess changes in ice sheet mass balance and surface elevation or to develop ice sheet models. In this study we investigate the possibility of estimating ice sheet changes due to ice dynamic rates by removing modelled rates of surface mass balance, firn compaction, and bedrock uplift from satellite altimetry and gravity observations. With similar rates of ice discharge acquired from two different satellite missions we show that it is possible to obtain an approximation of the rate of change due to ice dynamics by combining altimetry and gravity observations. Thus, surface elevation changes due to surface mass balance, firn compaction, and ice dynamic rates can be modelled and correlated with observed elevation changes from satellite altimetry.

  7. Modeling whole-tree carbon assimilation rate using observed transpiration rates and needle sugar carbon isotope ratios.

    Science.gov (United States)

    Hu, Jia; Moore, David J P; Riveros-Iregui, Diego A; Burns, Sean P; Monson, Russell K

    2010-03-01

    *Understanding controls over plant-atmosphere CO(2) exchange is important for quantifying carbon budgets across a range of spatial and temporal scales. In this study, we used a simple approach to estimate whole-tree CO(2) assimilation rate (A(Tree)) in a subalpine forest ecosystem. *We analysed the carbon isotope ratio (delta(13)C) of extracted needle sugars and combined it with the daytime leaf-to-air vapor pressure deficit to estimate tree water-use efficiency (WUE). The estimated WUE was then combined with observations of tree transpiration rate (E) using sap flow techniques to estimate A(Tree). Estimates of A(Tree) for the three dominant tree species in the forest were combined with species distribution and tree size to estimate and gross primary productivity (GPP) using an ecosystem process model. *A sensitivity analysis showed that estimates of A(Tree) were more sensitive to dynamics in E than delta(13)C. At the ecosystem scale, the abundance of lodgepole pine trees influenced seasonal dynamics in GPP considerably more than Engelmann spruce and subalpine fir because of its greater sensitivity of E to seasonal climate variation. *The results provide the framework for a nondestructive method for estimating whole-tree carbon assimilation rate and ecosystem GPP over daily-to weekly time scales.

  8. Identifying transition rates of ionic channels via observations at a single state

    CERN Document Server

    Deng Ying Chun; Qian Min Ping; Feng Jian Feng

    2003-01-01

    We consider how to determine all transition rates of an ion channel when it can be described by a birth-death chain or a Markov chain on a star-graph with continuous time. It is found that all transition rates are uniquely determined by the distribution of its lifetime and death-time histograms at a single state. An algorithm to calculate the transition rates exactly, based on the statistics of the lifetime and death-time of the Markov chain at the state, is provided. Examples to illustrate how an ion channel activity is fully determined by the observation of a single state of the ion channel are included.

  9. Identifying transition rates of ionic channels via observations at a single state

    International Nuclear Information System (INIS)

    Deng Yingchun; Peng Shenglun; Qian Minping; Feng Jianfeng

    2003-01-01

    We consider how to determine all transition rates of an ion channel when it can be described by a birth-death chain or a Markov chain on a star-graph with continuous time. It is found that all transition rates are uniquely determined by the distribution of its lifetime and death-time histograms at a single state. An algorithm to calculate the transition rates exactly, based on the statistics of the lifetime and death-time of the Markov chain at the state, is provided. Examples to illustrate how an ion channel activity is fully determined by the observation of a single state of the ion channel are included

  10. Identifying transition rates of ionic channels via observations at a single state

    Energy Technology Data Exchange (ETDEWEB)

    Deng Yingchun [School of Mathematics, Peking University, Beijing (China); Peng Shenglun [School of Mathematics, Peking University, Beijing (China); Qian Minping [School of Mathematics, Peking University, Beijing (China); Feng Jianfeng [COGS, Sussex University, Brighton (United Kingdom)

    2003-02-07

    We consider how to determine all transition rates of an ion channel when it can be described by a birth-death chain or a Markov chain on a star-graph with continuous time. It is found that all transition rates are uniquely determined by the distribution of its lifetime and death-time histograms at a single state. An algorithm to calculate the transition rates exactly, based on the statistics of the lifetime and death-time of the Markov chain at the state, is provided. Examples to illustrate how an ion channel activity is fully determined by the observation of a single state of the ion channel are included.

  11. An Evaluation of Lightning Flash Rate Parameterizations Based on Observations of Colorado Storms during DC3

    Science.gov (United States)

    Basarab, B.; Fuchs, B.; Rutledge, S. A.

    2013-12-01

    Predicting lightning activity in thunderstorms is important in order to accurately quantify the production of nitrogen oxides (NOx = NO + NO2) by lightning (LNOx). Lightning is an important global source of NOx, and since NOx is a chemical precursor to ozone, the climatological impacts of LNOx could be significant. Many cloud-resolving models rely on parameterizations to predict lightning and LNOx since the processes leading to charge separation and lightning discharge are not yet fully understood. This study evaluates predicted flash rates based on existing lightning parameterizations against flash rates observed for Colorado storms during the Deep Convective Clouds and Chemistry Experiment (DC3). Evaluating lightning parameterizations against storm observations is a useful way to possibly improve the prediction of flash rates and LNOx in models. Additionally, since convective storms that form in the eastern plains of Colorado can be different thermodynamically and electrically from storms in other regions, it is useful to test existing parameterizations against observations from these storms. We present an analysis of the dynamics, microphysics, and lightning characteristics of two case studies, severe storms that developed on 6 and 7 June 2012. This analysis includes dual-Doppler derived horizontal and vertical velocities, a hydrometeor identification based on polarimetric radar variables using the CSU-CHILL radar, and insight into the charge structure using observations from the northern Colorado Lightning Mapping Array (LMA). Flash rates were inferred from the LMA data using a flash counting algorithm. We have calculated various microphysical and dynamical parameters for these storms that have been used in empirical flash rate parameterizations. In particular, maximum vertical velocity has been used to predict flash rates in some cloud-resolving chemistry simulations. We diagnose flash rates for the 6 and 7 June storms using this parameterization and compare

  12. Explaining transgression in respiratory rate observation methods in the emergency department: A classic grounded theory analysis.

    Science.gov (United States)

    Flenady, Tracy; Dwyer, Trudy; Applegarth, Judith

    2017-09-01

    Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department(ED) patients. Despite the importance of respiratory rate observations, this vital sign is often inaccurately recorded on ED observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs. To develop a substantive theory explaining ED registered nurses' reasoning when they miss or misreport respiratory rate observations. This research project employed a classic grounded theory analysis of qualitative data. Seventy-nine registered nurses currently working in EDs within Australia. Data collected included detailed responses from individual interviews and open-ended responses from an online questionnaire. Classic grounded theory (CGT) research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. Constant comparison synonymous with CGT methods were employed to code data. This approach facilitated the identification of the main concern of the participants and aided in the generation of theory explaining how the participants processed this issue. The main concern identified is that ED registered nurses do not believe that collecting an accurate respiratory rate for ALL patients at EVERY round of observations is a requirement, and yet organizational requirements often dictate that a value for the respiratory rate be included each time vital signs are collected. The theory 'Rationalising Transgression', explains how participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing strategies that adjust the significance of the organisational requirement. These strategies include; Compensating, when nurses believe they are compensating for errant behaviour by enhancing the patient's outcome

  13. NIDA-Drug Addiction Treatment Outcome Study (DATOS) Relapse as a Function of Spirituality/Religiosity.

    Science.gov (United States)

    Schoenthaler, Stephen J; Blum, Kenneth; Braverman, Eric R; Giordano, John; Thompson, Ben; Oscar-Berman, Marlene; Badgaiyan, Rajendra D; Madigan, Margaret A; Dushaj, Kristina; Li, Mona; Demotrovics, Zsolt; Waite, Roger L; Gold, Mark S

    The connection between religion/spirituality and deviance, like substance abuse, was first made by Durkheim who defined socially expected behaviors as norms. He explained that deviance is due in large part to their absence (called anomie), and concluded that spirituality lowers deviance by preserving norms and social bonds. Impairments in brain reward circuitry, as observed in Reward Deficiency Syndrome (RDS), may also result in deviance and as such we wondered if stronger belief in spirituality practice and religious belief could lower relapse from drugs of abuse. The NIDA Drug Addiction Treatment Outcome Study data set was used to examine post hoc relapse rates among 2,947 clients who were interviewed at 12 months after intake broken down by five spirituality measures. Our main findings strongly indicate, that those with low spirituality have higher relapse rates and those with high spirituality have higher remission rates with crack use being the sole exception. We found significant differences in terms of cocaine, heroin, alcohol, and marijuana relapse as a function of strength of religious beliefs (x 2 = 15.18, p = 0.028; logistic regression = 10.65, p = 0.006); frequency of attending religious services (x 2 = 40.78, p Durkheim's social bond theory. Stronger spiritual/religious beliefs and practices are directly associated with remission from abused drugs except crack. Much like the value of having a sponsor, for clients who abuse drugs, regular spiritual practice, particularly weekly attendance at the religious services of their choice is associated with significantly higher remission. These results demonstrate the clinically significant role of spirituality and the social bonds it creates in drug treatment programs.

  14. Nijmegen Observer-Rated Depression scale for detection of depression in nursing home residents.

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Vernooij-Dassen, M.J.F.J.; Teerenstra, S.; Smalbrugge, M.; Koopmans, R.T.C.M.

    2012-01-01

    OBJECTIVE: This study aims to test the accuracy of the Nijmegen Observer-Rated Depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia. METHODS: This cross-sectional study with 103 residents with dementia (N = 19 depressed) and

  15. Nijmegen Observer-Rated Depression scale for detection of depression in nursing home residents

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Vernooij-Dassen, M.J.; Teerenstra, S.; Smalbrugge, M.; Koopmans, R.T.

    2012-01-01

    Objective This study aims to test the accuracy of the Nijmegen Observer-Rated Depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia. Methods This cross-sectional study with 103 residents with dementia (N = 19 depressed) and 72

  16. A Behavior Rating Scale for Emotionally Disturbed Students: The Pupil Observation Scale.

    Science.gov (United States)

    Armstrong-Hugg, Robin L.; And Others

    The paper describes development of the Pupil Observation Schedule (POS), a computer based system which provides a framework for assessing, evaluating, and reporting behavioral progress of emotionally disturbed students. The POS is used to rate five skill areas--computation, language, reading, reference, and psychomotor skills; and nine behavioral…

  17. THE HALO MERGER RATE IN THE MILLENNIUM SIMULATION AND IMPLICATIONS FOR OBSERVED GALAXY MERGER FRACTIONS

    International Nuclear Information System (INIS)

    Genel, Shy; Genzel, Reinhard; Bouche, Nicolas; Naab, Thorsten; Sternberg, Amiel

    2009-01-01

    We have developed a new method to extract halo merger rates from the Millennium Simulation. First, by removing superfluous mergers that are artifacts of the standard friends-of-friends (FOF) halo identification algorithm, we find a lower merger rate compared to previous work. The reductions are more significant at lower redshifts and lower halo masses, and especially for minor mergers. Our new approach results in a better agreement with predictions from the extended Press-Schechter model. Second, we find that the FOF halo finder overestimates the halo mass by up to 50% for halos that are about to merge, which leads to an additional ∼20% overestimate of the merger rate. Therefore, we define halo masses by including only particles that are gravitationally bound to their FOF groups. We provide new best-fitting parameters for a global formula to account for these improvements. In addition, we extract the merger rate per progenitor halo, as well as per descendant halo. The merger rate per progenitor halo is the quantity that should be related to observed galaxy merger fractions when they are measured via pair counting. At low-mass/redshift, the merger rate increases moderately with mass and steeply with redshift. At high enough mass/redshift (for the rarest halos with masses a few times the 'knee' of the mass function), these trends break down, and the merger rate per progenitor halo decreases with mass and increases only moderately with redshift. Defining the merger rate per progenitor halo also allows us to quantify the rate at which halos are being accreted onto larger halos, in addition to the minor and major merger rates. We provide an analytic formula that converts any given merger rate per descendant halo into a merger rate per progenitor halo. Finally, we perform a direct comparison between observed merger fractions and the fraction of halos in the Millennium Simulation that have undergone a major merger during the recent dynamical friction time, and find a

  18. [Clinical and biological prognostic factors in relapsed acute myeloid leukemia patients].

    Science.gov (United States)

    Yébenes-Ramírez, Manuel; Serrano, Josefina; Martínez-Losada, Carmen; Sánchez-García, Joaquín

    2016-09-02

    Acute myeloid leukemia (AML) is the most frequent type of acute leukemia in adults. Despite recent advances in the characterization of pathogenesis of AML, the cure rates are under 40%, being leukemia relapse the most common cause of treatment failure. Leukaemia relapse occurs due to clonal evolution or clonal escape. In this study, we aimed to analyze the clinical and biological factors influencing outcomes in patients with AML relapse. We included a total of 75 AML patients who experienced leukaemia relapse after achieving complete remission. We performed complete immunophenotyping and conventional karyotyping in bone marrow aspirates obtained at diagnosis and at leukemia relapse. Overall survival (OS) of the series was 3.7%±2.3, leukaemia progression being the most common cause of death. Patients relapsing before 12 months and those with adverse cytogenetic-molecular risk had statistically significant worse outcomes. A percentage of 52.5 of patients showed phenotypic changes and 50% cytogenetic changes at relapse. We did not find significant clinical factors predicting clonal evolution. The presence of clonal evolution at relapse did not have a significant impact on outcome. Patients with relapsed AML have a dismal prognosis, especially those with early relapse and adverse cytogenetic-molecular risk. Clonal evolution with phenotypic and cytogenetic changes occurred in half of the patients without predictive clinical factors or impact on outcome. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  19. Neurocognitive Predictors of Drug Relapse

    NARCIS (Netherlands)

    R. Marhe (Reshmi)

    2013-01-01

    textabstractWorldwide, about 35 million people, that is 0.8% of the world’s adult population, use heroin and/or cocaine and more than 10-13% of these drug users are or will become drug dependent (UNODC, World Drug Report, 2012). Drug dependency is characterized as a chronic relapsing disorder

  20. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Treating MS d Comprehensive Care Developing a Healthcare Team Make the Most of Your Doctor Visits Advance Medical Directives d Find an MS Care Provider Partners in MS Care d Managing Relapses Plasmapheresis d Rehabilitation Functional Electrical Stimulation (FES) ...

  1. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Become an MS Activist Take Action Current Advocacy Issues Advocacy Results Advocacy News d Raise Awareness d ... MS are more likely to experience gradually worsening problems with walking and mobility, along with whatever other symptoms they may have. Diagnosing relapsing-remitting MS (RRMS) Learn More Learn More ... Room MS Prevalence ...

  2. A Chinese patient with relapsed and refractory Hodgkin lymphoma treated with brentuximab vedotin

    Institute of Scientific and Technical Information of China (English)

    Zhi-Gang Cao; Hong-Wei Zhou; Chao-Jin Peng; Mo Liu; Yu Du; Qing-Ming Yang

    2013-01-01

    At present, approximately 20% of Hodgkin lymphomas (HL) are relapsed and refractory, and therapeutic methods including chemotherapy, radiotherapy, and even stem cell transplantation are unsatisfactory. Brentuximab vedotin, composed of CD30 antibody and a chemotherapeutic agent, is a new targeted drug that eradicates tumor cel s by binding to the CD30 antigen on their surface. In clinical trials, the response rate and complete remission rate of this drug were 73% and 40%, respectively, for relapsed and refractory HL. Here we report a case of CD30-positive relapsed and refractory HL that was treated with brentuximab. Before the treatment with brentuximab, the patient underwent chemotherapy, radiotherapy, and autologous stem cell transplantation. However, the disease continued to progress, affecting multiple organs and prompting symptoms such as persistent fever. After the treatment with brentuximab, the patient′s condition improved. Body temperature returned to normal after 4 days. Lung nodules were reduced in size and number after a single course of treatment, and PET/CT showed partial remission and complete remission after 3 and 6 courses of treatment, respectively. The entire treatment process progressed smoothly, though the patient experienced some symptoms due to chemotherapy, including peripheral neuritis of the limbs, irritating dry cough, and mild increase in aminotransferase. No serious adverse effects were observed. The current general condition of the patient is good;the continuous complete remission has amounted to 6 months.

  3. Radio observations and the mass flow rate of αCyg (A2Ia)

    International Nuclear Information System (INIS)

    Wolf, B.; Stahl, O.; Altenhoff, W.J.

    1981-01-01

    From the free-free excess at 10μ Barlow and Cohen (1977) derived a mass loss rate of 6.9 x 10 -7 solar masses yr -1 for αCyg. They predicted a 10 GHz radio flux of 2.2 mJy. On the other hand Praderie et al. (1980) derived a considerable lower mass loss rate of 1.1 x 10 -8 -8 solar masses yr -1 from a curve of growth analysis of the envelope ultraviolet FeII-lines of αCyg. Radio observations are desirable to make a decision about these discrepant results. Therefore the authors observed αCyg at 15 GHz with the 100 m telescope of the MPIfR at Effelsberg. The observations are discussed together with recent VLA data of Abbott et al. (1980). (Auth.)

  4. Cladribine tablets for relapsing-remitting multiple sclerosis

    DEFF Research Database (Denmark)

    Rammohan, Kottil; Giovannoni, Gavin; Comi, Giancarlo

    2012-01-01

    BACKGROUND: In the phase III CLARITY study, treatment with cladribine tablets at cumulative doses of 3.5 or 5.25mg/kg over 96 weeks led to significant reductions in annualized relapse rates (ARR) versus placebo in patients with relapsing-remitting multiple sclerosis. Further post hoc analyses...... of CLARITY study data were conducted to determine the efficacy of cladribine tablets across patient subgroups stratified by baseline characteristics. METHODS: Relapse rates over the 96-week CLARITY study were analyzed in cohorts stratified by demographics; disease duration; treatment history and disease...... activity at baseline. RESULTS: In the intent-to-treat population (n=437, 433 and 456 in the placebo, cladribine 3.5 and 5.25mg/kg groups, respectively), treatment with cladribine tablets 3.5 and 5.25mg/kg led to consistent improvements in ARR versus placebo in patients stratified by gender; age (≤40...

  5. Chaotic spin exchange: is the spin non-flip rate observable?

    International Nuclear Information System (INIS)

    Senba, Masayoshi

    1994-01-01

    If spin exchange is of the Poisson nature, that is, if the time distribution of collisions obeys an exponential distribution function and the collision process is random, the muon spin depolarization is determined only by the spin flip rate regardless of the spin non-flip rate. In this work, spin exchange is discussed in the case of chaotic spin exchange, where the distribution of collision time sequences, generated by a deterministic equation, is exponential but not random (deterministic chaos). Even though this process has the same time distribution as a Poisson process, the muon polarization is affected by the spin non-flip rate. Having an exponential time distribution function is not a sufficient condition for the non-observation of the spin non-flip rate and it is essential that the process is also random. (orig.)

  6. Does multimorbidity influence the occurrence rates of chronic conditions? A claims data based comparison of expected and observed prevalence rates.

    Directory of Open Access Journals (Sweden)

    Ingmar Schäfer

    Full Text Available OBJECTIVE: Multimorbidity is a complex phenomenon with an almost endless number of possible disease combinations with unclear implications. One important aspect in analyzing the clustering of diseases is to distinguish between random coexistence and statistical dependency. We developed a model to account for random coexistence based on stochastic distribution. We analyzed if the number of diseases of the patients influences the occurrence rates of chronic conditions. METHODS: We analyzed claims data of 121,389 persons aged 65+ using a list of 46 chronic conditions. Expected prevalences were simulated by drawing without replacement from all observed diseases using observed overall prevalences as initial probability weights. To determine if a disease occurs more or less frequently than expected by chance we calculated observed-minus-expected deltas for each disease. We defined clinical relevance as |delta| ≥ 5.0%. 18 conditions were excluded because of a prevalence < 5.0%. RESULTS: We found that (1 two chronic conditions (e.g. hypertension were more frequent than expected in patients with a low number of comorbidities; (2 four conditions (e.g. renal insufficiency were more frequent in patients with many comorbidities; (3 six conditions (e.g. cancer were less frequent with many comorbidities; and (4 16 conditions had an average course of prevalences. CONCLUSION: A growing extent of multimorbidity goes along with a rapid growth of prevalences. This is for the largest part merely a stochastic effect. If we account for this effect we find that only few diseases deviate from the expected prevalence curves. Causes for these deviations are discussed. Our approach also has methodological implications: Naive analyses of multimorbidity might easily be affected by bias, because the prevalence of all chronic conditions necessarily increases with a growing extent of multimorbidity. We should therefore always examine and discuss the stochastic interrelations

  7. Observations of turbulent energy dissipation rate in the upper ocean of the central South China Sea

    Science.gov (United States)

    Chen, G.

    2016-02-01

    Measurements of turbulent energy dissipation rate, velocity, temperature, and salinity were obtained in the upper ocean of the central South China Sea (14.5˚N, 117.0˚E) during an experimental campaign from May 11th to 13th 2010. Dissipation rate was elevated ( 10-7 Wkg-1) at night by convection mixing and was weakened ( 10-9 Wkg-1) in daytime due to the warming stratification. Thermocline dissipation rate varied with time ( 10-9 Wkg-1 to 10-8 Wkg-1) under the influence of internal waves. Energy was transferred from the diurnal internal tides to high frequency internal waves through nonlinear wave-wave interactions. This energy cascade process was accompanied by elevated shear and enhanced dissipation, which played an important role in the turbulent mixing in thermocline. Compare with the thermocline dissipation, dissipation below the thermocline was more stable and weak ( 10-10 Wkg-1). The observed dissipation rate during the measurement was well parameterized by the MacKinnon-Gregg parameterization (a model based on a reinterpretation of wave-wave interaction theory), whereas the Gregg-Henyey parameterization was not in good agreement with the observed dissipation rate.

  8. The cost of relapse for patients with a manic/mixed episode of bipolar disorder in the EMBLEM study.

    Science.gov (United States)

    Hong, Jihyung; Reed, Catherine; Novick, Diego; Haro, Josep Maria; Windmeijer, Frank; Knapp, Martin

    2010-01-01

    Bipolar disorder (BD) is characterized by episodes of mania and depression. The debilitating symptoms during an acute episode require intensive treatment, frequently leading to inpatient psychiatric care, which places significant demands on health and social care systems and incurs substantial costs. However, no study to date has estimated the economic impact of relapse. To estimate the direct costs associated with relapse in the treatment of BD following an acute manic or mixed episode over a 21-month follow-up period in routine clinical practice in Europe, using data from a large, prospective, observational study. EMBLEM was a prospective, observational study on the outcomes of patients with a manic/mixed episode of BD conducted in 14 European countries. Patients eligible for analysis were those enrolled in the 21-month maintenance phase of the study, following the 3-month acute phase. Relapse was defined as achieving any one of the following criteria: (i) at least a one-point increase in Clinical Global Impression - Bipolar Disorder (CGI-BP) overall score from the previous visit, with a final rating of > or =4; (ii) inpatient admission for an acute episode of BD; or (iii) psychiatrists' confirmation of relapse. Data on healthcare resource use were recorded retrospectively for the four respective periods (3-6, 6-12, 12-18 and 18-24 month visits). Multivariate analyses were performed to compare the cost of resource use (inpatient stay, day care, psychiatrist visits and medication) for those who relapsed during the 21-month maintenance phase and those who never relapsed. A sensitivity analysis was also conducted to examine the 6-month costs during relapse. The analyses were adjusted for patient characteristics and took account of non-Normality of the cost data by using a log link function. UK unit costs were applied to resource use. The analysis was repeated after multiple imputation for missing data. All costs were presented as year 2007/08 values. A total of 1379

  9. A Model for Estimation of Rain Rate on Tropical Land from TRMM Microwave Imager Radiometer Observations

    OpenAIRE

    C., PRABHAKARA; R., IACOVAZZI; J. M., YOO; K. M., KIM; NASA Goddard Space Flight Center; Center for Research on the Changing Earth System; EWHA Womans University; Science Systems and Applications, Inc.

    2005-01-01

    Over the tropical land regions scatter plots of the rain rate (R_), deduced from the TRMM Precipitation Radar (PR) versus the observed 85GHz brightness temperature (T_) made by the TRMM Microwave Imager (TMI) radiometer, for a period of a season over a given geographic region of 3°×5°(lat×lon), indicate that there are two maxima in rain rate. One strong maximum occurs when T_ has a value of about 220K, and the other weaker one when T_ is much colder ~150K. Also these two maxima are vividly re...

  10. CAR-T cells and allogeneic hematopoietic stem cell transplantation for relapsed/refractory B-cell acute lymphoblastic leukemia.

    Science.gov (United States)

    Liu, Jun; Zhang, Xi; Zhong, Jiang F; Zhang, Cheng

    2017-10-01

    Relapsed/refractory acute lymphoblastic leukemia (ALL) has a low remission rate after chemotherapy, a high relapse rate and poor long-term survival even when allogeneic hematopoietic stem cell transplantation (allo-HSCT) is performed. Chimeric antigen receptors redirected T cells (CAR-T cells) can enhance disease remission with a favorable outcome for relapsed/refractory ALL, though some cases quickly relapsed after CAR-T cell treatment. Thus, treatment with CAR-T cells followed by allo-HSCT may be the best way to treat relapsed/refractory ALL. In this review, we first discuss the different types of CAR-T cells. We then discuss the treatment of relapsed/refractory ALL using only CAR-T cells. Finally, we discuss the use of CAR-T cells, followed by allo-HSCT, for the treatment of relapsed/refractory ALL.

  11. Temporal changes in incidence and pattern of central nervous system relapses in children with acute lymphoblastic leukaemia treated on four consecutive Medical Research Council Trials, 1985–2001

    Science.gov (United States)

    Krishnan, Shekhar; Wade, Rachel; Moorman, Anthony V; Mitchell, Chris; Kinsey, Sally E; Eden, TOB; Parker, Catriona; Vora, Ajay; Richards, Sue; Saha, Vaskar

    2009-01-01

    Despite the success of contemporary treatment protocols in childhood acute lymphoblastic leukaemia (ALL), relapse within the central nervous system (CNS) remains a challenge. To better understand this phenomenon, we have analysed the changes in incidence and pattern of CNS relapses in 5564 children enrolled on four successive MRC-ALL trials between 1985 and 2001. Changes in the incidence and pattern of CNS relapses were examined and the relationship with patient characteristics assessed. Factors affecting post-relapse outcome were determined. Overall, relapses declined by 49%. Decreases occurred primarily in non-CNS and combined relapses with a progressive shift towards later (≥30 months from diagnosis) relapses (p<0·0001). Although isolated CNS relapses declined, the proportional incidence and timing of relapse remained unchanged. Age and presenting white cell count were risk factors for CNS relapse. On multivariate analysis, the time to relapse and the trial period influenced post-relapse outcomes. Relapse trends differed within biological subtypes. In ETV6-RUNX1 ALL, relapse patterns mirrored overall trends while in High Hyperdiploidy ALL, these appear to have plateaued over the latter two trial periods. Intensive systemic and intrathecal chemotherapy have decreased the overall CNS relapse rates and changed the patterns of recurrence. The heterogeneity of therapeutic response in the biological subtypes suggests room for further optimisation using currently available chemotherapy. PMID:20016529

  12. Observation of Repetition-Rate Dependent Emission From an Un-Gated Thermionic Cathode Rf Gun

    Energy Technology Data Exchange (ETDEWEB)

    Edelen, J. P.; Sun, Y.; Harris, J.R.; Lewellen, J.W.

    2017-06-02

    Recent work at Fermilab in collaboration with the Advanced Photon Source and members of other national labs, designed an experiment to study the relationship between the RF repetition rate and the average current per RF pulse. While existing models anticipate a direct relationship between these two parameters we observed an inverse relationship. We believe this is a result of damage to the barium coating on the cathode surface caused by a change in back-bombardment power that is unaccounted for in the existing theories. These observations shed new light on the challenges and fundamental limitations associated with scaling an ungated thermionic cathode RF gun to high average current.

  13. Parameterizing the Magnetopause Reconnection Rate from Observations of the Expanding Polar Cap

    Science.gov (United States)

    Milan, S. E.; Gosling, J. S.; Hubert, B.

    2012-04-01

    We determine an expression for the magnetopause reconnection rate in terms of upstream interplanetary parameters. We quantify the dayside reconnection rate from observations of the expanding polar cap when the nightside reconnection rate is assumed to be zero. The polar cap open flux is calculated from auroral images collected by the Imager for Magnetopause-to-Aurora Global Exploration (IMAGE) Far Ultraviolet camera (FUV), and its rate of increase is correlated with upstream solar wind and interplanetary magnetic field measurements from the OMNI data-set. We find that the reconnection rate is successfully reproduced by considering the magnetic flux transport within a 4 Re-wide channel within the solar wind (with an additional small correction for the solar wind velocity) and an IMF clock angle dependence with an exponent of 9/2. Contrary to several previous studies we do not find a dependence of the reconnection rate on solar wind density. We discuss our findings in the context of previous studies and solar wind-magnetosphere coupling models.

  14. Rate estimation in partially observed Markov jump processes with measurement errors

    OpenAIRE

    Amrein, Michael; Kuensch, Hans R.

    2010-01-01

    We present a simulation methodology for Bayesian estimation of rate parameters in Markov jump processes arising for example in stochastic kinetic models. To handle the problem of missing components and measurement errors in observed data, we embed the Markov jump process into the framework of a general state space model. We do not use diffusion approximations. Markov chain Monte Carlo and particle filter type algorithms are introduced, which allow sampling from the posterior distribution of t...

  15. Successful radiotherapy at the rare extramedullary localization of a chemotherapy refractory relapse Burkitt-All

    International Nuclear Information System (INIS)

    Menschel, E.; Koller, E.; Bernhart, M.; Noesslinger, T.; Pfeilstoecker, M.

    2003-01-01

    The intensive therapy of the Burkitt-All achieved higher remission rates in the last years. Relapses and therapy refractory are a big medial problem. Radiotherapy in contribution with radiosensitizer used by an extramedullary large relapse of Burkitt-All is documented in this article as a successful therapy method. (boteke)

  16. Smoking Cessation and Relapse Prevention among Undergraduate Students: A Pilot Demonstration Project.

    Science.gov (United States)

    Ramsay, Jim; Hoffmann, Anne

    2004-01-01

    The prevalence of college students' tobacco use is widely recognized, but successful cessation and relapse-prevention programs for these smokers have drawn little attention. The authors, who explored the feasibility of training peers to lead cessation and relapse-prevention programs for undergraduates, found a quit rate of 88.2%, suggesting that…

  17. One (rating) from many (observations): Factors affecting the individual assessment of voice behavior in groups.

    Science.gov (United States)

    Podsakoff, Nathan P; Maynes, Timothy D; Whiting, Steven W; Podsakoff, Philip M

    2015-07-01

    This article reports an investigation into how individuals form perceptions of overall voice behavior in group contexts. More specifically, the authors examine the effect of the proportion of group members exhibiting voice behavior in the group, the frequency of voice events in the group, and the measurement item referent (group vs. individual) on an individual's ratings of group voice behavior. In addition, the authors examine the effect that measurement item referent has on the magnitude of the relationship observed between an individual's ratings of group voice behavior and perceptions of group performance. Consistent with hypotheses, the results from 1 field study (N = 220) and 1 laboratory experiment (N = 366) indicate that: (a) When group referents were used, raters relied on the frequency of voice events (and not the proportion of group members exhibiting voice) to inform their ratings of voice behavior, whereas the opposite was true when individual-referent items were used, and (b) the magnitude of the relationship between observers' ratings of group voice behavior and their perceptions of group performance was higher when raters used group-referent, as opposed to an individual-referent, items. The authors discuss the implications of their findings for scholars interested in studying behavioral phenomena occurring in teams, groups, and work units in organizational behavior research. (c) 2015 APA, all rights reserved).

  18. On the observability of turbulent transport rates by Argo: supporting evidence from an inversion experiment

    Directory of Open Access Journals (Sweden)

    G. Forget

    2015-10-01

    Full Text Available Although estimation of turbulent transport parameters using inverse methods is not new, there is little evaluation of the method in the literature. Here, it is shown that extended observation of the broad-scale hydrography by Argo provides a path to improved estimates of regional turbulent transport rates. Results from a 20-year ocean state estimate produced with the ECCO v4 (Estimating the Circulation and Climate of the Ocean, version 4 non-linear inverse modeling framework provide supporting evidence. Turbulent transport parameter maps are estimated under the constraints of fitting the extensive collection of Argo profiles collected through 2011. The adjusted parameters dramatically reduce misfits to in situ profiles as compared with earlier ECCO solutions. They also yield a clear reduction in the model drift away from observations over multi-century-long simulations, both for assimilated variables (temperature and salinity and independent variables (biogeochemical tracers. Despite the minimal constraints imposed specifically on the estimated parameters, their geography is physically plausible and exhibits close connections with the upper-ocean stratification as observed by Argo. The estimated parameter adjustments furthermore have first-order impacts on upper-ocean stratification and mixed layer depths over 20 years. These results identify the constraint of fitting Argo profiles as an effective observational basis for regional turbulent transport rate inversions. Uncertainties and further improvements of the method are discussed.

  19. QualiCOP: real-world effectiveness, tolerability, and quality of life in patients with relapsing-remitting multiple sclerosis treated with glatiramer acetate, treatment-naïve patients, and previously treated patients.

    Science.gov (United States)

    Ziemssen, Tjalf; Calabrese, Pasquale; Penner, Iris-Katharina; Apfel, Rainer

    2016-04-01

    Treatment of symptoms and signs beyond the expanded disability status scale remains a major target in multiple sclerosis. QualiCOP was an observational, non-interventional, open-label study conducted at 170 sites in Germany. Of the 754 enrolled patients, 96 % had relapsing-remitting multiple sclerosis (MS) and were either disease-modifying therapy naïve (de novo, n = 481) or previously treated (n = 237) with once-daily, subcutaneous 20-mg/mL glatiramer acetate (GA). Assessments of relapse rate, disease progression, overall functioning, quality of life (QoL), cognition, fatigue, and depression were performed over 24 months. GA treatment over 24 months was associated with reduced annual relapse rate for previously treated (from 0.98 to 0.54 relapses) and de novo (from 0.81 to 0.48 relapses) patients. Multiple Sclerosis Functional Composite scores showed slight improvement in both cohorts (all p Multiple Sclerosis Inventory Cognition scale scores showed robust improvement in cognition among previously treated and de novo cohorts (all p treatment in important QoL parameters beyond standard measures of relapse and disease severity.

  20. The Cost of Relapse in Schizophrenia.

    Science.gov (United States)

    Pennington, Mark; McCrone, Paul

    2017-09-01

    Schizophrenia is a chronic and debilitating mental illness characterised by periods of relapse that require resource intensive management. Quantifying the cost of relapse is central to the evaluation of the cost effectiveness of treating schizophrenia. We aimed to undertake a comprehensive search of the available literature on the cost of relapse. We performed a search on multiple databases (MEDLINE, Embase, PsycINFO and Health Management Information Consortium) for any study reporting a cost of relapse or data from which such a cost could be calculated. Costs are reported in 2015 international dollars. We found 16 studies reporting costs associated with relapse over a defined period of time and identified a cost associated with hospitalisation for relapse in 43 studies. Eight clinical decision analyses also provided cost estimates. Studies from the US report excess costs of relapse of $6033-$32,753 (2015 Purchasing Power Parity dollars [PPP$]) over periods of 12-15 months. European studies report excess costs of $8665-$18,676 (2015 PPP$) over periods of 6-12 months. Estimates of the cost of hospitalisation for relapse are more diverse, and associated with marked differences in typical length of stay across jurisdictions. Wide ranges in the estimated cost of relapse may reflect differences in sample section and relapse definition as well as practice styles and differences in resource costs. Selection of the most appropriate cost estimate should be guided by the definition of relapse and the analysis setting.

  1. Randomized Phase II Trial Comparing Obinutuzumab (GA101) With Rituximab in Patients With Relapsed CD20(+) Indolent B-Cell Non-Hodgkin Lymphoma

    DEFF Research Database (Denmark)

    Sehn, L. H.; Goy, A.; Offner, F. C.

    2015-01-01

    Purpose Obinutuzumab (GA101), a novel glycoengineered type II anti-CD20 monoclonal antibody, demonstrated responses in single-arm studies of patients with relapsed/refractory non-Hodgkin lymphoma. This is the first prospective, randomized study comparing safety and efficacy of obinutuzumab...... with rituximab in relapsed indolent lymphoma. The primary end point of this study was the overall response rate (ORR) in patients with follicular lymphoma after induction and safety in patients with indolent lymphoma. Patients and Methods A total of 175 patients with relapsed CD20(+) indolent lymphoma requiring...... maintenance therapy every 2 months for up to 2 years. Results Among patients with follicular lymphoma (n = 149), ORR seemed higher for obinutuzumab than rituximab (44.6% v 33.3%; P = .08). This observation was also demonstrated by a blinded independent review panel that measured a higher ORR for obinutuzumab...

  2. Detection of relapse in early stage Hodgkin's disease: role of routine follow up studies

    International Nuclear Information System (INIS)

    Torrey, Margaret J.; Poen, Joseph C.; Hoppe, Richard T.

    1995-01-01

    Purpose: To examine the costs and benefits of an established practice of routine follow-up in a cohort of patients treated with radiation therapy for early stage Hodgkin's disease. Materials and Methods: We retrospectively examined patterns of follow-up and methods of relapse detection among 709 patients with Ann Arbor Stage I-II Hodgkin's disease treated with sub-total lymphoid irradiation (STLI) or total lymphoid irradiation (TLI) between 1969-1994. We determined the probability of relapse detection for each of 7 routine follow up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of overall survival following salvage therapy. Results: Relapse has occurred in 157 patients (22%) at a median 1.9 years (range 0-13 years) following treatment. 133 relapses (85%) occurred during the first 5 years of follow. Detailed information concerning the method of relapse detection was available on 107 patients. These 107 patients form the basis of this analysis. Relapse was identified by history (Hx) alone in 55% of patients, physical exam (PE) in 14%, chest x-ray (CXR) in 23% and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study - erythrocyte sedimentation rate (ESR). The rate of relapse detection was highest for a combination of history and physical exam (78/10,000 exams) followed by CXR (26/10,000 exams), KUB (10/10,000 exams) and ESR (1/10,000 tests). Complete blood count (CBC) and serum chemistries were never the primary factor in detecting HD relapse. Radiographs accounted for greater than 60% of charges while laboratory studies and physician charges accounted for approximately 20% each. The projected charges (1994 dollars) of relapse detection by routine follow up Hx and PE was [dollar]10,600 compared with [dollar]68,200 for CXR, [dollar]141,800 for KUB and [dollar]156,400 for ESR. 10 year actuarial survival following salvage therapy was 65% overall, 65% for patients in whom

  3. Detection of relapse in early stage Hodgkin's disease: role of routine follow up studies

    Energy Technology Data Exchange (ETDEWEB)

    Torrey, Margaret J; Poen, Joseph C; Hoppe, Richard T

    1995-07-01

    Purpose: To examine the costs and benefits of an established practice of routine follow-up in a cohort of patients treated with radiation therapy for early stage Hodgkin's disease. Materials and Methods: We retrospectively examined patterns of follow-up and methods of relapse detection among 709 patients with Ann Arbor Stage I-II Hodgkin's disease treated with sub-total lymphoid irradiation (STLI) or total lymphoid irradiation (TLI) between 1969-1994. We determined the probability of relapse detection for each of 7 routine follow up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of overall survival following salvage therapy. Results: Relapse has occurred in 157 patients (22%) at a median 1.9 years (range 0-13 years) following treatment. 133 relapses (85%) occurred during the first 5 years of follow. Detailed information concerning the method of relapse detection was available on 107 patients. These 107 patients form the basis of this analysis. Relapse was identified by history (Hx) alone in 55% of patients, physical exam (PE) in 14%, chest x-ray (CXR) in 23% and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study - erythrocyte sedimentation rate (ESR). The rate of relapse detection was highest for a combination of history and physical exam (78/10,000 exams) followed by CXR (26/10,000 exams), KUB (10/10,000 exams) and ESR (1/10,000 tests). Complete blood count (CBC) and serum chemistries were never the primary factor in detecting HD relapse. Radiographs accounted for greater than 60% of charges while laboratory studies and physician charges accounted for approximately 20% each. The projected charges (1994 dollars) of relapse detection by routine follow up Hx and PE was [dollar]10,600 compared with [dollar]68,200 for CXR, [dollar]141,800 for KUB and [dollar]156,400 for ESR. 10 year actuarial survival following salvage therapy was 65% overall, 65% for patients in whom

  4. Rates for parallax-shifted microlensing events from ground-based observations of the galactic bulge

    International Nuclear Information System (INIS)

    Buchalter, A.; Kamionkowski, M.

    1997-01-01

    The parallax effect in ground-based microlensing (ML) observations consists of a distortion to the standard ML light curve arising from the Earth's orbital motion. This can be used to partially remove the degeneracy among the system parameters in the event timescale, t 0 . In most cases, the resolution in current ML surveys is not accurate enough to observe this effect, but parallax could conceivably be detected with frequent follow-up observations of ML events in progress, providing the photometric errors are small enough. We calculate the expected fraction of ML events where the shape distortions will be observable by such follow-up observations, adopting Galactic models for the lens and source distributions that are consistent with observed microlensing timescale distributions. We study the dependence of the rates for parallax-shifted events on the frequency of follow-up observations and on the precision of the photometry. For example, we find that for hourly observations with typical photometric errors of 0.01 mag, 6% of events where the lens is in the bulge, and 31% of events where the lens is in the disk (or ∼10% of events overall), will give rise to a measurable parallax shift at the 95% confidence level. These fractions may be increased by improved photometric accuracy and increased sampling frequency. While long-duration events are favored, the surveys would be effective in picking out such distortions in events with timescales as low as t 0 ∼20 days. We study the dependence of these fractions on the assumed disk mass function and find that a higher parallax incidence is favored by mass functions with higher mean masses. Parallax measurements yield the reduced transverse speed, v, which gives both the relative transverse speed and lens mass as a function of distance. We give examples of the accuracies with which v may be measured in typical parallax events. (Abstract Truncated)

  5. Reirradiation and lomustine in patients with relapsed high-grade gliomas

    International Nuclear Information System (INIS)

    Arcicasa, Mauro; Roncadin, Mario; Bidoli, Ettore; Dedkov, Anatolyi; Gigante, Marco; Trovo, Mauro G.

    1999-01-01

    Purpose: The aim of this study was to evaluate the toxicity, response, and survival of patients with relapsed high-grade gliomas after radiation therapy (RT) combined with lomustine (CCNU). Methods and Materials: Thirty-one patients with relapsed gliomas at least 6 months after completion of RT were reirradiated. Twenty-four patients had a pathological diagnosis of high-grade gliomas, whereas 7 had a radiological diagnosis of relapsed malignant gliomas. The study focused on patients with high-grade relapsed gliomas. A total dose of 34.5 Gy was delivered in 23 fractions over 4.5 weeks. Oral administration of CCNU (130 mg/m 2 ) was begun at the same time as RT, and was repeated every 6 weeks until disease progression, or up to 12 courses. Results: Twelve of 24 patients had surgery before RT plus CCNU treatment. Median interval between RT courses was 14 months (range 6-73). All patients received a complete course of RT, and 22 of 24 patients received at least one course of CCNU. Objective responses were seen in 14 evaluable patients: 3 with partial response, 5 with stable disease, and 6 with progressive disease. Duration of partial response was 20, 9, and 8 months. Median time to progression and overall survival from the onset of retreatment were 8.4 months (range 1-22) and 13.7 months (range 1-63+), respectively. One case of G4 thrombocytopenia was observed. Five patients had G1 or G2 leucopenia and 3 patients had G3 leucopenia. Moderate nausea and vomiting were reported in 4 patients. One patient, after one course of CCNU, refused further chemotherapy. No significant difference in survival from relapse was found between patients who underwent surgery before RT plus CCNU and those who received only RT plus CCNU (p = 0.74). Conclusion: Overall, the acute toxicity was moderate, and patient compliance was good. Reirradiation of high-grade glioma was associated with modest subjective and objective response rates. It is remarkable that median overall survival from relapse

  6. Relationships between Medicare Advantage contract characteristics and quality-of-care ratings: an observational analysis of Medicare Advantage star ratings.

    Science.gov (United States)

    Xu, Peng; Burgess, James F; Cabral, Howard; Soria-Saucedo, Rene; Kazis, Lewis E

    2015-03-03

    The Centers for Medicare & Medicaid Services (CMS) publishes star ratings on Medicare Advantage (MA) contracts to measure plan quality of care with implications for reimbursement and bonuses. To investigate whether MA contract characteristics are associated with quality of care through the Medicare plan star ratings. Retrospective study of MA star ratings in 2010. Unadjusted and adjusted multivariable linear regression models assessed the relationship between 5-star rating summary scores and plan characteristics. CMS MA contracts nationally. 409 (71%) of a total of 575 MA contracts, covering 10.56 million Medicare beneficiaries (90% of the MA population) in the United States in 2010. The MA quality ratings summary score (stars range from 1 to 5) is a quality measure based on 36 indicators related to processes of care, health outcomes, access to care, and beneficiary satisfaction. Nonprofit, larger, and older MA contracts were more likely to receive higher star ratings. Star ratings ranged from 2 to 5. Nonprofit contracts received an average 0.55 (95% CI, 0.42 to 0.67) higher star ratings than for-profit contracts (P  star ratings than for-profit contracts. When comparing health plans in the future, the CMS should give increasing attention to for-profit plans with lower quality ratings and consider developing programs to assist newer and smaller plans in improving their care for Medicare beneficiaries. None.

  7. The Anaclitic-Introjective Depression Assessment: Development and preliminary validity of an observer-rated measure.

    Science.gov (United States)

    Rost, Felicitas; Luyten, Patrick; Fonagy, Peter

    2018-03-01

    The two-configurations model developed by Blatt and colleagues offers a comprehensive conceptual and empirical framework for understanding depression. This model suggests that depressed patients struggle, at different developmental levels, with issues related to dependency (anaclitic issues) or self-definition (introjective issues), or a combination of both. This paper reports three studies on the development and preliminary validation of the Anaclitic-Introjective Depression Assessment, an observer-rated assessment tool of impairments in relatedness and self-definition in clinical depression based on the item pool of the Shedler-Westen Assessment Procedure. Study 1 describes the development of the measure using expert consensus rating and Q-methodology. Studies 2 and 3 report the assessment of its psychometric properties, preliminary reliability, and validity in a sample of 128 patients diagnosed with treatment-resistant depression. Four naturally occurring clusters of depressed patients were identified using Q-factor analysis, which, overall, showed meaningful and theoretically expected relationships with anaclitic/introjective prototypes as formulated by experts, as well as with clinical, social, occupational, global, and relational functioning. Taken together, findings reported in this paper provide preliminary evidence for the reliability and validity of the Anaclitic-Introjective Depression Assessment, an observer-rated measure that allows the detection of important nuanced differentiations between and within anaclitic and introjective depression. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Global observation of Omori-law decay in the rate of triggered earthquakes

    Science.gov (United States)

    Parsons, T.

    2001-12-01

    Triggered earthquakes can be large, damaging, and lethal as evidenced by the 1999 shocks in Turkey and the 2001 events in El Salvador. In this study, earthquakes with M greater than 7.0 from the Harvard CMT catalog are modeled as dislocations to calculate shear stress changes on subsequent earthquake rupture planes near enough to be affected. About 61% of earthquakes that occurred near the main shocks are associated with calculated shear stress increases, while ~39% are associated with shear stress decreases. If earthquakes associated with calculated shear stress increases are interpreted as triggered, then such events make up at least 8% of the CMT catalog. Globally, triggered earthquakes obey an Omori-law rate decay that lasts between ~7-11 years after the main shock. Earthquakes associated with calculated shear stress increases occur at higher rates than background up to 240 km away from the main-shock centroid. Earthquakes triggered by smaller quakes (foreshocks) also obey Omori's law, which is one of the few time-predictable patterns evident in the global occurrence of earthquakes. These observations indicate that earthquake probability calculations which include interactions from previous shocks should incorporate a transient Omori-law decay with time. In addition, a very simple model using the observed global rate change with time and spatial distribution of triggered earthquakes can be applied to immediately assess the likelihood of triggered earthquakes following large events, and can be in place until more sophisticated analyses are conducted.

  9. Differences in rain rate intensities between TRMM observations and community atmosphere model simulations

    Science.gov (United States)

    Deng, Yi; Bowman, Kenneth P.; Jackson, Charles

    2007-01-01

    Precipitation related latent heating is important in driving the atmospheric general circulation and in generating intraseasonal to decadal atmospheric variability. Our ability to project future climate change, especially trends in costly precipitation extremes, hinges upon whether coupled GCMs capture processes that affect precipitation characteristics. Our study compares the tropical-subtropical precipitation characteristics of simulations by the NCAR CAM3.1 atmospheric GCM and observations derived from the NASA Tropical Rainfall Measuring Mission (TRMM) satellite. Despite a fairly good simulation of the annual mean rain rate, CAM rains about 10-50% more often than the real world and fails to capture heavy rainfall associated with deep convective systems over subtropical South America and U.S. Southern Plains. When it rains, there is a likelihood of 0.96-1.0 that it rains lightly in the model, compared to values of 0.84-1.0 in TRMM data. On the other hand, the likelihood of the occurrence of moderate to heavy rainfall is an order of magnitude higher in observations (0.12-0.2) than that in the model (model compensates for the lack of heavy precipitation through raining more frequently within the light rain category, which leads to an annual rainfall amount close to what is observed. CAM captures the qualitative change of rain rate PDF from a "dry" oceanic to a "wet" oceanic region, but it fails to simulate the change of precipitation characteristics from an oceanic region to a land region where thunderstorm rainfall dominates.

  10. Rates of ingestion and their variability between individual calanoid copepods: Direct observations

    Energy Technology Data Exchange (ETDEWEB)

    Paffenhoefer, G.A.; Lewis, K.D. [Skidaway Inst. of Oceanography, Savannah, GA (United States); Bundy, M.H. [Skidaway Inst. of Oceanography, Savannah, GA (United States)]|[Alfred-Wegener-Institut fuer Polar- und Meeresforschung, Bremerhaven (Germany). Inst. fuer Fernerkundung (IFE); Metz, C. [Alfred-Wegener-Institut fuer Polar- und Meeresforschung, Bremerhaven (Germany). Inst. fuer Fernerkundung (IFE)

    1995-12-01

    The goals of this study were to determine rates of ingestion and fecal pellet release, and their variability, for individual planktonic copepods over extended periods of time (>20 min). Ingestions and rejections of individual cells of the diatom Thalassiosira eccentrica by a adult females of the calanoid Paracalanus aculeatus were directly quantified by observing individual copepods continuously at cell concentrations ranging from 0.1 to 1.2 mm{sup 3} l{sup {minus}1}. Average ingestion rates increased with increasing food concentration, but were not significantly different between 0.3 and 1.0 mm{sup 3} l{sup {minus}1} (9.8 and 32.7 {mu}g Cl{sup {minus}1}) of T.eccentrica. Rates of cell rejections were low and similar at 0.1 and 0.3. but were significantly higher at 1.0 mm{sup 3} l{sup {minus}1}. The coefficients of variation for average ingestion rates of individual copepods hardly differed between food concentrations, ranging from 17 to 22%, and were close to those for average fecal pellet release intervals which ranged from 15 to 21%. A comparison between individuals at each food concentration found no significant differences at 1.0; at 0.1 and 0.3 mm{sup 3} l{sup {minus}1}, respectively, ingestion rates of four out of five females did not differ significantly from each other. Average intervals between fecal pellet releases were similar at 0.3 and 1.0 mm{sup 3} l{sup {minus}1}. Fecal pellet release intervals between individuals were significantly different at each food concentration; these significant differences were attributed to rather narrow ranges of pellet release intervals of each individual female. Potential sources/causes of variability in the sizes and rates of copepods in the ocean are evaluated.

  11. Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder.

    Science.gov (United States)

    Bech, Per; Lönn, Sara L; Overø, Kerstin F

    2010-02-01

    Analyses of data from 4 relapse-prevention studies with escitalopram were conducted in order to compare patients with and without residual symptoms with regard to relapse rates and global illness during double-blind, 24-week continuation periods. Clinical Global Impressions-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization. All studies showed a statistically significant (P 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill than patients without such a symptom. Patients who did not continue active treatment worsened, even if they were initially free of a residual symptom. In contrast, patients who continued receiving escitalopram remained stable or further improved, regardless of residual symptoms or diagnosis. No clear picture emerged regarding whether patients with residual symptoms had a higher relapse rate. The presence of residual symptoms is associated with significantly worse overall illness severity in all 4 diagnostic groups and with a higher (although not significantly) risk of relapse for patients with MDD or OCD. The greatest difference in all of the studies was between patients treated with escitalopram (relapse rates ~ 20%) and placebo (relapse rates of about 50%). Copyright 2010 Physicians Postgraduate Press, Inc.

  12. Binary and multi-category ratings in a laboratory observer performance study: a comparison.

    Science.gov (United States)

    Gur, David; Bandos, Andriy I; King, Jill L; Klym, Amy H; Cohen, Cathy S; Hakim, Christiane M; Hardesty, Lara A; Ganott, Marie A; Perrin, Ronald L; Poller, William R; Shah, Ratan; Sumkin, Jules H; Wallace, Luisa P; Rockette, Howard E

    2008-10-01

    -reader average (0.016) was (-0.0206, 0.0631) (two-sided p-value 0.35). In conclusion the authors found that in retrospective observer performance studies the use of a binary response or a semi-continuous rating scale led to consistent results in terms of performance as measured by sensitivity-specificity operating points.

  13. Determination of hyperfine-induced transition rates from observations of a planetary nebula.

    Science.gov (United States)

    Brage, Tomas; Judge, Philip G; Proffitt, Charles R

    2002-12-31

    Observations of the planetary nebula NGC3918 made with the STIS instrument on the Hubble Space Telescope reveal the first unambiguous detection of a hyperfine-induced transition 2s2p 3P(o)(0)-->2s2 1S0 in the berylliumlike emission line spectrum of N IV at 1487.89 A. A nebular model allows us to confirm a transition rate of 4x10(-4) sec(-1)+/-33% for this line. The measurement represents the first independent confirmation of the transition rate of hyperfine-induced lines in low ionization stages, and it provides support for the techniques used to compute these transitions for the determination of very low densities and isotope ratios.

  14. Supplement: The Rate of Binary Black Hole Mergers Inferred from Advanced LIGO Observations Surrounding GW150914

    Science.gov (United States)

    Abbott, B. P.; Abbott, R.; Abbott, T. D.; Abernathy, M. R.; Acernese, F.; Ackley, K.; Adams, C.; Adams, T.; Addesso, P.; Adhikari, R. X.; hide

    2016-01-01

    This article provides supplemental information for a Letter reporting the rate of (BBH) coalescences inferred from 16 days of coincident Advanced LIGO observations surrounding the transient (GW) signal GW150914. In that work wereported various rate estimates whose 90% confidence intervals fell in the range 2600 Gpc(exp -3) yr(exp -1). Here we givedetails on our method and computations, including information about our search pipelines, a derivation of ourlikelihood function for the analysis, a description of the astrophysical search trigger distribution expected frommerging BBHs, details on our computational methods, a description of the effects and our model for calibrationuncertainty, and an analytic method for estimating our detector sensitivity, which is calibrated to our measurements.

  15. A Qualitative Exploration of Drug Abuse Relapse Following Treatment

    Science.gov (United States)

    Islam, Manirul; Hashizume, Masahiro; Yamamoto, Taro; Alam, Faruq; Rabbani, Golam

    2012-01-01

    Drug use is an alarming issue in Bangladesh. Most drug users return to drugs after treatment, in what becomes a vicious cycle of treatment and relapse. This study explored why they return and what pathways they follow. We carried out 5 key informant interviews, 10 in-depth interviews, 2 focus group discussions, 3 case studies, 8 observations, and…

  16. A Model for Estimation of Rain Rate on Tropical Land from TRMM Microwave Imager Radiometer Observations

    Science.gov (United States)

    Prabhakara, C.; Iacovazzi, R., Jr.; Yoo, J.-M.; Kim, Kyu-Myong

    2004-01-01

    Over the tropical land regions observations of the 85 GHz brightness temperature (T(sub 85v)) made by the TRMM Microwave Imager (TMI) radiometer when analyzed with the help of rain rate (R(sub pR)) deduced from the TRMM Precipitation Radar (PR) indicate that there are two maxima in rain rate. One strong maximum occurs when T(sub 85) has a value of about 220 K and the other weaker one when T(sub 85v) is much colder approx. 150 K. Together with the help of earlier studies based on airborne Doppler Radar observations and radiative transfer theoretical simulations, we infer the maximum near 220 K is a result of relatively weak scattering due to super cooled rain drops and water coated ice hydrometeors associated with a developing thunderstorm (Cb) that has a strong updraft. The other maximum is associated with strong scattering due to ice particles that are formed when the updraft collapses and the rain from the Cb is transit2oning from convective type to stratiform type. Incorporating these ideas and with a view to improve the estimation of rain rate from existing operational method applicable to the tropical land areas, we have developed a rain retrieval model. This model utilizes two parameters, that have a horizontal scale of approx. 20km, deduced from the TMI measurements at 19, 21 and 37 GHz (T(sub 19v), T(sub 21v), T(sub 37v). The third parameter in the model, namely the horizontal gradient of brightness temperature within the 20 km scale, is deduced from TMI measurements at 85 GHz. Utilizing these parameters our retrieval model is formulated to yield instantaneous rain rate on a scale of 20 km and seasonal average on a mesoscale that agree well with that of the PR.

  17. Predictors of marijuana relapse in the human laboratory: robust impact of tobacco cigarette smoking status.

    Science.gov (United States)

    Haney, Margaret; Bedi, Gillinder; Cooper, Ziva D; Glass, Andrew; Vosburg, Suzanne K; Comer, Sandra D; Foltin, Richard W

    2013-02-01

    Few marijuana smokers in treatment achieve sustained abstinence, yet factors contributing to high relapse rates are unknown. Study 1: data from five inpatient laboratory studies assessing marijuana intoxication, withdrawal, and relapse were combined to assess factors predicting the likelihood and severity of relapse. Daily, nontreatment-seeking marijuana smokers (n = 51; 10 ± 5 marijuana cigarettes/day) were enrolled. Study 2: to isolate the effects of cigarette smoking, marijuana intoxication, withdrawal, and relapse were assessed in daily marijuana and cigarette smokers (n = 15) under two within-subject, counter-balanced conditions: while smoking tobacco cigarettes as usual (SAU), and after at least 5 days without cigarettes (Quit). Study 1: 49% of participants relapsed the first day active marijuana became available. Tobacco cigarette smokers (75%), who were not abstaining from cigarettes, were far more likely to relapse than non-cigarette smokers (odds ratio: 19, p marijuana administration and those with more negative affect and sleep disruption during marijuana withdrawal were more likely to have severe relapse episodes (p 87%) relapsed to marijuana whether in the SAU or Quit phase. Tobacco cigarette smoking did not significantly influence relapse, nor did it affect marijuana intoxication or most symptoms of withdrawal relative to tobacco cessation. Daily marijuana smokers who also smoke cigarettes have high rates of marijuana relapse, and cigarette smoking versus recent abstinence does not directly influence this association. These data indicate that current cigarette smoking is a clinically important marker for increased risk of marijuana relapse. Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  18. The Alcohol Relapse Risk Assessment: a scoring system to predict the risk of relapse to any alcohol use after liver transplant.

    Science.gov (United States)

    Rodrigue, James R; Hanto, Douglas W; Curry, Michael P

    2013-12-01

    Alcohol relapse after liver transplant heightens concern about recurrent disease, nonadherence to the immunosuppression regimen, and death. To develop a scoring system to stratify risk of alcohol relapse after liver transplant. Retrospective medical record review. All adult liver transplants performed from May 2002 to February 2011 at a single center in the United States. The incidence of return to any alcohol consumption after liver transplant. Thirty-four percent (40/118) of patients with a history of alcohol abuse/dependency relapsed to use of any alcohol after liver transplant. Nine of 25 hypothesized risk factors were predictive of alcohol relapse after liver transplant: absence of hepatocellular carcinoma, tobacco dependence, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, poor stress management skills, no rehabilitation relationship, limited social support, lack of nonmedical behavioral consequences, and continued engagement in social activities with alcohol present. Each independent predictor was assigned an Alcohol Relapse Risk Assessment (ARRA) risk value of 1 point, and patients were classified into 1 of 4 groups by ARRA score: ARRA I = 0, ARRA II = 1 to 3, ARRA III = 4 to 6, and ARRA IV = 7 to 9. Patients in the 2 higher ARRA classifications had significantly higher rates of alcohol relapse and were more likely to return to pretransplant levels of drinking. Alcohol relapse rates are moderately high after liver transplant. The ARRA is a valid and practical tool for identifying pretransplant patients with alcohol abuse or dependency at elevated risk of any alcohol use after liver transplant.

  19. Topotecan in the treatment of relapsed small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Elisabeth Quoix

    2008-12-01

    Full Text Available Elisabeth QuoixService de Pneumologie, Hôpitaux Universitaires, Strasbourg, FranceAbstract: Small cell lung cancer (SCLC represents about 15% to 20% of all lung cancers. Chemotherapy is the cornerstone of the treatment, cisplatin–etoposide combination being the most used combination as first-line therapy. Despite high initial chemosensitivity, most SCLC patients will experience relapse sooner or later. Unfortunately, second-line chemotherapy does not result in a high response rate like first-line therapy, most patients having developed wide chemoresistance. This chemoresistance is far more important in refractory patients, ie, those who never responded to first-line therapy or who relapsed within 3 months after the end of chemotherapy, than in sensitive patients, ie, those who relapse more than 3 months after the end of chemotherapy. Topotecan, a topoisomerase I inhibitor, is the most studied drug in this second-line setting and has proved its efficacy as a single agent and in combination. A phase III trial comparing oral topotecan to best supportive care (BSC in relapsed SCLC demonstrated a significant survival benefit as well as a better quality of life. Although the usual schedule is 1.5 mg/m2, days 1–5 intravenously, it is not convenient for patients with relapsed SCLC, especially those who are refractory because of their short survival expectation. Oral topotecan is of similar efficacy and much more convenient with limited stay in a treatment unit and has a comparable toxicity profile for these patients with short expected survival. Combination of topotecan with platinum salts or taxanes does not seem to improve further the outcome of the patients and thus single-agent therapy with topotecan is the standard treatment for relapsed SCLC.Keywords: topotecan, small cell lung cancer, chemoresistance

  20. Spacecraft Angular Rates Estimation with Gyrowheel Based on Extended High Gain Observer

    Directory of Open Access Journals (Sweden)

    Xiaokun Liu

    2016-04-01

    Full Text Available A gyrowheel (GW is a kind of electronic electric-mechanical servo system, which can be applied to a spacecraft attitude control system (ACS as both an actuator and a sensor simultaneously. In order to solve the problem of two-dimensional spacecraft angular rate sensing as a GW outputting three-dimensional control torque, this paper proposed a method of an extended high gain observer (EHGO with the derived GW mathematical model to implement the spacecraft angular rate estimation when the GW rotor is working at large angles. For this purpose, the GW dynamic equation is firstly derived with the second kind Lagrange method, and the relationship between the measurable and unmeasurable variables is built. Then, the EHGO is designed to estimate and calculate spacecraft angular rates with the GW, and the stability of the designed EHGO is proven by the Lyapunov function. Moreover, considering the engineering application, the effect of measurement noise in the tilt angle sensors on the estimation accuracy of the EHGO is analyzed. Finally, the numerical simulation is performed to illustrate the validity of the method proposed in this paper.

  1. The assessment of cognitive errors using an observer-rated method.

    Science.gov (United States)

    Drapeau, Martin

    2014-01-01

    Cognitive Errors (CEs) are a key construct in cognitive behavioral therapy (CBT). Integral to CBT is that individuals with depression process information in an overly negative or biased way, and that this bias is reflected in specific depressotypic CEs which are distinct from normal information processing. Despite the importance of this construct in CBT theory, practice, and research, few methods are available to researchers and clinicians to reliably identify CEs as they occur. In this paper, the author presents a rating system, the Cognitive Error Rating Scale, which can be used by trained observers to identify and assess the cognitive errors of patients or research participants in vivo, i.e., as they are used or reported by the patients or participants. The method is described, including some of the more important rating conventions to be considered when using the method. This paper also describes the 15 cognitive errors assessed, and the different summary scores, including valence of the CEs, that can be derived from the method.

  2. A variational technique to estimate snowfall rate from coincident radar, snowflake, and fall-speed observations

    Science.gov (United States)

    Cooper, Steven J.; Wood, Norman B.; L'Ecuyer, Tristan S.

    2017-07-01

    Estimates of snowfall rate as derived from radar reflectivities alone are non-unique. Different combinations of snowflake microphysical properties and particle fall speeds can conspire to produce nearly identical snowfall rates for given radar reflectivity signatures. Such ambiguities can result in retrieval uncertainties on the order of 100-200 % for individual events. Here, we use observations of particle size distribution (PSD), fall speed, and snowflake habit from the Multi-Angle Snowflake Camera (MASC) to constrain estimates of snowfall derived from Ka-band ARM zenith radar (KAZR) measurements at the Atmospheric Radiation Measurement (ARM) North Slope Alaska (NSA) Climate Research Facility site at Barrow. MASC measurements of microphysical properties with uncertainties are introduced into a modified form of the optimal-estimation CloudSat snowfall algorithm (2C-SNOW-PROFILE) via the a priori guess and variance terms. Use of the MASC fall speed, MASC PSD, and CloudSat snow particle model as base assumptions resulted in retrieved total accumulations with a -18 % difference relative to nearby National Weather Service (NWS) observations over five snow events. The average error was 36 % for the individual events. Use of different but reasonable combinations of retrieval assumptions resulted in estimated snowfall accumulations with differences ranging from -64 to +122 % for the same storm events. Retrieved snowfall rates were particularly sensitive to assumed fall speed and habit, suggesting that in situ measurements can help to constrain key snowfall retrieval uncertainties. More accurate knowledge of these properties dependent upon location and meteorological conditions should help refine and improve ground- and space-based radar estimates of snowfall.

  3. Assessing conflict communication in couples: comparing the validity of self-report, partner-report, and observer ratings.

    Science.gov (United States)

    Sanford, Keith

    2010-04-01

    This study of married couples investigated the short-term predictive validity of the partner-report and self-report scales of the Conflict Communication Inventory and compared the validity of these scales with the validity of observer ratings. A sample of 83 married couples completed two problem-solving conversations. Self-report, partner-report, and observer ratings from Conversation 1 were used to predict behavior in Conversation 2, as rated by a separate panel of observers. The short-term predictive validity of partner-report ratings was extremely high and indistinguishable from the validity of observer ratings. Self-report ratings also demonstrated good validity, albeit slightly lower than other methods. Both partner-report and self-report scores explained a substantial amount of variance in concurrent observer ratings of communication after controlling for relationship satisfaction. 2010 APA, all rights reserved

  4. THE OBSERVED RELATION BETWEEN STELLAR MASS, DUST EXTINCTION, AND STAR FORMATION RATE IN LOCAL GALAXIES

    International Nuclear Information System (INIS)

    Zahid, H. J.; Kewley, L. J.; Kudritzki, R. P.; Yates, R. M.

    2013-01-01

    In this study, we investigate the relation between stellar mass, dust extinction, and star formation rate (SFR) using ∼150,000 star-forming galaxies from SDSS DR7. We show that the relation between dust extinction and SFR changes with stellar mass. For galaxies at the same stellar mass, dust extinction is anti-correlated with the SFR at stellar masses 10 M ☉ . There is a sharp transition in the relation at a stellar mass of 10 10 M ☉ . At larger stellar masses, dust extinction is positively correlated with the SFR for galaxies at the same stellar mass. The observed relation between stellar mass, dust extinction, and SFR presented in this study helps to confirm similar trends observed in the relation between stellar mass, metallicity, and SFR. The relation reported in this study provides important new constraints on the physical processes governing the chemical evolution of galaxies. The correlation between SFR and dust extinction for galaxies with stellar masses >10 10 M ☉ is shown to extend to the population of quiescent galaxies suggesting that the physical processes responsible for the observed relation between stellar mass, dust extinction, and SFR may be related to the processes leading to the shutdown of star formation in galaxies.

  5. THE OBSERVED RELATION BETWEEN STELLAR MASS, DUST EXTINCTION, AND STAR FORMATION RATE IN LOCAL GALAXIES

    Energy Technology Data Exchange (ETDEWEB)

    Zahid, H. J.; Kewley, L. J.; Kudritzki, R. P. [Institute for Astronomy, University of Hawaii at Manoa, 2680 Woodlawn Dr., Honolulu, HI 96822 (United States); Yates, R. M. [Max-Planck-Institute for Astrophysics, Karl-Schwarzschild-Str. 1, D-85741 Garching (Germany)

    2013-02-15

    In this study, we investigate the relation between stellar mass, dust extinction, and star formation rate (SFR) using {approx}150,000 star-forming galaxies from SDSS DR7. We show that the relation between dust extinction and SFR changes with stellar mass. For galaxies at the same stellar mass, dust extinction is anti-correlated with the SFR at stellar masses <10{sup 10} M {sub Sun }. There is a sharp transition in the relation at a stellar mass of 10{sup 10} M {sub Sun }. At larger stellar masses, dust extinction is positively correlated with the SFR for galaxies at the same stellar mass. The observed relation between stellar mass, dust extinction, and SFR presented in this study helps to confirm similar trends observed in the relation between stellar mass, metallicity, and SFR. The relation reported in this study provides important new constraints on the physical processes governing the chemical evolution of galaxies. The correlation between SFR and dust extinction for galaxies with stellar masses >10{sup 10} M {sub Sun} is shown to extend to the population of quiescent galaxies suggesting that the physical processes responsible for the observed relation between stellar mass, dust extinction, and SFR may be related to the processes leading to the shutdown of star formation in galaxies.

  6. The increase in fatigue crack growth rates observed for Zircaloy-4 in a PWR environment

    Science.gov (United States)

    Cockeram, B. V.; Kammenzind, B. F.

    2018-02-01

    Cyclic stresses produced during the operation of nuclear reactors can result in the extension of cracks by processes of fatigue. Although fatigue crack growth rate (FCGR) data for Zircaloy-4 in air are available, little testing has been performed in a PWR primary water environment. Test programs have been performed by Gee et al., in 1989 and Picker and Pickles in 1984 by the UK Atomic Energy Authority, and by Wisner et al., in 1994, that have shown an enhancement in FCGR for Zircaloy-2 and Zircaloy-4 in high-temperature water. In this work, FCGR testing is performed on Zircaloy-4 in a PWR environment in the hydrided and non-hydrided condition over a range of stress-intensity. Measurements of crack extension are performed using a direct current potential drop (DCPD) method. The cyclic rate in the PWR primary water environment is varied between 1 cycle per minute to 0.1 cycle per minute. Faster FCGR rates are observed in water in comparison to FCGR testing performed in air for the hydrided material. Hydrided and non-hydrided materials had similar FCGR values in air, but the non-hydrided material exhibited much lower rates of FCGR in a PWR primary water environment than for hydrided material. Hydrides are shown to exhibit an increased tendency for cracking or decohesion in a PWR primary water environment that results in an enhancement in FCGR values. The FCGR in the PWR primary water only increased slightly with decreasing cycle frequency in the range of 1 cycle per minute to 0.1 cycle per minute. Comparisons between the FCGR in water and air show the enhancement from the PWR environment is affected by the applied stress intensity.

  7. Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study

    Directory of Open Access Journals (Sweden)

    Townell Nicola

    2012-06-01

    Full Text Available Abstract Background Relapsing Plasmodium vivax infection results in significant morbidity for the individual and is a key factor in transmission. Primaquine remains the only licensed drug for prevention of relapse. To minimize relapse rates, treatment guidelines have recently been revised to recommend an increased primaquine dose, aiming to achieve a cumulative dose of ≥6 mg/kg, i.e. ≥420 mg in a 70 kg patient. The aims of this study were to characterize the epidemiology of P. vivax infection imported into Queensland Australia, to determine the rates of relapse, to investigate the use of primaquine therapy, and its efficacy in the prevention of relapse. Methods A retrospective study was undertaken of laboratory confirmed P. vivax infection presenting to the two major tertiary hospitals in Queensland, Australia between January 1999 and January 2011. Primaquine dosing was classified as no dose, low dose ( Results Twenty relapses occurred following 151 primary episodes of P. vivax infection (13.2%. Relapses were confirmed among 3/21 (14.2%, 9/50 (18.0%, 1/54 (1.9% and 7/18 (38.9% of patients administered no dose, low dose, high dose and unknown primaquine dose respectively. High dose primaquine therapy was associated with a significantly lower rate of relapse compared to patients who were prescribed low dose therapy (OR 11.6, 95% CI 1.5-519, p = 0.005. Conclusions Relapse of P. vivax infection is more likely in patients who received low dose primaquine therapy. This study supports the recommendations that high dose primaquine therapy is necessary to minimize relapse of P. vivax malaria.

  8. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries.

    Science.gov (United States)

    Boatin, Adeline Adwoa; Schlotheuber, Anne; Betran, Ana Pilar; Moller, Ann-Beth; Barros, Aluisio J D; Boerma, Ties; Torloni, Maria Regina; Victora, Cesar G; Hosseinpoor, Ahmad Reza

    2018-01-24

    To provide an update on economic related inequalities in caesarean section rates within countries. Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Women aged 15-49 years with a live birth during the two or three years preceding the survey. Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Substantial within country economic inequalities in caesarean deliveries remain

  9. Cortico-amygdala coupling as a marker of early relapse risk in cocaine-addicted individuals

    Directory of Open Access Journals (Sweden)

    Meredith J Mchugh

    2014-02-01

    Full Text Available Addiction to cocaine is a chronic condition characterized by high rates of early relapse. This study builds on efforts to identify neural markers of relapse risk by studying resting state functional connectivity (rsFC in neural circuits arising from the amygdala; a brain region implicated in relapse-related processes including craving and reactivity to stress following acute and protracted withdrawal from cocaine. Whole-brain resting-state fMRI connectivity (6 min was assessed in 45 cocaine-addicted individuals and 22 healthy controls. Cocaine-addicted individuals completed scans in the final week of a residential treatment episode. To approximate preclinical models of relapse-related circuitry separate seeds were derived for the left and right basolateral (BLA and corticomedial (CMA amygdala. Participants also completed the Iowa Gambling Task, Wisconsin Card Sorting Test, Cocaine Craving Questionnaire, Obsessive Compulsive Cocaine Use scale, Temperament and Character Inventory and the NEO-PI-R. Relapse within the first 30 days post-treatment (n = 24 was associated with reduced rsFC between the left CMA and ventromedial prefrontal cortex/rostral anterior cingulate cortex (vmPFC/rACC relative to cocaine-addicted individuals who remained abstinent (non-relapse, n = 21. Non-relapse participants evidenced reduced rsFC between the bilateral BLA and visual processing regions (lingual gyrus/cuneus compared to controls and relapsed participants. Early relapse was associated with fewer years of education but unrelated to trait reactivity to stress, neurocognitive and clinical characteristics or cocaine use history. Findings suggest that rsFC within neural circuits implicated in preclinical models of relapse may provide a promising marker of relapse risk in cocaine-addicted individuals. Future efforts to replicate the current findings and alter connectivity within these circuits may yield novel interventions and improve treatment outcomes.

  10. Particle deposition from aqueous suspensions in turbulent pipe flow - a comparison of observed deposition rates and predicted arrival rates

    International Nuclear Information System (INIS)

    Rodliffe, R.S.

    1979-11-01

    At the present time, there appear to be only four adequately controlled and characterised experimental studies of particle deposition from single phase water in turbulent pipe flow. These are used to illustrate the ranges of applicability of methods for predicting particle arrival rates at tube walls. Arrival rates are predicted from mass transfer correlations and the theory of Reeks and Skyrme (1976) when transport is limited by Brownian diffusion and inertial behaviour, respectively. The regimes in which finite particle size limits the application of these methods are defined and preliminary consideration is given to the conditions under which gravitational settling may make a contribution to deposition in vertically mounted tubes. (author)

  11. Mathematical Models of Tuberculosis Reactivation and Relapse

    Directory of Open Access Journals (Sweden)

    Robert Steven Wallis

    2016-05-01

    Full Text Available The natural history of human infection with Mycobacterium tuberculosis (Mtb is highly variable, as is the response to treatment of active tuberculosis. There is presently no direct means to identify individuals in whom Mtb infection has been eradicated, whether by a bactericidal immune response or sterilizing antimicrobial chemotherapy. Mathematical models can assist in such circumstances by measuring or predicting events that cannot be directly observed. The 3 models discussed in this review illustrate instances in which mathematical models were used to identify individuals with innate resistance to Mtb infection, determine the etiology of tuberculosis in patients treated with tumor necrosis factor antagonists, and predict the risk of relapse in persons undergoing tuberculosis treatment. These examples illustrate the power of various types of mathematic models to increase knowledge and thereby inform interventions in the present global tuberculosis epidemic.

  12. Orexin Receptor Targets for Anti-Relapse Medication Development in Drug Addiction

    Directory of Open Access Journals (Sweden)

    Ronald E. See

    2011-06-01

    Full Text Available Drug addiction is a chronic illness characterized by high rates of relapse. Relapse to drug use can be triggered by re-exposure to drug-associated cues, stressful events, or the drug itself after a period of abstinence. Pharmacological intervention to reduce the impact of relapse-instigating factors offers a promising target for addiction treatment. Growing evidence has implicated an important role of the orexin/hypocretin system in drug reward and drug-seeking, including animal models of relapse. Here, we review the evidence for the role of orexins in modulating reward and drug-seeking in animal models of addiction and the potential for orexin receptors as specific targets for anti-relapse medication approaches.

  13. Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms.

    Science.gov (United States)

    Suchman, Nancy E; DeCoste, Cindy; Borelli, Jessica L; McMahon, Thomas J

    2018-02-01

    In this study, we replicated a rigorous test of the proposed mechanisms of change associated with Mothering from the Inside out (MIO), an evidence-based parenting therapy that aims to enhance maternal reflective functioning and mental representations of caregiving in mothers enrolled in addiction treatment and caring for young children. First, using data from 84 mothers who enrolled in our second randomized controlled trial, we examined whether therapist fidelity to core MIO treatment components predicted improvement in maternal reflective functioning and mental representations of caregiving, even after taking fidelity to non-MIO components into account. Next, we examined whether improvement in directly targeted outcomes (e.g., maternal mentalizing and mental representations of caregiving) led to improvements in the indirectly targeted outcome of maternal caregiving sensitivity, even after controlling for other plausible competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Third, we examined whether improvement in targeted parenting outcomes (e.g., maternal mentalizing, mental representations of caregiving and caregiving sensitivity) was associated in improvement in child attachment status, even after controlling for competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Finally, we examined whether improvement in maternal mentalizing and caregiving representations was associated with a reduction in relapse to substance use. Support was found for the first three tests of mechanisms but not the fourth. Implications for future research and intervention development are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Observations of the turbulent kinetic energy dissipation rate in the upper central South China Sea

    Science.gov (United States)

    Liang, Chang-Rong; Chen, Gui-Ying; Shang, Xiao-Dong

    2017-05-01

    Measurements of the turbulent kinetic energy dissipation rate ( ɛ), velocity, temperature, and salinity were obtained for the upper ocean of the central South China Sea (14.5° N, 117.0° E) during an experimental campaign from May 11 to 13, 2010. Dissipation in the diurnal mixed layer showed a diurnal variability that was strongly affected by the surface buoyancy flux. Dissipation was enhanced ( ɛ ˜ 10-7 W kg-1) at night due to the convective mixing and was weakened ( ɛ ˜ 10-9 W kg-1) in daytime due to the stratification. Dissipation in the thermocline varied with time under the influence of internal waves. Shear from high-frequency internal waves (period ˜8 h) played an important role in enhancing the turbulent mixing in the thermocline. In the period of strong high-frequency internal waves, the shear from high-frequency internal waves became strong and the depth-averaged ɛ in the thermocline was elevated by almost one order of magnitude. Compared with the dissipation in the thermocline, dissipation below was weaker (the time-averaged ɛ ˜ 10-10 W kg-1). The observation indicates that the dissipation rates during the measurements can be parameterized by the MacKinnon-Gregg model that is widely used in the continental shelf but are not in agreement with the Gregg-Henyey model used for the open ocean.

  15. Elevated Serum IL-17 Expression at Cessation Associated with Graves’ Disease Relapse

    Directory of Open Access Journals (Sweden)

    Jianhui Li

    2018-01-01

    Full Text Available Background. Antithyroid drug (ATD treatment occupies the cornerstone therapeutic modality of Graves’ disease (GD with a high relapse rate after discontinuation. This study aimed to assess potential risk factors for GD relapse especially serum interleukin-17 (IL-17 expression. Methods. Consecutive newly diagnosed GD patients who were scheduled to undergo ATD therapy from May 2011 to May 2014 were prospectively enrolled. Risk factors for GD relapse were analyzed by univariate and multivariate Cox proportional hazard analyses. The association between serum IL-17 expression at cessation and GD relapse was analyzed with relapse-free survival (RFS by the Kaplan–Meier survival analysis and log-rank test. Results. Of the 117 patients, 72 (61.5% maintained a remission for 12 months after ATD withdrawal and 45 (38.5% demonstrated GD relapse. The final multivariate Cox analysis indicated elevated IL-17 expression at cessation to be an independent risk factor for GD relapse within 12 months after ATD withdrawal (HR: 3.04, 95% CI: 1.14–7.67, p=0.021. Patients with higher expressions of IL-17 (≥median value at cessation demonstrated a significantly higher RFS than those with lower levels by the Kaplan–Meier analysis and log-rank test (p=0.028. Conclusions. This present study indicated elevated serum IL-17 expression at cessation to be a predictor for GD relapse within 12 months.

  16. Observer-rated depression in long-term care: frequency and risk factors.

    Science.gov (United States)

    McCusker, Jane; Cole, Martin G; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Dyachenko, Alina; Belzile, Eric

    2014-01-01

    The objectives of this study were: (1) to describe the prevalence and 6-month incidence of observer-rated depression in residents age 65 and over of long-term care (LTC) facilities; (2) to describe risk factors for depression, at baseline and over time. A multisite, prospective observational study was conducted in residents aged 65 and over of 7 LTC facilities. The Cornell Scale for Depression in Dementia (CSDD) was completed by nurses monthly for 6 months. We measured demographic, medical, and functional factors at baseline and monthly intervals, using data from research assessments, nurse interviews, and chart reviews. 274 residents were recruited and completed baseline depression assessments. The prevalence of depression (CSDD score of 6+) was 19.0%. The incidence of depression among those without prevalent depression was 73.3 per 100 person-years. A delirium diagnosis, pain, and diabetes were independently associated with prevalent depression. CSDD score at baseline and development of severe cognitive impairment at follow-up were independent risk factors for incident depression. A diagnosis of delirium and uncorrected visual impairment at follow-up occurred concurrently with incident depression. The results of this study have implications for the detection and prevention of depression in LTC. Delirium diagnosis, pain and diabetes at baseline were associated with prevalent depression; depression symptoms at baseline and development of severe cognitive impairment at follow-up were risk factors for incident depression. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Optimally decoding the input rate from an observation of the interspike intervals

    Energy Technology Data Exchange (ETDEWEB)

    Feng Jianfeng [COGS, University of Sussex at Brighton (United Kingdom) and Computational Neuroscience Laboratory, Babraham Institute, Cambridge (United Kingdom)]. E-mail: jf218@cam.ac.uk

    2001-09-21

    A neuron extensively receives both inhibitory and excitatory inputs. What is the ratio r between these two types of input so that the neuron can most accurately read out input information (rate)? We explore the issue in this paper provided that the neuron is an ideal observer - decoding the input information with the attainment of the Cramer-Rao inequality bound. It is found that, in general, adding certain amounts of inhibitory inputs to a neuron improves its capability of accurately decoding the input information. By calculating the Fisher information of an integrate-and-fire neuron, we determine the optimal ratio r for decoding the input information from an observation of the efferent interspike intervals. Surprisingly, the Fisher information can be zero for certain values of the ratio, seemingly implying that it is impossible to read out the encoded information at these values. By analysing the maximum likelihood estimate of the input information, it is concluded that the input information is in fact most easily estimated at the points where the Fisher information vanishes. (author)

  18. Observations and simulations of snowpack cold content and its relationship to snowmelt timing and rate

    Science.gov (United States)

    Jennings, K. S.; Molotch, N. P.

    2017-12-01

    Mountain snowpacks serve as a vital water resource for more than 1 billion people across the globe. Two key properties of snowmelt—rate and timing—are controlled by the snowpack energy budget where incoming positive fluxes are balanced by a decrease in the energy deficit of the snowpack and a change in the phase of water from solid to liquid. In this context, the energy deficit, or cold content, regulates snowmelt as runoff does not commence until the deficit approaches zero. There is significant uncertainty surrounding cold content despite its relevance to snowmelt processes, likely due to the inherent difficulties in its observation. Our work has clarified the previously unresolved meteorological and energy balance controls on cold content development in seasonal snowpacks by leveraging two unique datasets from the Niwot Ridge LTER in the Rocky Mountains of Colorado. The first is a long-term snow pit record of snowpack properties from an alpine and subalpine site within the LTER. These data were augmented with a 23-year simulation of the snowpack at both sites using a quality controlled, serially complete, hourly forcing dataset. The observations and simulations both indicated that cold content primarily developed through new snowfall, while a negative energy budget provided a secondary pathway for cold content development, mainly through longwave emission and sublimation. Cold content gains from snowfall outnumbered energy balance gains by 438% in the alpine and 166% in the subalpine. Increased spring precipitation and later peak cold content significantly delayed snowmelt onset and daily melt rates were reduced by 32.2% in the alpine and 36.1% in the subalpine when an energy deficit needed to be satisfied. Furthermore, preliminary climate change simulations indicated warmer air temperatures reduced cold content accumulation, which increased the amount of snow lost to melt throughout the winter as incoming positive fluxes had to overcome smaller energy

  19. Observational and Genetic Associations of Resting Heart Rate With Aortic Valve Calcium.

    Science.gov (United States)

    Whelton, Seamus P; Mauer, Andreas C; Pencina, Karol M; Massaro, Joseph M; D'Agostino, Ralph B; Fox, Caroline S; Hoffmann, Udo; Michos, Erin D; Peloso, Gina M; Dufresne, Line; Engert, James C; Kathiresan, Sekar; Budoff, Matthew; Post, Wendy S; Thanassoulis, George; O'Donnell, Christopher J

    2018-05-15

    It is unknown if lifelong exposure to increased hemodynamic stress from an elevated resting heart rate (HR) may contribute to aortic valve calcium (AVC). We performed multivariate regression analyses using data from 1,266 Framingham Heart Study (FHS) Offspring cohort participants and 6,764 Multi-Ethnic Study of Atherosclerosis (MESA) participants. We constructed a genetic risk score (GRS) for HR using summary-level data in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) AVC Consortium to investigate if there was evidence in favor of a causal relation. AVC was present in 39% of FHS Offspring cohort participants and in 13% of MESA cohort participants. In multivariate adjusted models, participants in the highest resting HR quartiles had significantly greater prevalence of AVC, with a prevalence ratio of 1.19 (95% confidence interval [CI] 0.99 to 1.44) for the FHS Offspring cohort and 1.32 (95% CI 1.12 to 1.63) for the MESA cohort, compared with those in the lowest quartile. There was a similar increase in the prevalence of AVC per standard deviation increase in resting HR in both FHS Offspring (prevalence ratio 1.08, 95% CI 1.01 to 1.15) and MESA (1.10, 95% CI 1.03 to 1.17). In contrast with these observational findings, a HR associated GRS was not significantly associated with AVC. Although our observational analysis indicates that a higher resting HR is associated with AVC, our genetic results do not support a causal relation. Unmeasured environmental and/or lifestyle factors associated with both increased resting HR and AVC that are not fully explained by covariates in our observational models may account for the association between resting HR and AVC. Copyright © 2018. Published by Elsevier Inc.

  20. Formation and growth rates of atmospheric nanoparticles: four years of observations at two West Siberian stations

    Science.gov (United States)

    Arshinov, Mikhail Yu.; Belan, Boris D.; Davydov, Denis K.; Kozlov, Artem V.; Arshinova, Victoria

    2015-04-01

    In spite of fact that the first report on the new particle formation (NPF) itself was done by John Aitken more than one century ago (Aitken, 1898), a phenomenon of NPF bursts taken place in the atmosphere was discovered not very long ago. Nevertheless, to date it is known that they may occur quite often in a variety of environments (Kulmala et al., 2004; Hirsikko et al., 2011). Siberia occupies a vast area covered by forests, but the comprehensive data on burst frequency, as well as on formation and growth rates of freshly nucleated particles in this key region are still lacking. Continuous measurements of aerosol size distribution carried out in recent years at two West Siberian stations (TOR-station - 56o28'41"N, 85o03'15"E; Fonovaya Observatory - 56o25'07"N, 84o04'27"E) allowed this gap in data to be filled up. Analysis of the size spectra classified in accordance with criteria proposed by Dal Maso et al. (2005) and Hammed et al. (2007) enabled a conclusion to be drawn that NPF events in Wets Siberia are more often observed during spring (from March to May) and early autumn (secondary frequency peak in September). On average, particle formation bursts took place on 23-28 % of all days. Such a seasonal pattern of the NPF occurrence is very similar to one observed at SMEAR II Station (Hyytiälä, Finland; Dal Maso et al. 2005, 2007). Formation rates (FR) of particles with diameters below 25 nm varied in a wide range from 0.1 to 10 cm-3 s-1. Mean values of FR for the entire period of observations were 1.7 cm-3s-1 (median = 1.13 cm-3 s-1) at TOR-station and 0.88 cm-3 s-1 (median = 0.69 cm-3 s-1) at Fonovaya Observatory. Enhanced values of FR are usually observed from spring to autumn. Mean growth rates of observed at TOR-station and Fonovaya Observatory were 6.5 nm h-1 (median = 5.0 nm h-1) and 8.3 nm h-1 (median = 6.4 nm h-1), respectively. This work was supported by the Branch of Geology, Geophysics and Mining Sciences of RAS (Program No. 5); State contracts of

  1. Melarsoprol sensitivity profile of Trypanosoma brucei gambiense isolates from cured and relapsed sleeping sickness patients from the Democratic Republic of the Congo.

    Directory of Open Access Journals (Sweden)

    Patient Pyana Pati

    2014-10-01

    Full Text Available Sleeping sickness caused by Trypanosoma brucei (T.b. gambiense constitutes a serious health problem in sub-Sahara Africa. In some foci, alarmingly high relapse rates were observed in patients treated with melarsoprol, which used to be the first line treatment for patients in the neurological disease stage. Particularly problematic was the situation in Mbuji-Mayi, East Kasai Province in the Democratic Republic of the Congo with a 57% relapse rate compared to a 5% relapse rate in Masi-Manimba, Bandundu Province. The present study aimed at investigating the mechanisms underlying the high relapse rate in Mbuji-Mayi using an extended collection of recently isolated T.b. gambiense strains from Mbuji-Mayi and from Masi-Manimba.Forty five T.b. gambiense strains were used. Forty one were isolated from patients that were cured or relapsed after melarsoprol treatment in Mbuji-Mayi. In vivo drug sensitivity tests provide evidence of reduced melarsoprol sensitivity in these strains. This reduced melarsoprol sensitivity was not attributable to mutations in TbAT1. However, in all these strains, irrespective of the patient treatment outcome, the two aquaglyceroporin (AQP 2 and 3 genes are replaced by chimeric AQP2/3 genes that may be associated with resistance to pentamidine and melarsoprol. The 4 T.b. gambiense strains isolated in Masi-Manimba contain both wild-type AQP2 and a different chimeric AQP2/3. These findings suggest that the reduced in vivo melarsoprol sensitivity of the Mbuji-Mayi strains and the high relapse rates in that sleeping sickness focus are caused by mutations in the AQP2/AQP3 locus and not by mutations in TbAT1.We conclude that mutations in the TbAQP2/3 locus of the local T.b. gambiense strains may explain the high melarsoprol relapse rates in the Mbuji-Mayi focus but other factors must also be involved in the treatment outcome of individual patients.

  2. Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial.

    Science.gov (United States)

    Levine, Michele D; Cheng, Yu; Marcus, Marsha D; Kalarchian, Melissa A; Emery, Rebecca L

    2016-04-01

    Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence. To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse. Pregnant women who recently had quit smoking were recruited before the end of pregnancy. Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum. Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks postpartum. Participants were recruited between March 2008 and December 2012. The dates of the analysis were April 2014 to February 2015. Women received postpartum-adapted, behavioral smoking relapse prevention intervention and were randomly assigned to an enhanced cognitive behavioral intervention that included additional specialized strategies and content focused on women's postpartum concerns about mood, stress, and weight (Strategies to Avoid Returning to Smoking [STARTS]) or a supportive, time and attention-controlled comparison (SUPPORT). Intervention began before delivery and continued through 24 weeks postpartum. The primary outcome was biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum. Secondary outcomes were self-reported mood, levels of perceived stress, and degree of concern about smoking-related weight gain. The study cohort comprised 300 participants (150 randomly assigned to each group). Their mean (SD) age was 24.99 (5.65) years. Overall, 38.0% (114 of 300), 33.7% (101 of 300), and 24.0% (72 of 300) of the sample maintained abstinence at 12, 24, and 52 weeks' postpartum, respectively. There were no differences between the intervention groups in abstinence or time to relapse. Self-reported depressive symptoms and perceived stress significantly improved over time, and improvements were similar for both

  3. Tumor relapse present in oncologic nasal repair

    International Nuclear Information System (INIS)

    Galvez Chavez, Julio Cesar; Sanchez Wals, Lenia; Monzon Fernandez, Abel Nicolas; Morales Tirado, Roxana

    2009-01-01

    Tumor relapse is one of the more fearsome complications of the oncologic course and also to obscure the life prognosis, causing the loss of many reconstructions and of exhausting the repairing surgical possibilities. The aim of this study was to determine the relapse frequency, the repercussion on the repair and the subsequent medical course of patients operated on malign nasal tumors

  4. 3D analysis of high ozone production rates observed during the ESCOMPTE campaign

    Science.gov (United States)

    Coll, Isabelle; Pinceloup, Stéphanie; Perros, Pascal E.; Laverdet, Gérard; Le Bras, Georges

    2005-03-01

    The development of environmental policies to reduce the ozone levels around large agglomerations requires a good understanding of the development of ozone episodes. In particular, it is necessary to know the location and photochemical activity of the plume where ozone is formed. Measurement campaigns make it possible not only to characterize the concentration fields of ozone and its precursors but also to identify the zones of strong ozone production, by means of specific measurements and kinetic calculations. The combination of the observation-based data with numerical simulations allows to better characterize photochemical pollution. This paper presents a study carried out within the ESCOMPTE program and based on the determination of ozone production rates by experimental and numerical methods: ground measurements of peroxy radicals, NO x at a rural site, airborne measurements of NO X and O 3, Eulerian modeling. The reported case is of particular interest since it corresponds to an episode with very different photochemical situations. The diurnal variations of the peroxy radical concentration are analyzed in relation to those of ozone and its precursors. Ozone production rates— P(O 3)-are studied over one particular day. The results show particularly high concentrations of RO 2+HO 2 at ground level (up to 200 pptv) under the influence of the urban and industrial plume, but also highlight very high production rates of ozone (60 to 80 ppbv h -1) a few tens of kilometers from the sources. The results show satisfactory agreement between the various approaches. Modeling provides a four-dimensional (4D) description of the plumes, in particular the relation between the ozone precursor concentrations and P(O 3) on the ground.

  5. Predicting Relapse among Young Adults: Psychometric Validation of the Advanced Warning of Relapse (AWARE) Scale

    Science.gov (United States)

    Kelly, John F.; Hoeppner, Bettina B.; Urbanoski, Karen A.; Slaymaker, Valerie

    2011-01-01

    Objective Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure - the Advance WArning of RElapse scale (AWARE) scale (Miller and Harris, 2000) in an understudied but clinically important sample of young adults. Method Inpatient youth (N=303; Age 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment. Results Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors. Conclusions The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts. PMID:21700396

  6. Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scale.

    Science.gov (United States)

    Kelly, John F; Hoeppner, Bettina B; Urbanoski, Karen A; Slaymaker, Valerie

    2011-10-01

    Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure-the Advance WArning of RElapse (AWARE) scale (Miller & Harris, 2000) in an understudied but clinically important sample of young adults. Inpatient youth (N=303; Ages 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment. Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors. The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Assessment of Measurement Tools of Observation Rate of Nursing Handover Standards in Clinical Wards of Hospital

    Directory of Open Access Journals (Sweden)

    Saadi Amini

    2015-08-01

    Full Text Available Background and objectives : In health centers, clinical information of patient is transferred among care staffs regularly. One of the common cases in information transferring is during the time of nurses’ handover in hospital which performing it correctly will help schedule patient care, providing safety and facilitating exact transferring of information. The aim of this study is investigating validity and reliability of assessment of observance rate of shift handover in clinical wards checklist. Material and Methods : In order to determine the reliability of checklist, two experts panel meetings were held with the presence of 10 experts in clinical field that in those meetings the reliability was investigated with discussion and consensus of participants. Checklist validity was investigated through pilot study in 4 wards of 4 hospitals and calculated by Kronbach- alpha method with 28 cases of shifts handover in morning, noon, and night shift. Results : In studying reliability, the primary checklist was divided into two checklists: patient handover, equipments and ward handover that included 27 and 72 items, respectively. The reliability of patient handover checklist was verified with 0.9155 Kronbach-alpha and that of equipments and ward handover was verified with 0.8779 Kronbach-alpha. Conclusion : Verifying checklists by mentioned scientific and statistical methods showed that these are very powerful instruments that can be used as one of the assessment tools of shift handover in clinical wards to be used towards promoting received services by customers of healthcare system.

  8. Alcohol consumption and symptoms as predictors for relapse of DSM-5 alcohol use disorder.

    Science.gov (United States)

    Tuithof, Marlous; ten Have, Margreet; van den Brink, Wim; Vollebergh, Wilma; de Graaf, Ron

    2014-07-01

    Alcohol consumption levels and alcohol use disorder (AUD) symptoms may serve as easily quantifiable markers for AUD relapse after remission and might help prevention workers identify at-risk individuals. We investigated the predictive value of alcohol consumption and AUD symptoms on relapse. Data are from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). We selected 506 people in ≥12-month DSM-5 AUD remission at baseline and assessed their status at 3-year follow-up. AUD symptoms and drinking patterns were assessed using the Composite International Diagnostic Interview 3.0. Time since remission was assessed retrospectively at baseline and ranged from 1 to 48 years. Predictors for relapse were examined using Cox regression analysis. Cumulative AUD relapse rate was 5.6% at 5 years, 9.1% at 10 years and 12.0% at 20 years. Relapse was predicted by both medium (15-28/22-42 drinks weekly for women/men) and high (≥29/43) past alcohol intake, 6+ lifetime AUD symptoms, 'impaired control over use', and at-risk (≥8/15) current intake. The risk of relapse was especially high when medium or high past intake or 6+ lifetime symptoms coincided with current at-risk drinking. Only a minority of people in DSM-5 AUD remission relapsed, but the risk of relapse increased substantially with the presence of at least one of the risk factors. Moreover, at-risk current drinking coupled with other risk factors substantially increased the likelihood of relapse. Therefore, current drinking may provide an adequate reference point for relapse prevention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Favorable bed utilization and readmission rates for emergency department observation unit heart failure patients.

    Science.gov (United States)

    Schrager, Justin; Wheatley, Matthew; Georgiopoulou, Vasiliki; Osborne, Anwar; Kalogeropoulos, Andreas; Hung, Olivia; Butler, Javed; Ross, Michael

    2013-06-01

    The objective was to compare readmission rates and hospital bed-days between acute decompensated heart failure (AHF) patients admitted or discharged following accelerated treatment protocol (ATP)-driven care in an emergency department observation unit (OU). This was a retrospective cohort study conducted at two urban university-affiliated hospitals. A total of 358 selected AHF patients received treatment on an ATP in the OU between October 1, 2007, and June 30, 2011. The comparison of interest was admission or discharge following OU treatment. The outcome of interest was readmission within 30 and 90 days of hospital discharge following care in the OU. We also examined resource use (inpatient, inpatient plus outpatient-days) between the admitted and discharged groups. Time to readmission analysis was performed with Cox proportional hazards regression. Discharged and admitted patients were similar with respect to age, race, sex, ED length of stay (LOS), and OU LOS. Patients admitted from the OU had a higher median B-type natriuretic peptide (BNP; 1,063 pg/mL [interquartile range {IQR} = 552 to 2,067 pg/mL] vs. 708 pg/mL [IQR = 254 to 1,683 pg/mL]; p = 0.002) and blood urea nitrogen (BUN; 19 mg/dL [IQR = 14 to 26 mg/dL] vs. 17 mg/dL [IQR = 13 to 23 mg/dL]) than those discharged (p = 0.04) and a lower median ejection fraction (EF; 22.5% [15% to 43%] vs. 35% [IQR 20% to 55%]; p = 0.002). In models controlling for age, race, sex, clinical site, BNP, BUN, creatinine, and EF, the 30-day readmission rate (13.8% in the study population as a whole) was not significantly different between the patients discharged or admitted following OU care (hazard ratio [HR] = 0.99; 95% confidence interval [CI] = 0.47 to 2.10). The readmission rates were also not significantly different at 90 days (HR = 1.07; 95% CI = 0.65 to 1.77). Within 30 days of discharge from the OU, patients spent a median of 1.7 days (IQR = 0.0 to 5.1 days) as inpatients, compared to 3.5 days (IQR = 2.3 to 5.8 days

  10. Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.

    LENUS (Irish Health Repository)

    Moran, D

    2014-08-23

    We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.

  11. Inferences About the Distribution, Merger Rate, and Evolutionary Processes of Compact Binaries From Gravitational Wave Observations

    Science.gov (United States)

    Wysocki, Daniel

    We are living through the dawn of the era of gravitational wave astronomy. Our first glances through this new window upon the sky has revealed a new population of objects. Since it first began observing in late 2015, the advanced Laser Interferometer Gravitational-Wave Observatory (LIGO) has detected gravitational waves three times, along with an additional strong candidate - and there shall be orders of magnitude more in the years to come. In all four cases, the waveform's signature is consistent with general relativity's predictions for the merging of two black holes. Through parameter estimation studies, estimates on features such as the black holes' masses and spins have been determined. At least two of the black hole pairs lie above the mass range spanned by comparable black holes observed through traditional means. This suggests they constitute a separate population, either too elusive or rare to be found with traditional telescopes. The most natural questions to ask about these black holes - how did they form, how many of them are there, and how can they be categorized - remain open ended. We know black holes can form when massive stars die, so it's most natural to claim stars as their progenitors. Since we now know black holes merge into larger black holes, could it be the case that they formed from previous mergers? Were the two black holes part of a binary from their birth, or did they become coupled later on in life? The measurements provided by LIGO can help answer these questions and more. Throughout this thesis, I will describe and demonstrate results from a number of novel methods whose purpose is to better understand these black holes and their progenitors. At their heart, these methods give answers to a few, critical questions. a) What is the overall rate at which these objects merge? b) What is the range of values these objects' properties can take, and how are they distributed? c) Given a number of physical models, how can we evaluate the

  12. Bendamustine mitoxantrone and rituximab (BMR): a new effective regimen for refractory or relapsed indolent lymphomas.

    Science.gov (United States)

    Weide, Rudolf; Heymanns, Jochen; Gores, Annette; Köppler, Hubert

    2002-02-01

    Bendamustine (B) and mitoxantrone (M) have been shown to be potent cytotoxic drugs for the treatment of relapsed or refractory indolent lymphomas. The anti-CD20 monoclonal antibody rituximab (R) has produced an overall response rate (ORR) of 50% as a single agent in relapsed or refractory indolent lymphomas. We posed the question whether a combination of the above agents (BMR) could improve these results. This study was an open label, single center pilot study for patients with relapsed or refractory, CD20-positive (indolent) lymphoma or chronic lymphocytic leukaemia. The therapy consisted of bendamustine (80 mg/m2, day 1-3), mitoxantrone (10 mg/m2, day 1), rituximab (375 mg/m2, week 2-5). BM was repeated on day 36 or when the haematological parameters had recovered. The maximum therapy consisted of one BMR-cycle, followed by five BM courses. Treatment was stopped when the disease responded with PR/CR. During March 1999 and December 2000, 20 patients received the BMR-regimen (four secondary high grade lymphoma, 12 indolent lymphoma, four B-CLL). The median age of the patients was 67 years (range 36-82) and their performance status ranged from 0 to 3. Median number of previous treatment regimens was two (1-6). Of the lymphoma patients, 14 had stage IV disease, 1 stage III and 1 stage II. B-CLL patients were all Rai stage IV (Binet C). Overall response rate was 95% (19/20) with seven patients achieving a CR (35%) and 12 patients achieving a PR (60%). Median time to progression is 7 months (1-21) with a median observation time of 7 months (1-21). Response is still durable in 15/20 patients (75%) (1+ to 21+ months after therapy). Symptomatic, reversible grade three or four haematotoxicity occurred in 4/20 patients (20%). Non-symptomatic grade three or four haematotoxicity was seen in 9/20 patients (45%). No major non-haematological toxicity was observed. In conclusion, BMR is a well tolerated, very effective outpatient regimen of treatment for relapsed and refractory

  13. Evaluation of oestrus observation and conception rates in suckling beef cows using whole milk progesterone concentration

    Directory of Open Access Journals (Sweden)

    D.C. Lourens

    2002-07-01

    Full Text Available A 2-sample regime was used to measure whole milk progesterone concentration on the day of oestrus and insemination (Day 0 and 6 days later (Day 6 in a sample of 50 primiparous and 100 multiparous suckling beef cows. Exposure to teaser bulls and observation by cattlemen identified the occurrence of oestrus. Three sets of criteria used to define ovulatory oestrus were compared : a milk progesterone concentration less than 6 nmol / l on Day 0 ; b milk progesterone less than 6 nmol / l on Day 0 and rising to greater than 6 nmol / l on Day 6; c milk progesterone less than 6 nmol / l on Day 0 and rising to greater than 6 nmol / l on Day 6, or cow diagnosed pregnant to 1st insemination. Using only a single milk sample on Day 0 (criterion a would have resulted in the positive predictive value of heat detection being estimated at 98.7%. Using a paired measurement (criterion b resulted in a significantly lower estimate of 84.7%. The inclusion of cows that conceived despite not showing a marked rise in milk progesterone concentration (criterion c resulted in a more accurate estimate of 89.3%. Use of a 2-sample regime also allowed calculation of conception rates while eliminating the effect of heat detection errors. In the cows sampled, of those in ovulatory oestrus that were inseminated, 73.1% conceived to the 1st insemination. These results demonstrate that artificial insemination within a limited breeding season can be successful if nutrition is optimal and management is intensive. The use of a 2-sample milk progesterone test may be a valuable tool in investigating heat detection and conception problems in beef herds in which artificial insemination is used.

  14. Observer-rated coping associated with borderline personality disorder: an exploratory study.

    Science.gov (United States)

    Kramer, Ueli

    2014-01-01

    Little is known about coping specificities, as operationalization of the concept of affect regulation, in borderline personality disorder (BPD). It is most important to take into account methodological criticisms addressed to the self-report questionnaire approach and to compare BPD coping specificities to the ones of neighbouring diagnostic categories, such as bipolar disorder (BD). The present exploratory study compared the coping profiles of N = 25 patients presenting BPD to those of N = 25 patients presenting BD and to those of N = 25 healthy controls. All participants underwent a clinical interview that was transcribed and rated using the Coping Patterns observer-rater system. Results partially confirmed study hypotheses and showed differences between BPD patients and healthy controls in all coping domains (competence, resources and autonomy), whereas the only coping domain presenting a BPD-specific lack of skills, compared with the BD patients, was autonomy, a set of coping strategies facing stress appraised as challenge. These coping processes were linked to general and BPD symptomatology. These results extend conclusions of earlier studies on affect regulation processes in BPD and bear important clinical implications, in the context of dialectical behavior therapy and other therapeutic approaches. Limitations of this exploratory study, such as the small sample size, are acknowledged. Coping can be reliably assessed in the narrative process in an non-structured interview frame. Patients with borderline personality disorder present with a specific lack of skills in affect regulation related to autonomy issues, compared to patients with bipolar disorder and healthy controls. Lack of skills in accommodation to distressing emotions in borderline personality disorder is related to symptom gravity and may be treated using radical acceptance strategies. Copyright © 2012 John Wiley & Sons, Ltd.

  15. Analysis of audiometric relapse-free survival in patients with immune-mediated hearing loss exclusively treated with corticosteroids.

    Science.gov (United States)

    Mata-Castro, Nieves; García-Chilleron, Raimon; Gavilanes-Plasencia, Javier; Ramírez-Camacho, Rafael; García-Fernández, Alfredo; García-Berrocal, José Ramón

    2017-10-12

    To describe the results in terms of audiometric relapse-free survival and relapse rate in immunomediated hearing loss patients treated exclusively with corticosteroids. Retrospective study of patients with audiometric relapses, monitored from 1995 to 2014, in two centres of the Community of Madrid. We evaluated 31 patients with a mean age of 48.52 years (14.67 SD), of which 61.3% were women. Most hearing loss was fluctuating (48.4%). Only 16.1% of patients had systemic autoimmune disease. There is a moderate positive correlation between the sex variable and the systemic involvement variable (Spearman's correlation coefficient=0.356): specifically, between being female and systemic disease. The relative incidence rate of relapse in the first year was 2.01 relapses/year with a 95% CI (1.32 to 2.92). The mean survival time of the event (audiometric relapse) was 5.25 months (SD 0.756). With multivariate analysis, the only variable that achieved statistical significance was age, with a hazard ratio of 1.032 (95% CI; 1.001-1.063, P=.043). Immune-mediated disease of the inner ear is a chronic disease with relapses. Half of the patients with immunomediated hearing loss treated exclusively with corticosteroids relapse before 6 months of follow-up. In addition, if a patient has not relapsed, they are more likely to relapse as each year passes. Analysis of the of audiometric relapse- free survival will enable the effect of future treatments to be compared and their capacity to reduce the rhythm of relapses. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  16. Inconsistencies in patient perceptions and observer ratings of shared decision making: the case of colorectal cancer screening.

    Science.gov (United States)

    Wunderlich, Tracy; Cooper, Gregory; Divine, George; Flocke, Susan; Oja-Tebbe, Nancy; Stange, Kurt; Lafata, Jennifer Elston

    2010-09-01

    To compare patient-reported and observer-rated shared decision making (SDM) use for colorectal cancer (CRC) screening and evaluate patient, physician and patient-reported relational communication factors associated with patient-reported use of shared CRC screening decisions. Study physicians are salaried primary care providers. Patients are insured, aged 50-80 and due for CRC screening. Audio-recordings from 363 primary care visits were observer-coded for elements of SDM. A post-visit patient survey assessed patient-reported decision-making processes and relational communication during visit. Association of patient-reported SDM with observer-rated elements of SDM, as well as patient, physician and relational communication factors were evaluated using generalized estimating equations. 70% of patients preferred SDM for preventive health decisions, 47% of patients reported use of a SDM process, and only one of the screening discussions included all four elements of SDM per observer ratings. Patient report of SDM use was not associated with observer-rated elements of SDM, but was significantly associated with female physician gender and patient-reported relational communication. Inconsistencies exist between patient reports and observer ratings of SDM for CRC screening. Future studies are needed to understand whether SDM that is patient-reported, observer-rated or both are associated with informed and value-concordant CRC screening decisions. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  17. Metaplastic carcinoma. Breast. Relapse. Chemotherapy and Radiotherapy

    International Nuclear Information System (INIS)

    Marquez, A.; Terrasa, J.; Garcia, J.M.; Rifa, J.

    1996-01-01

    Metaplastic carcinoma of the breast is a rare tumor. The appearance of unexpected mesenchymal elements within the epithelial tumors is the squamous metaplasia. These tumors have a different clinical behaviour that classical breast carcinoma. We present a case of metaplastic mammary carcinoma with multiple relapses treated with a combination of chemotherapy and radiotherapy. The use of chemotherapy after local treatment has enhanced the relapse-free survival. The combined treatment modality seems to produce some benefit in the management of the local relapses of this neoplasms

  18. Investigation of the behaviour of both dead time and observed counting rates of He-3 gas filled neutron detector

    Energy Technology Data Exchange (ETDEWEB)

    Adib, M.; Eid, Y.; Abdel Kawy, A.; Maayouf, R.M.A.; Shuriet, G.M.; Hamouda, I.

    1981-01-01

    The behaviour of the dead time of He-3 detector, operating at both the proportional and the corona discharge regions, is investigated as a function of the neutron reaction rate inside the detector. The applied experimental method makes use of the fluctuations, due to the detector dead time in the observed counting rates from Poisson's distribution. In order to check the validity of the experimental method used in the present work, the dead time of BF/sub 3/ neutron detectors with different efficiencies (due to different enrichement in B-10) were determined. It is shown that the observed counting rate from the He-3 detector operating at the proportional region for neutron reaction rates ranging from 8 x 10/sup 3/ to 2.5 x 10/sup 4/ reaction/sec decreases with the increase of the neutron reaction rate. Such behaviour was not observed when operating the He-3 detector at the corona discharge region.

  19. Investigation of the behaviour of both dead time and observed counting rates of He-3 gas filled neutron detector

    International Nuclear Information System (INIS)

    Adib, M.; Eid, Y.; Abdel Kawy, A.; Maayouf, R.M.A.; Shuriet, G.M.; Hamouda, I.

    1981-01-01

    The behaviour of the dead time of He-3 detector, operating at both the proportional and the corona discharge regions, is investigated as a function of the neutron reaction rate inside the detector. The applied experimental method makes use of the fluctuations, due to the detector dead time in the observed counting rates from Poisson's distribution. In order to check the validity of the experimental method used in the present work, the dead time of BF 3 neutron detectors with different efficiencies (due to different enrichement in B-10) were determined. It is shown that the observed counting rate from the He-3 detector operating at the proportional region for neutron reaction rates ranging from 8 x 10 3 to 2.5 x 10 4 reaction/sec decreases with the increase of the neutron reaction rate. Such behaviour was not observed when operating the He-3 detector at the corona discharge region. (orig.) [de

  20. New England observed and predicted August stream/river temperature maximum positive daily rate of change points

    Data.gov (United States)

    U.S. Environmental Protection Agency — The shapefile contains points with associated observed and predicted August stream/river temperature maximum positive daily rate of change in New England based on a...

  1. New England observed and predicted July stream/river temperature maximum positive daily rate of change points

    Data.gov (United States)

    U.S. Environmental Protection Agency — The shapefile contains points with associated observed and predicted July stream/river temperature maximum positive daily rate of change in New England based on a...

  2. New England observed and predicted July maximum negative stream/river temperature daily rate of change points

    Data.gov (United States)

    U.S. Environmental Protection Agency — The shapefile contains points with associated observed and predicted July stream/river temperature maximum negative daily rate of change in New England based on a...

  3. The Secant Rate of Corrosion: Correlating Observations of the USS Arizona Submerged in Pearl Harbor

    Science.gov (United States)

    Johnson, Donald L.; DeAngelis, Robert J.; Medlin, Dana J.; Johnson, Jon E.; Carr, James D.; Conlin, David L.

    2018-03-01

    Contrary to previous linear projections of steel corrosion in seawater, analysis of an inert marker embedded in USS Arizona concretion since the 7 December 1941 attack on Pearl Harbor reveals evidence that the effective corrosion rate decreases with time. The secant rate of corrosion, or SRC correlation, derived from this discovery could have a significant impact on failure analysis investigations for concreted shipwrecks or underwater structures. The correlation yields a lower rate of metal thinning than predicted. Development of the correlation is described.

  4. Corrosion rate transients observed by linear polarization techniques at Zr-1%Nb alloy

    International Nuclear Information System (INIS)

    Beran, J.; Cerny, K.

    1997-01-01

    Momentary corrosion rate of Zr-1%Nb alloy during nonisothermal autoclave experiments at temperature up to 328 deg. C in various solutions was determined by T/R p values (T - absolute temperature, R p - polarization resistance), multiplied by temperature independent conversion factor. This factor was found by comparison of conventional corrosion loss evaluation with electrochemical measurements. Corrosion rate transients in boric acid solutions and in lithium hydroxide differed significantly. Great differences were also found in stabilized corrosion rates at the end of experiments. Temperature irregularities caused considerable changes in corrosion rate. (author). 5 refs, 5 figs, 1 tab

  5. Corrosion rate transients observed by linear polarization techniques at Zr-1%Nb alloy

    Energy Technology Data Exchange (ETDEWEB)

    Beran, J; Cerny, K [ZJS SKODA plc., Pelzen (Czech Republic)

    1997-02-01

    Momentary corrosion rate of Zr-1%Nb alloy during nonisothermal autoclave experiments at temperature up to 328 deg. C in various solutions was determined by T/R{sub p} values (T - absolute temperature, R{sub p}- polarization resistance), multiplied by temperature independent conversion factor. This factor was found by comparison of conventional corrosion loss evaluation with electrochemical measurements. Corrosion rate transients in boric acid solutions and in lithium hydroxide differed significantly. Great differences were also found in stabilized corrosion rates at the end of experiments. Temperature irregularities caused considerable changes in corrosion rate. (author). 5 refs, 5 figs, 1 tab.

  6. Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma

    International Nuclear Information System (INIS)

    Tabori, Uri; Sung, Lillian; Hukin, Juliette; Laperriere, Normand; Crooks, Bruce; Carret, Anne-Sophie; Silva, Mariana; Odame, Isaac; Mpofu, Chris; Strother, Douglas; Wilson, Beverly; Samson, Yvan; Bouffet, Eric

    2006-01-01

    Purpose: To report the clinical course of adolescents with medulloblastoma, with specific emphasis on prognosis and pattern of relapse. Methods and Materials: We retrospectively studied the clinical course and outcomes of children aged 10-20 years with medulloblastoma, treated at centers throughout Canada between 1986 and 2003. To better assess time to relapse, a cohort of patients aged 3-20 years at diagnosis was generated. Results: A total of 72 adolescents were analyzed. Five-year overall survival and event-free survival rates were 78.3% ± 5.4% and 68.0% ± 6.2%, respectively. Late relapses occurred at a median of 3.0 years (range, 0.3-6.8 years). In univariate analysis, conventional risk stratification and the addition of chemotherapy to craniospinal radiation did not have prognostic significance. Female patients had improved overall survival (p = 0.007). Time to relapse increased with age in a linear fashion. After relapse, patients faired poorly regardless of treatment modality. Patients who did not receive chemotherapy initially had improved progression-free survival at relapse (p 0.05). Conclusions: Our study suggests that adolescents with medulloblastoma might have a unique prognosis and pattern of relapse, dissimilar to those in younger children. They might benefit from different risk stratifications and prolonged follow-up. These issues should be addressed in future prospective trials

  7. Modulations of Heart Rate, ECG, and Cardio-Respiratory Coupling Observed in Polysomnography

    Directory of Open Access Journals (Sweden)

    Thomas Penzel

    2016-10-01

    Full Text Available The cardiac component of cardio-respiratory polysomnography is covered by ECG and heart rate recordings. However their evaluation is often underrepresented in summarizing reports. As complements to EEG, EOG, and EMG, these signals provide diagnostic information for autonomic nervous activity during sleep. This review presents major methodological developments in sleep research regarding heart rate, ECG and cardio-respiratory couplings in a chronological (historical sequence. It presents physiological and pathophysiological insights related to sleep medicine obtained by new technical developments. Recorded nocturnal ECG facilitates conventional heart rate variability analysis, studies of cyclical variations of heart rate, and analysis of ECG waveform. In healthy adults, the autonomous nervous system is regulated in totally different ways during wakefulness, slow-wave sleep, and REM sleep. Analysis of beat-to-beat heart-rate variations with statistical methods enables us to estimate sleep stages based on the differences in autonomic nervous system regulation. Furthermore, up to some degree, it is possible to track transitions from wakefulness to sleep by analysis of heart-rate variations. ECG and heart rate analysis allow assessment of selected sleep disorders as well. Sleep disordered breathing can be detected reliably by studying cyclical variation of heart rate combined with respiration-modulated changes in ECG morphology (amplitude of R wave and T wave.

  8. Modulations of Heart Rate, ECG, and Cardio-Respiratory Coupling Observed in Polysomnography.

    Science.gov (United States)

    Penzel, Thomas; Kantelhardt, Jan W; Bartsch, Ronny P; Riedl, Maik; Kraemer, Jan F; Wessel, Niels; Garcia, Carmen; Glos, Martin; Fietze, Ingo; Schöbel, Christoph

    2016-01-01

    The cardiac component of cardio-respiratory polysomnography is covered by ECG and heart rate recordings. However, their evaluation is often underrepresented in summarizing reports. As complements to EEG, EOG, and EMG, these signals provide diagnostic information for autonomic nervous activity during sleep. This review presents major methodological developments in sleep research regarding heart rate, ECG, and cardio-respiratory couplings in a chronological (historical) sequence. It presents physiological and pathophysiological insights related to sleep medicine obtained by new technical developments. Recorded nocturnal ECG facilitates conventional heart rate variability (HRV) analysis, studies of cyclical variations of heart rate, and analysis of ECG waveform. In healthy adults, the autonomous nervous system is regulated in totally different ways during wakefulness, slow-wave sleep, and REM sleep. Analysis of beat-to-beat heart-rate variations with statistical methods enables us to estimate sleep stages based on the differences in autonomic nervous system regulation. Furthermore, up to some degree, it is possible to track transitions from wakefulness to sleep by analysis of heart-rate variations. ECG and heart rate analysis allow assessment of selected sleep disorders as well. Sleep disordered breathing can be detected reliably by studying cyclical variation of heart rate combined with respiration-modulated changes in ECG morphology (amplitude of R wave and T wave).

  9. High maternal and neonatal mortality rates in northern Nigeria: an 8-month observational study

    Directory of Open Access Journals (Sweden)

    Guerrier G

    2013-08-01

    Full Text Available Gilles Guerrier,1 Bukola Oluyide,2 Maria Keramarou,1 Rebecca Grais1 1Epicentre, Paris, France; 2Médecins Sans Frontières, Paris, France Background: Despite considerable efforts to reduce the maternal mortality ratio, numerous pregnant women continue to die in many developing countries, including Nigeria. We conducted a study to determine the incidence and causes of maternal mortality over an 8-month period in a rural-based secondary health facility located in Jahun, northern Nigeria. Methods: A retrospective observational study was performed in a 41-bed obstetric ward. From October 2010 to May 2011, demographic data, obstetric characteristics, and outcome were collected from all pregnant women admitted. The total number of live births during the study period was recorded in order to calculate the maternal mortality ratio. Results: There were 2,177 deliveries and 39 maternal deaths during the study period, with a maternal mortality ratio of 1,791/100,000 live births. The most common causes of maternal mortality were hemorrhage (26%, puerperal sepsis (19%, and obstructed labor (5%. No significant difference (P = 0.07 in mean time to reach the hospital was noted between fatal cases (1.9 hours, 95% confidence interval [CI] 1.1–2.6 and nonfatal cases (1.4 hours, 95% CI 1.4–1.5. Two hundred and sixty-six women were admitted presenting with stillbirth. Maternal mortality was higher for unbooked patients than for booked patients (odds ratio 5.1, 95% CI 3.5–6.2, P < 0.0001. The neonatal mortality rate was calculated at 46/1,000 live births. The main primary causes of neonatal deaths were prematurity (44% and birth asphyxia (22%. Conclusion: Maternal and neonatal mortality remains unacceptably high in this setting. Reducing unbooked emergencies should be a priority with continuous programs including orthodox practices in order to meet the fifth Millennium Development Goal. Keywords: fetal mortality, maternal mortality, Nigeria, antenatal care

  10. Reevaluation of the O+(2P) reaction rate coefficients derived from atmosphere explorer C observations

    International Nuclear Information System (INIS)

    Chang, T.; Torr, D.G.; Richards, P.G.; Solomon, S.C.

    1993-01-01

    O + ( 2 P) is an important species for studies of the ionosphere and thermosphere: its emission at 7320 angstrom can be used as a diagnostic of the thermospheric atomic oxygen density. Unfortunately, there are no laboratory measurements of the O and N 2 reaction rates which are needed to determine the major sinks of O + ( 2 P). The reaction rates that are generally used were determined from aeronomic data by Rusch et al. but there is evidence that several important inputs that they used should be changed. The authors have recalculated the O and N 2 reaction rates for O + ( 2 P) using recent improvements in the solar EUV flux, cross sections, and photoelectron fluxes. For the standard solar EUV flux, the new N 2 reaction rate of 3.4 ± 1.5 x 10 -10 cm 3 s -1 is close to the value obtained by Rusch et al., but the new O reaction rate of 4.0 ± 1.9 x 10 -10 cm 3 s -1 is about 8 times larger. These new reaction rates are derived using neutral densities, electron density, and solar EUV fluxes measured by Atmosphere Explorer C in 1974 during solar minimum. The new theoretical emission rates are in good agreement with the data for the two orbits studied by Rusch et al. and they are in reasonable agreement with data from five additional orbits that are used in this study. The authors have also examined the effect of uncertainties in the solar EUV flux on the derived reaction rates and found that 15% uncertainties in the solar flux could cause additional uncertainties of up to a factor of 1.5 in the O quenching rate. 19 refs., 4 figs., 8 tabs

  11. Gait in children with cerebral palsy : observer reliability of Physician Rating Scale and Edinburgh Visual Gait Analysis Interval Testing scale

    NARCIS (Netherlands)

    Maathuis, KGB; van der Schans, CP; van Iperen, A; Rietman, HS; Geertzen, JHB

    2005-01-01

    The aim of this study was to test the inter- and intra-observer reliability of the Physician Rating Scale (PRS) and the Edinburgh Visual Gait Analysis Interval Testing (GAIT) scale for use in children with cerebral palsy (CP). Both assessment scales are quantitative observational scales, evaluating

  12. [Application of Competing Risks Model in Predicting Smoking Relapse Following Ischemic Stroke].

    Science.gov (United States)

    Hou, Li-Sha; Li, Ji-Jie; Du, Xu-Dong; Yan, Pei-Jing; Zhu, Cai-Rong

    2017-07-01

    To determine factors associated with smoking relapse in men who survived from their first stroke. Data were collected through face to face interviews with stroke patients in the hospital, and then repeated every three months via telephone over the period from 2010 to 2014. Kaplan-Meier method and competing risk model were adopted to estimate and predict smoking relapse rates. The Kaplan-Meier method estimated a higher relapse rate than the competing risk model. The four-year relapse rate was 43.1% after adjustment of competing risk. Exposure to environmental tobacco smoking outside of home and workplace (such as bars and restaurants) ( P =0.01), single ( P <0.01), and prior history of smoking at least 20 cigarettes per day ( P =0.02) were significant predictors of smoking relapse. When competing risks exist, competing risks model should be used in data analyses. Smoking interventions should give priorities to those without a spouse and those with a heavy smoking history. Smoking ban in public settings can reduce smoking relapse in stroke patients.

  13. Pharmacological interventions for alcohol relapse prevention

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    Health NHS Foundation Trust, Birmingham, UK ... ABSTRACT: Alcohol dependence is a chronic, debilitating disorder that is an important .... hours, or as long as alcohol remains in the blood. ... term and slightly improving days to relapse.

  14. Second hematopoietic SCT for leukemia relapsing after myeloablative T cell-depleted transplants does not prolong survival.

    Science.gov (United States)

    McIver, Z A; Yin, F; Hughes, T; Battiwalla, M; Ito, S; Koklanaris, E; Haggerty, J; Hensel, N F; Barrett, A John

    2013-09-01

    Patients with leukemia relapsing after allogeneic hematopoietic SCT have a dismal prognosis. A second SCT offers a further opportunity for cure, but has a high rate of treatment failure. To determine the utility of this option, we analyzed 59 consecutive patients relapsing after a myeloablative HLA-matched sibling T cell-depleted (TCD) SCT. Twenty-five patients (13 relapsing within 6 months and 12 relapsing between 6 and 170 months after the first SCT) received a T-replete second SCT. Thirty-eight patients relapsing early had a shorter survival than the 21 patients relapsing later (median 96 vs 298 days, P=0.0002). In patients relapsing early, the second SCT did not improve OS compared with patients receiving non-SCT treatments (median survival 109 vs 80 days, P=0.41). In patients relapsing late, despite an early trend in favor of second SCT, survival was comparable for patients receiving a second SCT compared with non retransplanted patients (median survival 363.5 vs 162 days, P=0.49). Disappointingly, our results do not demonstrate an important survival benefit for a second T-replete allogeneic SCT to treat relapse following a TCD SCT.

  15. Controls on surface soil drying rates observed by SMAP and simulated by the Noah land surface model

    Science.gov (United States)

    Shellito, Peter J.; Small, Eric E.; Livneh, Ben

    2018-03-01

    Drydown periods that follow precipitation events provide an opportunity to assess controls on soil evaporation on a continental scale. We use SMAP (Soil Moisture Active Passive) observations and Noah simulations from drydown periods to quantify the role of soil moisture, potential evaporation, vegetation cover, and soil texture on soil drying rates. Rates are determined using finite differences over intervals of 1 to 3 days. In the Noah model, the drying rates are a good approximation of direct soil evaporation rates, and our work suggests that SMAP-observed drying is also predominantly affected by direct soil evaporation. Data cover the domain of the North American Land Data Assimilation System Phase 2 and span the first 1.8 years of SMAP's operation. Drying of surface soil moisture observed by SMAP is faster than that simulated by Noah. SMAP drying is fastest when surface soil moisture levels are high, potential evaporation is high, and when vegetation cover is low. Soil texture plays a minor role in SMAP drying rates. Noah simulations show similar responses to soil moisture and potential evaporation, but vegetation has a minimal effect and soil texture has a much larger effect compared to SMAP. When drying rates are normalized by potential evaporation, SMAP observations and Noah simulations both show that increases in vegetation cover lead to decreases in evaporative efficiency from the surface soil. However, the magnitude of this effect simulated by Noah is much weaker than that determined from SMAP observations.

  16. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    Directory of Open Access Journals (Sweden)

    Bryan A Loy

    Full Text Available Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011 and after (2013 the payment method introduction using relative risks (RR. After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05. For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008 from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20. These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  17. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    Science.gov (United States)

    Loy, Bryan A; Shkedy, Clive I; Powell, Adam C; Happe, Laura E; Royalty, Julie A; Miao, Michael T; Smith, Gary L; Long, James W; Gupta, Amit K

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  18. Binary and multi-category ratings in a laboratory observer performance study: A comparison

    OpenAIRE

    Gur, David; Bandos, Andriy I.; King, Jill L.; Klym, Amy H.; Cohen, Cathy S.; Hakim, Christiane M.; Hardesty, Lara A.; Ganott, Marie A.; Perrin, Ronald L.; Poller, William R.; Shah, Ratan; Sumkin, Jules H.; Wallace, Luisa P.; Rockette, Howard E.

    2008-01-01

    The authors investigated radiologists, performances during retrospective interpretation of screening mammograms when using a binary decision whether to recall a woman for additional procedures or not and compared it with their receiver operating characteristic (ROC) type performance curves using a semi-continuous rating scale. Under an Institutional Review Board approved protocol nine experienced radiologists independently rated an enriched set of 155 examinations that they had not personally...

  19. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma.

    Science.gov (United States)

    Stewart, A Keith; Rajkumar, S Vincent; Dimopoulos, Meletios A; Masszi, Tamás; Špička, Ivan; Oriol, Albert; Hájek, Roman; Rosiñol, Laura; Siegel, David S; Mihaylov, Georgi G; Goranova-Marinova, Vesselina; Rajnics, Péter; Suvorov, Aleksandr; Niesvizky, Ruben; Jakubowiak, Andrzej J; San-Miguel, Jesus F; Ludwig, Heinz; Wang, Michael; Maisnar, Vladimír; Minarik, Jiri; Bensinger, William I; Mateos, Maria-Victoria; Ben-Yehuda, Dina; Kukreti, Vishal; Zojwalla, Naseem; Tonda, Margaret E; Yang, Xinqun; Xing, Biao; Moreau, Philippe; Palumbo, Antonio

    2015-01-08

    Lenalidomide plus dexamethasone is a reference treatment for relapsed multiple myeloma. The combination of the proteasome inhibitor carfilzomib with lenalidomide and dexamethasone has shown efficacy in a phase 1 and 2 study in relapsed multiple myeloma. We randomly assigned 792 patients with relapsed multiple myeloma to carfilzomib with lenalidomide and dexamethasone (carfilzomib group) or lenalidomide and dexamethasone alone (control group). The primary end point was progression-free survival. Progression-free survival was significantly improved with carfilzomib (median, 26.3 months, vs. 17.6 months in the control group; hazard ratio for progression or death, 0.69; 95% confidence interval [CI], 0.57 to 0.83; P=0.0001). The median overall survival was not reached in either group at the interim analysis. The Kaplan-Meier 24-month overall survival rates were 73.3% and 65.0% in the carfilzomib and control groups, respectively (hazard ratio for death, 0.79; 95% CI, 0.63 to 0.99; P=0.04). The rates of overall response (partial response or better) were 87.1% and 66.7% in the carfilzomib and control groups, respectively (P<0.001; 31.8% and 9.3% of patients in the respective groups had a complete response or better; 14.1% and 4.3% had a stringent complete response). Adverse events of grade 3 or higher were reported in 83.7% and 80.7% of patients in the carfilzomib and control groups, respectively; 15.3% and 17.7% of patients discontinued treatment owing to adverse events. Patients in the carfilzomib group reported superior health-related quality of life. In patients with relapsed multiple myeloma, the addition of carfilzomib to lenalidomide and dexamethasone resulted in significantly improved progression-free survival at the interim analysis and had a favorable risk-benefit profile. (Funded by Onyx Pharmaceuticals; ClinicalTrials.gov number, NCT01080391.).

  20. Relapsing polychondritis and airway involvement.

    Science.gov (United States)

    Ernst, Armin; Rafeq, Samaan; Boiselle, Phillip; Sung, Arthur; Reddy, Chakravarthy; Michaud, Gaetane; Majid, Adnan; Herth, Felix J F; Trentham, David

    2009-04-01

    To assess the prevalence and characteristics of airway involvement in relapsing polychondritis (RP). Retrospective chart review and data analysis of RP patients seen in the Rheumatology Clinic and the Complex Airway Center at Beth Israel Deaconess Medical Center from January 2004 through February 2008. RP was diagnosed in 145 patients. Thirty-one patients had airway involvement, a prevalence of 21%. Twenty-two patients were women (70%), and they were between 11 and 61 years of age (median age, 42 years) at the time of first symptoms. Airway symptoms were the first manifestation of disease in 17 patients (54%). Dyspnea was the most common symptom in 20 patients (64%), followed by cough, stridor, and hoarseness. Airway problems included the following: subglottic stenosis (n = 8; 26%); focal and diffuse malacia (n = 15; 48%); and focal stenosis in different areas of the bronchial tree in the rest of the patients. Twelve patients (40%) required and underwent intervention including balloon dilatation, stent placement, tracheotomy, or a combination of the above with good success. The majority of patients experienced improvement in airway symptoms after intervention. One patient died during the follow-up period from the progression of airway disease. The rest of the patients continue to undergo periodic evaluation and intervention. In this largest cohort described in the English language literature, we found symptomatic airway involvement in RP to be common and at times severe. The nature of airway problems is diverse, with tracheomalacia being the most common. Airway intervention is frequently required and in experienced hands results in symptom improvement.

  1. Reevaluation of the O(+)(2P) reaction rate coefficients derived from Atmosphere Explorer C observations

    Science.gov (United States)

    Chang, T.; Torr, D. G.; Richards, P. G.; Solomon, S. C.

    1993-01-01

    O(+)(2P) is an important species for studies of the ionosphere and thermosphere: its emission at 7320 A can be used as a diagnostic of the thermospheric atomic oxygen density. Unfortunately, there are no laboratory measurements of the O and N2 reaction rates which are needed to determine the major sinks of (O+)(2p). We have recalculated the O and N2 reaction rates for O(+) (2P) using recent improvements in the solar EUV flux, cross sections, and photoelectron fluxes. For the standard solar EUV flux, the new N2 reaction rate of 3.4 +/- 1.5 x 10 exp -10 cu cm/s is close to the value obtained by Rusch et al. (1977), but the new O reaction rate of 4.0 +/- 1.9 x 10 exp -10 cu cm/sec is about 8 times larger. These new reaction rates are derived using neutral densities, electron density, and solar EUV fluxes measured by Atmosphere Explorer C in 1974 during solar minimum. The new theoretical emission rates are in good agreement with the data for the two orbits studied by Rusch et al.

  2. Coloring Rate of Phenolphthalein by Reaction with Alkaline Solution Observed by Liquid-Droplet Collision.

    Science.gov (United States)

    Takano, Yuuka; Kikkawa, Shigenori; Suzuki, Tomoko; Kohno, Jun-ya

    2015-06-11

    Many important chemical reactions are induced by mixing two solutions. This paper presents a new way to measure rates of rapid chemical reactions induced by mixing two reactant solutions using a liquid-droplet collision. The coloring reaction of phenolphthalein (H2PP) by a reaction with NaOH is investigated kinetically. Liquid droplets of H2PP/ethanol and NaOH/H2O solutions are made to collide, which induces a reaction that transforms H2PP into a deprotonated form (PP(2-)). The concentration of PP(2-) is evaluated from the RGB values of pixels in the colored droplet images, and is measured as a function of the elapsed time from the collision. The obtained rate constant is (2.2 ± 0.7) × 10(3) M(-1) s(-1), which is the rate constant for the rate-determining step of the coloring reaction of H2PP. This method was shown to be applicable to determine rate constants of rapid chemical reactions between two solutions.

  3. Hydrostatic Pressurization of Lung Surfactant Microbubbles: Observation of a Strain-Rate Dependent Elasticity.

    Science.gov (United States)

    Thomas, Alec N; Borden, Mark A

    2017-11-28

    The microbubble offers a unique platform to study lung surfactant mechanics at physiologically relevant geometry and length scale. In this study, we compared the response of microbubbles (∼15 μm initial radius) coated with pure dipalmitoyl-phosphatidylcholine (DPPC) versus naturally derived lung surfactant (SURVANTA) when subjected to linearly increasing hydrostatic pressure at different rates (0.5-2.3 kPa/s) at room temperature. The microbubbles contained perfluorobutane gas and were submerged in buffered saline saturated with perfluorobutane at atmospheric pressure. Bright-field microscopy showed that DPPC microbubbles compressed spherically and smoothly, whereas SURVANTA microbubbles exhibited wrinkling and smoothing cycles associated with buckling and collapse. Seismograph analysis showed that the SURVANTA collapse amplitude was constant, but the collapse rate increased with the pressurization rate. An analysis of the pressure-volume curves indicated that the dilatational elasticity increased during compression for both shell types. The initial dilatational elasticity for SURVANTA was nearly twice that of DPPC at higher pressurization rates (>1.5 kPa/s), producing a pressure drop of up to 60 kPa across the film prior to condensation of the perfluorobutane core. The strain-rate dependent stiffening of SURVANTA shells likely arises from their composition and microstructure, which provide enhanced in-plane monolayer rigidity and lateral repulsion from surface-associated collapse structures. Overall, these results provide new insights into lung surfactant mechanics and collapse behavior during compression.

  4. Field observations of turbulent dissipation rate profiles immediately below the air-water interface

    Science.gov (United States)

    Wang, Binbin; Liao, Qian

    2016-06-01

    Near surface profiles of turbulence immediately below the air-water interface were measured with a free-floating Particle Image Velocimetry (PIV) system on Lake Michigan. The surface-following configuration allowed the system to measure the statistics of the aqueous-side turbulence in the topmost layer immediately below the water surface (z≈0˜15 cm, z points downward with 0 at the interface). Profiles of turbulent dissipation rate (ɛ) were investigated under a variety of wind and wave conditions. Various methods were applied to estimate the dissipation rate. Results suggest that these methods yield consistent dissipation rate profiles with reasonable scattering. In general, the dissipation rate decreases from the water surface following a power law relation in the top layer, ɛ˜z-0.7, i.e., the slope of the decrease was lower than that predicted by the wall turbulence theory, and the dissipation was considerably higher in the top layer for cases with higher wave ages. The measured dissipation rate profiles collapse when they were normalized with the wave speed, wave height, water-side friction velocity, and the wave age. This scaling suggests that the enhanced turbulence may be attributed to the additional source of turbulent kinetic energy (TKE) at the "skin layer" (likely due to micro-breaking), and its downward transport in the water column.

  5. Can Mindful Parenting Be Observed? Relations between Observational Ratings of Mother-Youth Interactions and Mothers’ Self-Report Mindful Parenting

    Science.gov (United States)

    Duncan, Larissa G.; Coatsworth, J. Douglas; Gayles, Jochebed G.; Geier, Mary H.; Greenberg, Mark T.

    2015-01-01

    Research on mindful parenting, an extension of mindfulness to the interpersonal domain of parent-child relationships, has been limited by its reliance on self-report assessment. The current study is the first to examine whether observational indices of parent-youth interactions differentiate between high and low levels of self-reported mindful parenting. The Iowa Family Interaction Rating Scales (IFIRS) were used to code interactions between mothers and their 7th grade youth. Mothers drawn from the top and bottom quartiles (n = 375) of a larger distribution of self-reported interpersonal mindfulness in parenting (N = 804) represented clearly defined high and low mindful parenting groups. Discriminant function analysis (DFA) was used to analyze how well six composite IFIRS observational rating variables (e.g., parental warmth, consistent discipline) discriminated between high and low self-reports of mindful parenting. DFA results were cross-validated, with statistically significant canonical correlations found for both subsamples (p parenting and the observational ratings was also provided through hierarchical regression analyses conducted with a continuous predictor of mindful parenting using the full sample. Thus, the present study provides preliminary evidence for a link between self-reported mindful parenting and observed interactions between parents and youth. PMID:25844494

  6. Andrographis paniculata decreases fatigue in patients with relapsing-remitting multiple sclerosis: a 12-month double-blind placebo-controlled pilot study.

    Science.gov (United States)

    Bertoglio, J C; Baumgartner, M; Palma, R; Ciampi, E; Carcamo, C; Cáceres, D D; Acosta-Jamett, G; Hancke, J L; Burgos, R A

    2016-05-23

    Andrographis paniculata (A. paniculata), a medicinal plant, has shown anti-inflammatory, neuroprotective and antifibrotic effects in animal models as well as clinical efficacy in different studies, including an anti-fatigue effect in autoimmune diseases such as rheumatoid arthritis. In multiple sclerosis (MS), fatigue is rated as one of the most common and disabling symptoms. In the present trial, we investigated the effect of A. paniculata on relapse rate and fatigue in relapsing-remitting MS (RRMS) patients receiving interferon beta. A randomised double-blind placebo-controlled trial assessed the effects of 170 mg of A. paniculata dried extract tablet b.i.d. p.o. on relapse rate and fatigue using the Fatigue Severity Scores (FSS) over 12 months in RRMS patients receiving interferon. The Expanded Disability Status Scale (EDSS) score, inflammatory parameters and radiological findings were also investigated. Twenty-five patients were enrolled, and twenty-two patients were ultimately analysed and randomised to the active or placebo group. Patients treated with A. paniculata showed a significant reduction in their FSS score as compared to the placebo, equivalent to a 44 % reduction at 12 months. No statistically significant differences were observed for relapse rate, EDSS or inflammatory parameters, with a trend in reducing new lesions among the A. paniculata group. One patient in the A. paniculata group presented with a mild and transient skin rash, which was alleviated with anti-histamine treatment for three weeks. A. paniculata was well tolerated in patients and no changes in clinical parameters were observed. A. paniculata significantly reduces fatigue in patients with RRMS receiving interferon beta in comparison to placebo and only interferon beta treatment. ClinicalTrials.gov Identifier: NCT02280876 ; Trial registration date: 20.10.2014.

  7. Cognitive impairment in relapsing remitting Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Saška Roškar

    2003-06-01

    Full Text Available The purpose of the study was to identify changes in cognitive abilities that affect patients with relapsing remitting form of multiple sclerosis (MS and to find out which instrument manifests them best. The performance of MS patients was compared to a matched group of healthy people using three neuropsychological tests: Wisconsin card sorting test (WCST, Stroop color and word test and Trail making test (TMT part B. Results on all three tests indicate general cognitive impairments in the group of patients. Compared to the group of healthy people patients with MS exhibited impaired ability of abstract reasoning (WCST, impaired cognitive flexibility and less resistance to irrelevant stimuli (Stroop color and word test, slowed information processing and impaired ability of shifting attention from one symbol to another (TMT. The largest differences between groups occured in Stroop color and word test as well as in TMT. The estimation of cognitive abilities of MS patients is of high importance and sistematicaly observing of changes in those abilities should be considered.

  8. A therapeutic trial of decitabine and vorinostat in combination with chemotherapy for relapsed/refractory acute lymphoblastic leukemia.

    Science.gov (United States)

    Burke, Michael J; Lamba, Jatinder K; Pounds, Stanley; Cao, Xueyuan; Ghodke-Puranik, Yogita; Lindgren, Bruce R; Weigel, Brenda J; Verneris, Michael R; Miller, Jeffrey S

    2014-09-01

    DNA hypermethylation and histone deacetylation are pathways of leukemia resistance. We investigated the tolerability and efficacy of decitabine and vorinostat plus chemotherapy in relapse/refractory acute lymphoblastic leukemia (ALL). Decitabine (15 mg/m(2) iv) and vorinostat (230 mg/m(2) PO div BID) were given days 1-4 followed by vincristine, prednisone, PEG-asparaginase, and doxorubicin. Genome wide methylation profiles were performed in 8 matched patient bone marrow (BM) samples taken at day 0 and day 5 (postdecitabine). The median age was 16 (range, 3-54) years. All patients had a prior BM relapse, with five relapsing after allogeneic transplant. The most common nonhematological toxicities possibly related to decitabine or vorinostat were infection with neutropenia (grade 3; n = 4) and fever/neutropenia (grade 3, n = 4; grade 4, n = 1). Of the 13 eligible patients, four achieved complete remission without platelet recovery (CRp), two partial response (PR), one stable disease (SD), one progressive disease (PD), two deaths on study and three patients who did not have end of therapy disease evaluations for an overall response rate of 46.2% (CRp + PR). Following decitabine, significant genome-wide hypo-methylation was observed. Comparison of clinical responders with nonresponders identified methylation profiles of clinical and biological relevance. Decitabine and vorinostat followed by re-Induction chemotherapy was tolerable and demonstrated clinical benefit in relapsed patients with ALL. Methylation differences were identified between responders and nonresponders indicating interpatient variation, which could impact clinical outcome. This study was registered at www.clinicaltrials.gov as NCT00882206. © 2014 Wiley Periodicals, Inc.

  9. Clinical significance of determination of serum TRAb levels in patients with relapsing graves' disease

    International Nuclear Information System (INIS)

    Guo Chunlei; Zhou Jiaqiang; Li Wenpeng

    2004-01-01

    Objective: To explore the clinical significance of changes of serum TRAb levels in patients with relapsing Graves' disease. Methods: Serum TRAb (with RRA) and several other thyroid-related hormones (TT 4 , TT 3 , TSH, FT 3 , with CLIA) were determined in the following subjects: 1. 25 cases of relapsing Graves' disease after previous successful treatment; 2. 18 cases of recently diagnosed Graves' disease; 3. 31 cases of successfully treated Graves' disease; 4. 15 cases of simple goiter; 5. 10 cases of nodular goiter; 6. 18 cases of hypothyroidism due to Hashimoto disease. Results: Positive rate of TRAb was 76.00% in patients with relapsing Graves' disease and 77.78% in recently diagnosed Graves' disease cases, both being significantly higher than that in all the other sets of patients studied (P<0.01). Conclusion: Determination of serum TRAb levels was helpful for the diagnosis of relapse in Graves' disease

  10. Concordance between VDU-users' ratings of comfort and perceived exertion with experts' observations of workplace layout and working postures.

    Science.gov (United States)

    Lindegård, A; Karlberg, C; Wigaeus Tornqvist, E; Toomingas, A; Hagberg, M

    2005-05-01

    The aim of the present study was to evaluate the concordance (agreement) between VDU-users' ratings of comfort and ergonomists' observations of workplace layout, and the concordance between VDU-users' ratings of perceived exertion and ergonomists' observations of working postures during VDU-work. The study population consisted of 853 symptom free subjects. Data on perceived comfort in different dimensions and data regarding perceived exertion in different body locations were collected by means of a questionnaire. Data concerning workplace layout and working postures were collected with an observation protocol, by an ergonomist. Concordance between ratings of comfort and observations of workplace layout was reasonably good for the chair and the keyboard (0.60, 0.58) and good regarding the screen and the input device (0.72, 0.61). Concordance between ratings of perceived exertion and observations of working postures indicated good agreement (0.63-0.77) for all measured body locations (neck, shoulder, wrist and trunk). In conclusion ratings of comfort and perceived exertion could be used as cost-efficient and user-friendly methods for practitioners to identify high exposure to poor workplace layout and poor working postures.

  11. Rate Constant Change of Photo Reaction of Bacteriorhodopsin Observed in Trimeric Molecular System.

    Science.gov (United States)

    Tsujiuchi, Yutaka; Masumoto, Hiroshi; Goto, Takashi

    2016-04-01

    To elucidate the time evolution of photo reaction of bacteriorhodopsin in glycerol mixed purple membrane at around 196 K under irradiation by red light, a kinetic model was constructed. The change of absorption with irradiation at times of 560 nm and 412 nm was analyzed for the purpose of determining reaction rates of photo reaction of bacteriorhodopsin and its product M intermediate. In this study it is shown that reaction rates of conversion from bacteriorhodopsin to the M intermediate can be explained by a set of linear differential equations. This model analysis concludes that bacteriorhodopsin in which constitutes a trimer unit with other two bacteriorhodopsin molecules changes into M intermediates in the 1.73 of reaction rate, in the initial step, and according to the number of M intermediate in a trimer unit, from three to one, the reaction rate of bacteriorhodopsin into M intermediates smaller as 1.73, 0.80, 0.19 which caused by influence of inter-molecular interaction between bacteriorhodopsin.

  12. Occurrence rate of ion upflow and downflow observed by the Poker Flat Incoherent Scatter Radar (PFISR)

    Science.gov (United States)

    Zou, S.; Lu, J.; Varney, R. H.

    2017-12-01

    This study aims to investigate the occurrence rate of ion upflow and downflow events in the auroral ionosphere, using a full 3-year (2011-2013) dataset collected by the Poker Flat Incoherent Scatter Radar (PFISR) at 65.5° magnetic latitude. Ion upflow and downflow events are defined if there are three consecutive data points larger/smaller than 100/-100 m/s in the ion field-aligned velocity altitude profile. Their occurrence rates have been evaluated as a function of magnetic local time (MLT), season, geomagnetic activity, solar wind and interplanetary magnetic field (IMF). We found that the ion upflows are twice more likely to occur on the nightside than the dayside, and have slightly higher occurrence rate near Fall equinox. In contrast, the ion downflow events are more likely to occur in the afternoon sector but also during Fall equinox. In addition, the occurrence rate of ion upflows on the nightside increases when the aurora electrojet index (AE) and planetary K index (Kp) increase, while the downflows measured on the dayside clearly increase as the AE and Kp increase. In general, the occurrence rate of ion upflows increases with enhanced solar wind and IMF drivers. This correlation is particularly strong between the upflows on the nightside and the solar wind dynamic pressure and IMF Bz. The lack of correlation of upflows on the dayside with these parameters is due to the location of PFISR, which is usually equatorward of the dayside auroral zone and within the nightside auroral zone under disturbed conditions. The occurrence rate of downflow at all MLTs does not show strong dependence on the solar wind and IMF conditions. However, it occurs much more frequently on the dayside when the IMF By is strongly positive, i.e., >10 nT and the IMF Bz is strongly negative, i.e., < -10 nT. We suggest that the increased occurrence rate of downflows on the dayside is associated with dayside storm-enhanced density and the plume.

  13. [Central nervous system relapse in diffuse large B cell lymphoma: Risk factors].

    Science.gov (United States)

    Sancho, Juan-Manuel; Ribera, Josep-Maria

    2016-01-15

    Central nervous system (CNS) involvement by lymphoma is a complication associated, almost invariably, with a poor prognosis. The knowledge of the risk factors for CNS relapse is important to determine which patients could benefit from prophylaxis. Thus, patients with very aggressive lymphomas (such as lymphoblastic lymphoma or Burkitt's lymphoma) must systematically receive CNS prophylaxis due to a high CNS relapse rate (25-30%), while in patients with indolent lymphoma (such as follicular lymphoma or marginal lymphoma) prophylaxis is unnecessary. However, the question about CNS prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL), the most common type of lymphoma, remains controversial. The information available is extensive, mainly based on retrospective and heterogeneous studies. There seems that immunochemotherapy based on rituximab reduces the CNS relapse rate. On the other hand, patients with increased serum lactate dehydrogenase plus more than one extranodal involvement seem to have a higher risk of CNS relapse, but a prophylaxis strategy based only on the presence of these 2 factors does not prevent all CNS relapses. Patients with involvement of testes or breast have high risk of CNS relapse and prophylaxis is mandatory. Finally, CNS prophylaxis could be considered in patients with DLBCL and renal or epidural space involvement, as well as in those cases with MYC rearrangements, although additional studies are necessary. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  14. Analysis of outcomes achieved with squamous cell carcinomas of the anus in a single university hospital over the last two decades: Clinical response rate, relapse and survival of 190 patients.

    Science.gov (United States)

    Gravante, Gianpiero; Stephenson, James Andrew; Elshaer, Mohamed; Osman, Ahmed; Vasanthan, Subramaniam; Mullineux, Joseph H; Gani, Mohamed Akil Dilawar; Sharpe, David; Yeung, Justin; Norwood, Michael; Miller, Andrew; Boyle, Kirsten; Hemingway, David

    2018-02-01

    We reviewed our series of anal squamous cell carcinomas (ASCC) treated over the last two decades. ASCC patients undergoing treatment at the Leicester Royal Infirmary between 1998 and 2016 were selected. Age, gender, pathological tumor characteristics, treatment adopted, the overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) at 5-year follow-up were recorded and calculated. A total of 190 ASCC were reviewed, of these 64.2% (n = 122) received primary radical chemoradiotherapy. Complete response rate was 92.6% (n = 113) and four patients with residual disease underwent a salvage APER. Twenty-eight patients experienced recurrent disease (23.0%) either systemic (n = 8), local (n = 14), or both (n = 6); six had a salvage APER. Complete follow-up data are available for 63.1% patients (77/122). Overall, the locoregional failure rate of primary chemoradiotherapy (residual + recurrent disease) was present in 29 patients (29/122; 23.8%). OS was 41.6% CSS was 69.2% and DFS 60.0% at 5 years follow-up. In our series of ASCC primary chemoradiotherapy had achieved significant initial complete response rates, however, long term-follow ups still present systemic and local recurrences. APR is able to treat 30% of the pelvic recurrences (6/20), the others are either associated with systemic disease or locally inoperable masses. © 2017 Wiley Periodicals, Inc.

  15. Sequential treatment with fluoxetine and relapse--prevention CBT to improve outcomes in pediatric depression.

    Science.gov (United States)

    Kennard, Betsy D; Emslie, Graham J; Mayes, Taryn L; Nakonezny, Paul A; Jones, Jessica M; Foxwell, Aleksandra A; King, Jessica

    2014-10-01

    The authors evaluated a sequential treatment strategy of fluoxetine and relapse-prevention cognitive-behavioral therapy (CBT) to determine effects on remission and relapse in youths with major depressive disorder. Youths 8-17 years of age with major depression were treated openly with fluoxetine for 6 weeks. Those with an adequate response (defined as a reduction of 50% or more on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomly assigned to receive continued medication management alone or continued medication management plus CBT for an additional 6 months. The CBT was modified to address residual symptoms and was supplemented by well-being therapy. Primary outcome measures were time to remission (with remission defined as a CDRS-R score of 28 or less) and rate of relapse (with relapse defined as either a CDRS-R score of 40 or more with a history of 2 weeks of symptom worsening, or clinical deterioration). Of the 200 participants enrolled in acute-phase treatment, 144 were assigned to continuation treatment with medication management alone (N=69) or medication management plus CBT (N=75). During the 30-week continuation treatment period, time to remission did not differ significantly between treatment groups (hazard ratio=1.26, 95% CI=0.87, 1.82). However, the medication management plus CBT group had a significantly lower risk of relapse than the medication management only group (hazard ratio=0.31, 95% CI=0.13, 0.75). The estimated probability of relapse by week 30 was lower with medication management plus CBT than with medication management only (9% compared with 26.5%). Continuation-phase relapse-prevention CBT was effective in reducing the risk of relapse but not in accelerating time to remission in children and adolescents with major depressive disorder.

  16. The use of crowdsourcing for dietary self-monitoring: crowdsourced ratings of food pictures are comparable to ratings by trained observers.

    Science.gov (United States)

    Turner-McGrievy, Gabrielle M; Helander, Elina E; Kaipainen, Kirsikka; Perez-Macias, Jose Maria; Korhonen, Ilkka

    2015-04-01

    Crowdsourcing dietary ratings for food photographs, which uses the input of several users to provide feedback, has potential to assist with dietary self-monitoring. This study assessed how closely crowdsourced ratings of foods and beverages contained in 450 pictures from the Eatery mobile app as rated by peer users (fellow Eatery app users) (n = 5006 peers, mean 18.4 peer ratings/photo) using a simple 'healthiness' scale were related to the ratings of the same pictures by trained observers (raters). In addition, the foods and beverages present in each picture were categorized and the impact on the peer rating scale by food/beverage category was examined. Raters were trained to provide a 'healthiness' score using criteria from the 2010 US Dietary Guidelines. The average of all three raters' scores was highly correlated with the peer healthiness score for all photos (r = 0.88, pcrowdsourcing holds potential to provide basic feedback on overall diet quality to users utilizing a low burden approach. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Saccharomyces boulardii does not prevent relapse of Crohn's disease.

    Science.gov (United States)

    Bourreille, Arnaud; Cadiot, Guillaume; Le Dreau, Gérard; Laharie, David; Beaugerie, Laurent; Dupas, Jean-Louis; Marteau, Philippe; Rampal, Patrick; Moyse, Dominique; Saleh, Ashraf; Le Guern, Marie-Emmanuelle; Galmiche, Jean-Paul

    2013-08-01

    Saccharomyces boulardii is a probiotic yeast that has been shown to have beneficial effects on the intestinal epithelial barrier and digestive immune system. There is preliminary evidence that S boulardii could be used to treat patients with Crohn's disease (CD). We performed a randomized, placebo-controlled trial to evaluate the effects of S boulardii in patients with CD who underwent remission during therapy with steroids or aminosalicylates. We performed a prospective study of 165 patients who achieved remission after treatment with steroids or salicylates; they were randomly assigned to groups given S boulardii (1 g/day) or placebo for 52 weeks. The primary end point was the percentage of patients in remission at week 52. Time to relapse, Crohn's disease activity index scores, and changes in parameters of inflammation were secondary end points. CD relapsed in 80 patients, 38 in the S boulardii group (47.5%) and 42 in the placebo group (53.2%, a nonsignificant difference). The median time to relapse did not differ significantly between patients given S boulardii (40.7 weeks) vs placebo (39.0 weeks). There were no significant differences between groups in mean Crohn's disease activity index scores or erythrocyte sedimentation rates or in median levels of C-reactive protein. In a post hoc analysis, nonsmokers given S boulardii were less likely to experience a relapse of CD than nonsmokers given placebo, but this finding requires confirmation. Although the probiotic yeast S boulardii is safe and well tolerated, it does not appear to have any beneficial effects for patients with CD in remission after steroid or salicylate therapies. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  18. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

    Science.gov (United States)

    Loy, Bryan A.; Shkedy, Clive I.; Powell, Adam C.; Happe, Laura E.; Royalty, Julie A.; Miao, Michael T.; Smith, Gary L.; Long, James W.; Gupta, Amit K.

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, ppayment model and assess implications in other populations. PMID:26870963

  19. Observation of advanced particle removal rates in pump limiter simulation experiments

    International Nuclear Information System (INIS)

    Goebel, D.M.; Conn, R.W.

    1984-05-01

    The performance of particle removal schemes for density and impurity control in tokamaks and mirror machines depends strongly on the plasma parameters and local recycling near the plasma neutralizier plates and gas pumping ducts. The relationship between plasma density, electron temperature, ion energy and gas flow and particle removal rate through a pumping duct located near a plasma neutralizer plate has been experimentally investigated in the steady state plasma device PISCES. Results indicate that initially the particle removal by pumps at the end of the duct is proportional to the plasma flux to the plate. A nonlinear increase in the pumping rate occurs when the ionization mean free path for neutrals from the plate becomes less than the plasma radius. The transition from a transparent to an opaque plasma due to local ionization of the neutrals produced at the neutralizer plate greatly enhances the particle removal rate by recycling of the neutral gas as it flows away from the neutralizer plate or out of the pumping ducts. Parameters were varied to determine the importance of ballistic scattering of higher energy ions from the plate, but no effects were found in these experiments

  20. Vitamin D supplementation reduces relapse rate in relapsing-remitting multiple sclerosis patients treated with natalizumab

    DEFF Research Database (Denmark)

    Laursen, Julie Hejgaard; Søndergaard, Helle Bach; Sørensen, Per Soelberg

    2016-01-01

    Background Vitamin D insufficiency is common among multiple sclerosis patients, and hypovitaminosis D has been associated with multiple sclerosis (MS) risk and disease activity.  Objective To investigate how recommendations on vitamin D3 supplements affect 25-hydroxyvitamin D (25(OH)D) levels in ...

  1. Observation of motorcycle helmet use rates in Michigan after partial repeal of the universal motorcycle helmet law.

    Science.gov (United States)

    Buckley, Lisa; Bingham, C Raymond; Flannagan, Carol A; Carter, Patrick M; Almani, Farideh; Cicchino, Jessica B

    2016-10-01

    Motorcycle crashes result in a significant health burden, including many fatal injuries and serious non-fatal head injuries. Helmets are highly effective in preventing such trauma, and jurisdictions that require helmet use of all motorcyclists have higher rates of helmet use and lower rates of head injuries among motorcyclists. The current study examines helmet use and characteristics of helmeted operators and their riding conditions in Michigan, following a weakening of the state's universal motorcycle helmet use law in April 2012. Data on police-reported crashes occurring during 2012-14 and from a stratified roadside observational survey undertaken in Southeast Michigan during May-September 2014 were used to estimate statewide helmet use rates. Observed helmet use was more common among operators of sports motorcycles, on freeways, and in the morning, and least common among operators of cruisers, on minor arterials, and in the afternoon. The rate of helmet use across the state was estimated at 75%, adjusted for roadway type, motorcycle class, and time of day. Similarly, the helmet use rate found from examination of crash records was 73%. In the observation survey, 47% of operators wore jackets, 94% wore long pants, 54% wore boots, and 80% wore gloves. Protective clothing of jackets and gloves was most often worn by sport motorcycle operators and long pants and boots most often by riders of touring motorcycles. Findings highlight the much lower rate of helmet use in Michigan compared with states that have a universal helmet use law, although the rate is higher than observed in many states with partial helmet laws. Targeted interventions aimed at specific groups of motorcyclists and situations where helmet use rates are particularly low should be considered to increase helmet use. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Validity of observer ratings of the five-factor model of personality traits: a meta-analysis.

    Science.gov (United States)

    Oh, In-Sue; Wang, Gang; Mount, Michael K

    2011-07-01

    Conclusions reached in previous research about the magnitude and nature of personality-performance linkages have been based almost exclusively on self-report measures of personality. The purpose of this study is to address this void in the literature by conducting a meta-analysis of the relationship between observer ratings of the five-factor model (FFM) personality traits and overall job performance. Our results show that the operational validities of FFM traits based on observer ratings are higher than those based on self-report ratings. In addition, the results show that when based on observer ratings, all FFM traits are significant predictors of overall performance. Further, observer ratings of FFM traits show meaningful incremental validity over self-reports of corresponding FFM traits in predicting overall performance, but the reverse is not true. We conclude that the validity of FFM traits in predicting overall performance is higher than previously believed, and our results underscore the importance of disentangling the validity of personality traits from the method of measurement of the traits.

  3. The brief negative symptom scale: validation of the German translation and convergent validity with self-rated anhedonia and observer-rated apathy.

    Science.gov (United States)

    Bischof, Martin; Obermann, Caitriona; Hartmann, Matthias N; Hager, Oliver M; Kirschner, Matthias; Kluge, Agne; Strauss, Gregory P; Kaiser, Stefan

    2016-11-22

    Negative symptoms are considered core symptoms of schizophrenia. The Brief Negative Symptom Scale (BNSS) was developed to measure this symptomatic dimension according to a current consensus definition. The present study examined the psychometric properties of the German version of the BNSS. To expand former findings on convergent validity, we employed the Temporal Experience Pleasure Scale (TEPS), a hedonic self-report that distinguishes between consummatory and anticipatory pleasure. Additionally, we addressed convergent validity with observer-rated assessment of apathy with the Apathy Evaluation Scale (AES), which was completed by the patient's primary nurse. Data were collected from 75 in- and outpatients from the Psychiatric Hospital, University Zurich diagnosed with either schizophrenia or schizoaffective disorder. We assessed convergent and discriminant validity, internal consistency and inter-rater reliability. We largely replicated the findings of the original version showing good psychometric properties of the BNSS. In addition, the primary nurses evaluation correlated moderately with interview-based clinician rating. BNSS anhedonia items showed good convergent validity with the TEPS. Overall, the German BNSS shows good psychometric properties comparable to the original English version. Convergent validity extends beyond interview-based assessments of negative symptoms to self-rated anhedonia and observer-rated apathy.

  4. The modified Puestow procedure for chronic relapsing pancreatitis in children.

    Science.gov (United States)

    Crombleholme, T M; deLorimier, A A; Way, L W; Adzick, N S; Longaker, M T; Harrison, M R

    1990-07-01

    Chronic relapsing pancreatitis in children is an unusual condition that often goes undiagnosed and untreated for years. In light of recent reports in adults that endocrine and exocrine function may be preserved by early pancreaticojejunostomy, we reviewed our experience with this procedure (one Duval, 10 Puestows) in 10 children between 1969 and 1989. The underlying etiology was familial pancreatitis in four patients, one case of unknown etiology, congenital ductal anomalies in four (one pancreas divisum, one annular pancreas, one choledochal cyst, and one ductal stenosis), and posttraumatic in one. All 10 had intractable recurrent abdominal pain. Preoperatively, only three patients evidenced exocrine insufficiency and none had endocrine insufficiency. There was complete resolution of pain in eight patients and improvement in two during a mean observation period of 4 years (range, 7 months to 19.75 years). Exocrine insufficiency resolved in two patients but has persisted in the third patient now on Viokase. Endocrine insufficiency has developed during follow-up in one patient. Pancreaticojejunostomy provides excellent relief of recurrent pain in chronic relapsing pancreatitis in children. Endoscopic retrograde cholangiopancreatography (ERCP) is indicated when the diagnosis of chronic relapsing pancreatitis is suspected to define the ductal anatomy. Pancreaticojejunostomy may prevent the progression of exocrine and endocrine insufficiency if performed early in the course of the disease.

  5. Relapsing-Remitting MS (RRMS)

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    Full Text Available ... About the Society Vision Careers Leadership Cultural Values Financials News Press Room MS Prevalence Charitable Ratings Corporate Support Helpful Links Donate Society Store MSConnection Blog ...

  6. Disagreements in meta-analyses using outcomes measured on continuous or rating scales: observer agreement study

    DEFF Research Database (Denmark)

    Tendal, Britta; Higgins, Julian P T; Jüni, Peter

    2009-01-01

    difference (SMD), the protocols for the reviews and the trial reports (n=45) were retrieved. DATA EXTRACTION: Five experienced methodologists and five PhD students independently extracted data from the trial reports for calculation of the first SMD result in each review. The observers did not have access...... to the reviews but to the protocols, where the relevant outcome was highlighted. The agreement was analysed at both trial and meta-analysis level, pairing the observers in all possible ways (45 pairs, yielding 2025 pairs of trials and 450 pairs of meta-analyses). Agreement was defined as SMDs that differed less...... than 0.1 in their point estimates or confidence intervals. RESULTS: The agreement was 53% at trial level and 31% at meta-analysis level. Including all pairs, the median disagreement was SMD=0.22 (interquartile range 0.07-0.61). The experts agreed somewhat more than the PhD students at trial level (61...

  7. Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

    Directory of Open Access Journals (Sweden)

    Orchard Jo

    2007-02-01

    Full Text Available Abstract Background Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of £5 for the completion of postal questionnaires. Methods We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of £5 to patients for the completion and return of questionnaires. The first 105 patients did not receive the £5 incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results The response rate following reminders for the historical controls was 78.1% (82 of 105 compared with 88.0% (389 of 442 for those patients who received the £5 payment (diff = 9.9%, 95% CI 2.3% to 19.1%. Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009 with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial – the extra cost per additional respondent was almost £50. Conclusion The direct payment of £5 significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study.

  8. Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

    Science.gov (United States)

    Brealey, Stephen D; Atwell, Christine; Bryan, Stirling; Coulton, Simon; Cox, Helen; Cross, Ben; Fylan, Fiona; Garratt, Andrew; Gilbert, Fiona J; Gillan, Maureen GC; Hendry, Maggie; Hood, Kerenza; Houston, Helen; King, David; Morton, Veronica; Orchard, Jo; Robling, Michael; Russell, Ian T; Torgerson, David; Wadsworth, Valerie; Wilkinson, Clare

    2007-01-01

    Background Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of £5 for the completion of postal questionnaires. Methods We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of £5 to patients for the completion and return of questionnaires. The first 105 patients did not receive the £5 incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results The response rate following reminders for the historical controls was 78.1% (82 of 105) compared with 88.0% (389 of 442) for those patients who received the £5 payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial – the extra cost per additional respondent was almost £50. Conclusion The direct payment of £5 significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study. PMID:17326837

  9. Relapse outcomes, safety, and treatment patterns in patients diagnosed with relapsing-remitting multiple sclerosis and initiated on subcutaneous interferon β-1a or dimethyl fumarate: a real-world study.

    Science.gov (United States)

    Ernst, Frank R; Barr, Peri; Elmor, Riad; Wong, Schiffon L

    2017-12-01

    To estimate real-world treatment patterns, safety, and relapse outcomes of subcutaneous (sc) interferon (IFN) β-1a (Rebif) vs dimethyl fumarate (DMF; Tecfidera), to treat relapsing-remitting multiple sclerosis (RRMS). A US retrospective chart review of 450 randomly selected adults newly diagnosed with RRMS who received sc IFN β-1a (n = 143) or DMF (n = 307) was conducted. Patients were either (a) treatment-naïve, initiating first-line treatment with sc IFN β-1a or DMF, or (b) previously treated, switching to sc IFN β-1a or DMF. Two years' follow-up data were captured. Patient characteristics, persistence, and adverse events between treatment groups were compared using t-tests or Chi-square tests. Kaplan-Meier curves with log-rank tests and Cox proportional hazards models were used to compare time to, and risk of non-persistence. Annualized Relapse Rates (ARR) were calculated using a robust variance Poisson model adjusting for covariates. Propensity scores were used to address possible selection bias. One hundred and twelve patients became non-persistent, most commonly due to an adverse event (n = 37). No difference was observed in time to overall non-persistence between sc IFN β-1a and DMF patients. Among treatment-naïve patients, those receiving DMF had 2.4-times the risk (HR = 2.439, 95% CI = 1.007-5.917, p = .0483) of experiencing a discontinuation than patients receiving sc IFN β-1a. Non-persistent patients receiving DMF had 2.3-times the risk (HR = 2.311, 95% CI = 1.350-3.958, p = .0023) of experiencing an adverse event at a given time point than patients prescribed sc IFN β-1a. No differences in relapse risk or ARR between sc IFN β-1a- and DMF-treated patients were observed. sc IFN β-1a-treated patients had comparable persistence and relapse outcomes, and better safety outcomes vs DMF-treated patients across 2 years.

  10. InSAR observations of low slip rates on the major faults of western Tibet.

    Science.gov (United States)

    Wright, Tim J; Parsons, Barry; England, Philip C; Fielding, Eric J

    2004-07-09

    Two contrasting views of the active deformation of Asia dominate the debate about how continents deform: (i) The deformation is primarily localized on major faults separating crustal blocks or (ii) deformation is distributed throughout the continental lithosphere. In the first model, western Tibet is being extruded eastward between the major faults bounding the region. Surface displacement measurements across the western Tibetan plateau using satellite radar interferometry (InSAR) indicate that slip rates on the Karakoram and Altyn Tagh faults are lower than would be expected for the extrusion model and suggest a significant amount of internal deformation in Tibet.

  11. Dynamic strain and rotation ground motions of the 2011 Tohoku earthquake from dense high-rate GPS observations in Taiwan

    Science.gov (United States)

    Huang, B. S.; Rau, R. J.; Lin, C. J.; Kuo, L. C.

    2017-12-01

    Seismic waves generated by the 2011 Mw 9.0 Tohoku, Japan earthquake were well recorded by continuous GPS in Taiwan. Those GPS were operated in one hertz sampling rate and densely distributed in Taiwan Island. Those continuous GPS observations and the precise point positioning technique provide an opportunity to estimate spatial derivatives from absolute ground motions of this giant teleseismic event. In this study, we process and investigate more than one and half hundred high-rate GPS displacements and its spatial derivatives, thus strain and rotations, to compare to broadband seismic and rotational sensor observations. It is shown that continuous GPS observations are highly consistent with broadband seismic observations during its surface waves across Taiwan Island. Several standard Geodesy and seismic array analysis techniques for spatial gradients have been applied to those continuous GPS time series to determine its dynamic strain and rotation time histories. Results show that those derivate GPS vertical axis ground rotations are consistent to seismic array determined rotations. However, vertical rotation-rate observations from the R1 rotational sensors have low resolutions and could not compared with GPS observations for this special event. For its dese spatial distribution of GPS stations in Taiwan Island, not only wavefield gradient time histories at individual site was obtained but also 2-D spatial ground motion fields were determined in this study also. In this study, we will report the analyzed results of those spatial gradient wavefields of the 2011 Tohoku earthquake across Taiwan Island and discuss its geological implications.

  12. Does observer bias contribute to variations in the rate of retinopathy of prematurity between centres?

    Science.gov (United States)

    Darlow, Brian A; Elder, Mark J; Horwood, L John; Donoghue, Deborah A; Henderson-Smart, David J

    2008-01-01

    We aimed to indirectly assess the contribution from observer bias to between centre variability in the incidence of acute retinopathy of prematurity (ROP). The Australian and New Zealand Neonatal Network (ANZNN) collected data on the highest stage of acute ROP in either eye in 2286 infants born at less than 29 weeks in 1998-1999 and cared for in one of 25 neonatal intensive care units (NICUs). Chi-squared analysis was used to detect differences in the proportion of stages of ROP for each neonatal intensive care unit. These proportions were compared with those reported in two large studies of treatment for ROP. The incidence of acute ROP in the ANZNN cohort was 42% and the ratio of stage 1:2:3 ROP was 1.5:1.9:1. There was considerable variation in both the incidence of acute ROP and the proportions with stage 1:2:3 ROP between centres. A chi-squared test determined that the assignment of stages 1, 2 and 3/4 ROP was not independent of centre (chi(2)(48) = 165.2; P < 0.0001). Treatment of stage 3 ROP varied between 15% and 120%, indicating some eyes were treated at less than stage 3. The data are highly suggestive of observer bias contributing to the observed between centre variation in the incidence of acute ROP. In neonatal intervention studies where acute ROP is an outcome it would seem important to have an accreditation process for examining ophthalmologists, and there are similar arguments for neonatal networks which collect these data.

  13. Strain rates estimated by geodetic observations in the Borborema Province, Brazil

    Science.gov (United States)

    Marotta, Giuliano Sant'Anna; França, George Sand; Monico, João Francisco Galera; Bezerra, Francisco Hilário R.; Fuck, Reinhardt Adolfo

    2015-03-01

    The strain rates for the Borborema Province, located in northeastern Brazil, were estimated in this study. For this purpose, we used GNSS tracking stations with a minimum of two years data. The data were processed using the software GIPSY, version 6.2, provided by the JPL of the California Institute of Technology. The PPP method was used to process the data using the non-fiducial approach. Satellite orbits and clock were supplied by the JPL. Absolute phase center offsets and variations for both the receiver and the satellite antennaes were applied, together with ambiguity resolution; corrections of the first and second order effects of the ionosphere and troposphere models adopting the VMF1 mapping function; 10° elevation mask; FES2004 oceanic load model and terrestrial tide WahrK1 PolTid FreqDepLove OctTid. From a multi annual solution, involving at least 2 years of continuous data, the coordinates and velocities as well as their accuracies were estimated. The strain rates were calculated using the Delaunay triangulation and the Finite Element Method. The results show that the velocity direction is predominantly west and north, with maximum variation of 4.0 ± 1.5 mm/year and 4.1 ± 0.5 mm/year for the x and y components, respectively. The highest strain values of extension and contraction were 0.109552 × 10-6 ± 3.65 × 10-10/year and -0.072838 × 10-6 ± 2.32 × 10-10/year, respectively. In general, the results show that the highest strain and variation of velocity values are located close to the Potiguar Basin, region that concentrates seismic activities of magnitudes of up to 5.2 mb. We conclude that the contraction direction of strain is consistent with the maximum horizontal stress derived from focal mechanism and breakout data. In addition, we conclude that the largest strain rates occur around the Potiguar Basin, an area already recognized as one of the major sites of seismicity in intraplate South America.

  14. Observational study of the relationship between entrainment rate and relative dispersion in deep convective clouds

    Science.gov (United States)

    Guo, Xiaohao; Lu, Chunsong; Zhao, Tianliang; Liu, Yangang; Zhang, Guang Jun; Luo, Shi

    2018-01-01

    This study investigates the influence of entrainment rate (λ) on relative dispersion (ε) of cloud droplet size distributions (CDSD) in the 99 growing precipitating deep convective clouds during TOGA-COARE. The results show that entrainment suppresses ε, which is opposite to the traditional understanding that entrainment-mixing broadens CDSD. To examine how the relationship between ε and λ is affected by droplets with different sizes, CDSDs are divided into three portions with droplet radius processes is developed to illustrate the possible scenarios entailing different relationships between ε and λ. The number concentration of small droplets and the degree of evaporation of small droplets are found to be key factors that shift the sign (i.e., positive or negative) of the ε-λ relationship.

  15. Empirically observed learning rates for concentrating solar power and their responses to regime change

    Science.gov (United States)

    Lilliestam, Johan; Labordena, Mercè; Patt, Anthony; Pfenninger, Stefan

    2017-07-01

    Concentrating solar power (CSP) capacity has expanded slower than other renewable technologies and its costs are still high. Until now, there have been too few CSP projects to derive robust conclusions about its cost development. Here we present an empirical study of the cost development of all operating CSP stations and those under construction, examining the roles of capacity growth, industry continuity, and policy support design. We identify distinct CSP expansion phases, each characterized by different cost pressure in the policy regime and different industry continuity. In 2008-2011, with low cost pressure and following industry discontinuity, costs increased. In the current phase, with high cost pressure and continuous industry development, costs decreased rapidly, with learning rates exceeding 20%. Data for projects under construction suggest that this trend is continuing and accelerating. If support policies and industrial structure are sustained, we see no near-term factors that would hinder further cost decreases.

  16. Relapse Prevention: An Introduction to Marlatt’s Cognitive – Behavior Model

    Directory of Open Access Journals (Sweden)

    Farshad Nemati

    2002-10-01

    Full Text Available High rate of relapse after apparently successful treatment is a common problem facing with most approaches to treatment of drug dependency. This has led to the development of a variety of strategies for relapse prevention. Among these, Marlatt’s cognitive – behavioural model has received a good deal of attention. It is based on two major axes: Identification of warning sings and development of necessary skills for coping with risk situations. In fact, client’s perception relating to their abilities to cope with high - risk situations can lead to lapse. Relapes is a function of client’s reaction to this initial lapes.Since formal training for addiction counsellors typically includes instruction on Marlatt’s relapes taxonomy and intervention strategies have been designed based on his classification systems of high – risk stimuli, it is nececsary for addiction counsellors to become familiar with this system. This paper presents an overview of Marlatts taxonomy of high – risk situations for relapse and his approach to relapse prevention. Special attention is given to definition of relapse, stages of relaps and relapse prevention strategies.

  17. Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients.

    Science.gov (United States)

    Wojnar, Marcin; Ilgen, Mark A; Jakubczyk, Andrzej; Wnorowska, Anna; Klimkiewicz, Anna; Brower, Kirk J

    2008-10-01

    The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined. A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months. Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chi-square=2.37, d.f.=1, p=0.124). However, impulsive suicide attempts strongly predicted relapse (OR=2.81, 95% CI=1.13-6.95, p=0.026) and time to relapse (OR=2.10, 95% CI=1.18-3.74, p=0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity. This study is the first to document the relationship between pre-treatment impulsive suicide attempts and higher likelihood of post-treatment relapse in alcohol-dependent patents. Clinicians should routinely conduct an assessment for previous suicide attempts in patients with alcohol use disorders, and when impulsive suicidality is reported, they should recognize the increased risk for relapse and formulate their patients' treatment plans accordingly with the goals of reducing both alcoholic relapse and suicide rates.

  18. Sludge Settling Rate Observations and Projections at the Savannah River Site - 13238

    Energy Technology Data Exchange (ETDEWEB)

    Gillam, Jeffrey M.; Shah, Hasmukh B.; Keefer, Mark T. [Savannah River Remediation LLC, Aiken SC 29808 (United States)

    2013-07-01

    Since 2004, sludge batches have included a high percentage of stored sludge generated from the H- modified (HM) process. The slow-settling nature of HM sludge means that the settling is often the major part of the washing tank quiescent period between required pump runs to maintain flammability control. Reasonable settling projections are needed to wash soluble salts from sludge in an efficient manner, to determine how much sludge can be washed in a batch within flammability limits, and to provide composition projections for batch qualification work done in parallel with field preparation. Challenges to providing reasonably accurate settling projections include (1) large variations in settling behavior from tank-to-tank, (2) accounting for changing initial concentrations, sludge masses, and combinations of different sludge types, (3) changing the settling behavior upon dissolving some sludge compounds, and (4) sludge preparation schedules that do not allow for much data collection for a particular sludge before washing begins. Scaling from laboratory settling tests has provided inconsistent results. Several techniques have been employed to improve settling projections and therefore the overall batch preparation efficiency. Before any observations can be made on a particular sludge mixture, projections can only be made based on historical experience with similar sludge types. However, scaling techniques can be applied to historical settling models to account for different sludge masses, concentrations, and even combinations of types of sludge. After sludge washing/settling cycles begin, the direct measurement of the sludge height, once generally limited to a single turbidity meter measurement per settle period, is now augmented by examining the temperature profile in the settling tank, to help determine the settled sludge height over time. Recently, a settling model examined at PNNL [1,2,3] has been applied to observed thermocouple and turbidity meter readings to

  19. Relapsing-Remitting MS (RRMS)

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    Full Text Available ... Contact Us Newly Diagnosed If you or somone close to you has recently been diagnosed, access our MS information and resources. Start ... Room MS Prevalence Charitable Ratings Corporate Support Helpful Links ...

  20. Relapsing-Remitting MS (RRMS)

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    Full Text Available ... Senior Leadership Team Founder Sylvia Lawry d Cultural Values d Financials Annual Reports Sources of Support d ... Connection About the Society Vision Careers Leadership Cultural Values Financials News Press Room MS Prevalence Charitable Ratings ...

  1. Relationship between interplanetary parameters and the magnetopause reconnection rate quantified from observations of the expanding polar cap

    Science.gov (United States)

    Milan, S. E.; Gosling, J. S.; Hubert, B.

    2012-03-01

    Many studies have attempted to quantify the coupling of energy from the solar wind into the magnetosphere. In this paper we parameterize the dependence of the magnetopause reconnection rate on interplanetary parameters from the OMNI data set. The reconnection rate is measured as the rate of expansion of the polar cap during periods when the nightside reconnection rate is thought to be low, determined from observations by the Imager for Magnetopause-to-Aurora Global Exploration (IMAGE) Far Ultraviolet (FUV) imager. Our fitting suggests that the reconnection rate is determined by the magnetic flux transport in the solar wind across a channel approximately 4 RE in width, with a small correction dependent on the solar wind speed, and a clock angle dependence. The reconnection rate is not found to be significantly dependent on the solar wind density. Comparison of the modeled reconnection rate with SuperDARN measurements of the cross-polar cap potential provides broad support for the magnitude of the predictions. In the course of the paper we discuss the relationship between the dayside reconnection rate and the cross-polar cap potential.

  2. Head and neck: treatment of primary and relapsed nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Wang, C.C.

    1995-01-01

    Purpose/Objective: Nasopharyngeal carcinoma (NPC) is not a common malignancy of the head and neck in the United States and presents a great challenge to the radiation oncologists in this country. Its management is radiotherapeutic and technically demanding and calls for careful treatment techniques to include the primary and the lymphatic drainage areas to high doses while sparing the neighboring organs such as the spinal cord, eyes, temporal lobes and midrain. This refresher course will review the clinical course, pattern of spread with manifestations of various neurologic syndromes of the disease. The radiotherapeutic management of primary lesion will be discussed in detail including the treatment techniques, placement of the irradiation portals, dose levels, etc. Treatment results as reported in the literature as well as those achieved at the MGH will be presented. Special emphasis will be placed on the routine use of intracavitary implant to boost the primary site and its technical aspects. Relapsed NPC after previous radiation therapy presents a difficult problem in management, but can be re-irradiated with occasional success by observing careful technique and fractionated intracavitary brachytherapy and the local control rates will be briefly covered. Recurrent disease in the neck will be managed by neck dissection. Xerostomia is undesirable and common sequelae following radical radiation therapy for NPC. Efforts are being made to decrease its magnitude by using higher energies of photons, i.e. 10 MV to spare a portion of the parotid glands with some promising results. Because of the unique location of the primary lesion, currently a modified BID program (MBID) is used and its techniques and treatment concept are discussed

  3. Parameterization of ion-induced nucleation rates based on ambient observations

    Directory of Open Access Journals (Sweden)

    T. Nieminen

    2011-04-01

    Full Text Available Atmospheric ions participate in the formation of new atmospheric aerosol particles, yet their exact role in this process has remained unclear. Here we derive a new simple parameterization for ion-induced nucleation or, more precisely, for the formation rate of charged 2-nm particles. The parameterization is semi-empirical in the sense that it is based on comprehensive results of one-year-long atmospheric cluster and particle measurements in the size range ~1–42 nm within the EUCAARI (European Integrated project on Aerosol Cloud Climate and Air Quality interactions project. Data from 12 field sites across Europe measured with different types of air ion and cluster mobility spectrometers were used in our analysis, with more in-depth analysis made using data from four stations with concomitant sulphuric acid measurements. The parameterization is given in two slightly different forms: a more accurate one that requires information on sulfuric acid and nucleating organic vapor concentrations, and a simpler one in which this information is replaced with the global radiation intensity. These new parameterizations are applicable to all large-scale atmospheric models containing size-resolved aerosol microphysics, and a scheme to calculate concentrations of sulphuric acid, condensing organic vapours and cluster ions.

  4. Preventing smoking relapse via Web-based computer-tailored feedback: a randomized controlled trial.

    Science.gov (United States)

    Elfeddali, Iman; Bolman, Catherine; Candel, Math J J M; Wiers, Reinout W; de Vries, Hein

    2012-08-20

    Web-based computer-tailored approaches have the potential to be successful in supporting smoking cessation. However, the potential effects of such approaches for relapse prevention and the value of incorporating action planning strategies to effectively prevent smoking relapse have not been fully explored. The Stay Quit for You (SQ4U) study compared two Web-based computer-tailored smoking relapse prevention programs with different types of planning strategies versus a control group. To assess the efficacy of two Web-based computer-tailored programs in preventing smoking relapse compared with a control group. The action planning (AP) program provided tailored feedback at baseline and invited respondents to do 6 preparatory and coping planning assignments (the first 3 assignments prior to quit date and the final 3 assignments after quit date). The action planning plus (AP+) program was an extended version of the AP program that also provided tailored feedback at 11 time points after the quit attempt. Respondents in the control group only filled out questionnaires. The study also assessed possible dose-response relationships between abstinence and adherence to the programs. The study was a randomized controlled trial with three conditions: the control group, the AP program, and the AP+ program. Respondents were daily smokers (N = 2031), aged 18 to 65 years, who were motivated and willing to quit smoking within 1 month. The primary outcome was self-reported continued abstinence 12 months after baseline. Logistic regression analyses were conducted using three samples: (1) all respondents as randomly assigned, (2) a modified sample that excluded respondents who did not make a quit attempt in conformance with the program protocol, and (3) a minimum dose sample that also excluded respondents who did not adhere to at least one of the intervention elements. Observed case analyses and conservative analyses were conducted. In the observed case analysis of the randomized sample

  5. Prognostic value of comorbidity for auto-SCT eligibility and outcome in relapsed or refractory aggressive non-Hodgkin's lymphoma.

    Science.gov (United States)

    Plattel, W J; Kluin-Nelemans, H C; de Bock, G H; van Imhoff, G W

    2011-06-01

    Salvage reinduction therapy followed by high-dose chemotherapy (HDCT) and auto-SCT is the treatment of choice for fit patients with refractory or relapsed aggressive non-Hodgkin's lymphoma (NHL). We assessed the prognostic value of comorbidity at the time of relapse to predict receipt of auto-SCT and outcome. We analyzed 156 consecutive NHL patients, referred to our center between 1999 and 2007 for salvage reinduction therapy, followed by HDCT and auto-SCT. Comorbidity according to the hematopoietic SCT comorbidity index was scored at relapse and directly before HDCT and auto-SCT. Primary end points were actual receipt of auto-SCT and survival. At relapse, comorbidity scores of 0, 1-2 and ≥3 were found among 64 (41%), 62 (40%) and 30 (19%) patients, respectively. Ultimately, 95 patients received auto-SCT. Higher comorbidity scores at relapse were associated with significantly less chance of receiving auto-SCT and with inferior OS, independently from secondary age-adjusted International Prognostic Index (sAAIPI) scores. For transplanted patients, OS rates at 5 years were 62, 30 and 17% for relapse comorbidity scores of 0, 1-2 and ≥3, respectively. In patients with relapsed NHL, comorbidity at relapse is associated with receipt of auto-SCT and subsequent survival independently from the sAAIPI.

  6. Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia.

    Science.gov (United States)

    Byrd, John C; Furman, Richard R; Coutre, Steven E; Flinn, Ian W; Burger, Jan A; Blum, Kristie A; Grant, Barbara; Sharman, Jeff P; Coleman, Morton; Wierda, William G; Jones, Jeffrey A; Zhao, Weiqiang; Heerema, Nyla A; Johnson, Amy J; Sukbuntherng, Juthamas; Chang, Betty Y; Clow, Fong; Hedrick, Eric; Buggy, Joseph J; James, Danelle F; O'Brien, Susan

    2013-07-04

    The treatment of relapsed chronic lymphocytic leukemia (CLL) has resulted in few durable remissions. Bruton's tyrosine kinase (BTK), an essential component of B-cell-receptor signaling, mediates interactions with the tumor microenvironment and promotes the survival and proliferation of CLL cells. We conducted a phase 1b-2 multicenter study to assess the safety, efficacy, pharmacokinetics, and pharmacodynamics of ibrutinib (PCI-32765), a first-in-class, oral covalent inhibitor of BTK designed for treatment of B-cell cancers, in patients with relapsed or refractory CLL or small lymphocytic lymphoma. A total of 85 patients, the majority of whom were considered to have high-risk disease, received ibrutinib orally once daily; 51 received 420 mg, and 34 received 840 mg. Toxic effects were predominantly grade 1 or 2 and included transient diarrhea, fatigue, and upper respiratory tract infection; thus, patients could receive extended treatment with minimal hematologic toxic effects. The overall response rate was the same in the group that received 420 mg and the group that received 840 mg (71%), and an additional 20% and 15% of patients in the respective groups had a partial response with lymphocytosis. The response was independent of clinical and genomic risk factors present before treatment, including advanced-stage disease, the number of previous therapies, and the 17p13.1 deletion. At 26 months, the estimated progression-free survival rate was 75% and the rate of overall survival was 83%. Ibrutinib was associated with a high frequency of durable remissions in patients with relapsed or refractory CLL and small lymphocytic lymphoma, including patients with high-risk genetic lesions. (Funded by Pharmacyclics and others; ClinicalTrials.gov number, NCT01105247.).

  7. Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

    Directory of Open Access Journals (Sweden)

    Serhan Sevim

    2016-09-01

    Full Text Available Relapse in multiple sclerosis (MS is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the postpartum first 3 months. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed.

  8. PARATHYROID CANCER OCCURRING IN RELAPSING SECONDARY HYPERPARATHYROIDISM

    Directory of Open Access Journals (Sweden)

    I. V. Kotova

    2016-01-01

    Full Text Available We present a clinical case of parathyroid cancer in a patient with relapsing secondary hyperparathyroidism at 4 years after subtotal parathyroidectomy. Its unique character is related to the combination of relapsing secondary hyperparathyroidism, parathyromatosis, ectopic of an adenomatous hyperplastic parathyroid gland into the thyroid gland, and parathyroid cancer. Several most complicated aspects of parathyroid surgery are disclosed, such as the choice of strategy for surgical intervention in secondary hyperparathyroidism, complexity of morphological and cytological diagnostics of this disorder.

  9. Tropical cyclone turbulent mixing as observed by autonomous oceanic profilers with the high repetition rate

    International Nuclear Information System (INIS)

    Baranowski, D B; Malinowski, S P; Flatau, P J

    2011-01-01

    Changes in the ocean mixed layer caused by passage of two consecutive typhoons in the Western Pacific are presented. Ocean profiles were measured by a unique Argo float sampling the upper ocean in high repetition cycle with a period of about one day. It is shown that the typhoon passage coincides with cooling of the mixed layer and variations of its salinity. Independent data from satellite measurements of surface winds were used to set-up an and idealized numerical simulation of mixed layer evolution. Results, compared to Argo profiles, confirm known effect that cooling is a result of increased entrainment from the thermocline due to enhancement of turbulence in the upper ocean by the wind stress. Observed pattern of salinity changes in the mixed layer suggest important role of typhoon precipitation. Fast changes of the mixed layer in course of typhoon passage show that fast profiling (at least once a day) is crucial to study response of the upper ocean to tropical cyclone.

  10. Phase II study of concomitant chemoradiotherapy in bulky refractory or chemoresistant relapsed lymphomas

    International Nuclear Information System (INIS)

    Girinsky, Theodore; Lapusan, Simona; Ribrag, Vincent; Koscielny, Serge; Ferme, Christophe; Carde, Patrice

    2005-01-01

    Purpose: To evaluate the local efficacy of concomitant chemoradiotherapy in patients with mostly refractory lymphoma. Methods and materials: Patients with refractory or chemoresistant-relapsed lymphoma and bulky life-threatening masses were included in this study. A split course of concomitant radiotherapy and chemotherapy (mostly cisplatin and etoposide) was delivered during a 6-week period. Weekly blood tests and a clinical examination using the Radiation Therapy Oncology Group guidelines were performed to assess acute toxicity. The tumor response was evaluated 1-3 months after treatment and at regular follow-up visits. Results: We enrolled 21 patients in the study between January 1998 and April 2003. Of the 21 patients, 60% had disseminated disease with bulky tumor masses and 85% had refractory lymphoma, of which most had been treated with at least two different chemotherapy regimens before concomitant chemoradiotherapy. Seventy-five percent received regimens containing cisplatinum and etoposide. The median radiation dose was 40 Gy (range, 12-62.5 Gy). Grade 3-4 hematologic toxicity and mucositis was observed in 70% and 30% of cases respectively, without any deaths. The overall response and complete remission rate was 70% and 20%, respectively. The 1-year overall survival and local progression-free survival rate was 20.4% and 54%, respectively. Three patients with localized disease were still alive 16, 33, and 48 months after treatment. Conclusion: Concomitant chemoradiotherapy for refractory or chemoresistant-relapsed lymphoma induced high hematologic toxicity, but seemed adequate for controlling local bulky tumor masses. No toxicity-related death was observed

  11. Associations between informant ratings of personality disorder traits, self-reports of personality, and directly observed behavior.

    Science.gov (United States)

    Kaurin, Aleksandra; Sauerberger, Kyle S; Funder, David C

    2018-03-02

    Diagnoses of personality disorders (PD) must rely on judgments of observers-either clinicians or acquaintances-because personality disorders are primarily defined in terms of maladaptive interpersonal behavior. Little is known, however, about how closely acquaintances' judgments of PD traits relate to self-reports of theoretically relevant Big Five traits or directly observed behavioral outcomes in interpersonal situations. The present study examines associations between judgments of the 10 PD traits provided by close acquaintances, self-reports of PD-relevant Big Five personality traits, and observed interpersonal behaviors across three different three-person laboratory interactions (i.e., unstructured chat, cooperative task, competitive game). The sample consisted of 256 undergraduate students (130 females; M age  = 19.83, SD = 1.25). Four unacquainted observers independently rated participants' behaviors from video recordings. In line with previous work, informant reports of PD traits demonstrate strong convergent validity with relevant self-reported Big Five traits (as identified by Lynam & Widiger, 2001). Directly observed behavior is meaningfully associated with acquaintances' judgments and self-reports of PD-relevant traits, and the associations between these judgments and behavior are strongest for traits associated with histrionic and schizoid PD. Vector correlations between behavioral profiles associated with informant and self-reports show that both assessments have similar behavioral correlates. Associations between PD trait ratings and behavior appeared to differ as a function of gender, with males showing more and stronger correlations. Informants' ratings of PD traits are impressively accurate, converging both with self-reports of relevant traits and directly observed interpersonal behavior. Therefore, a comprehensive understanding of PDs and associated traits can be augmented by information from multiple acquaintances who have the

  12. Effect of Radiotherapy Dose and Volume on Relapse in Merkel Cell Cancer of the Skin

    International Nuclear Information System (INIS)

    Foote, Matthew; Harvey, Jennifer; Porceddu, Sandro

    2010-01-01

    Purpose: To assess the effect of radiotherapy (RT) dose and volume on relapse patterns in patients with Stage I-III Merkel cell carcinoma (MCC). Patients and Methods: This was a retrospective analysis of 112 patients diagnosed with MCC between January 2000 and December 2005 and treated with curative-intent RT. Results: Of the 112 evaluable patients, 88% had RT to the site of primary disease for gross (11%) or subclinical (78%) disease. Eighty-nine percent of patients had RT to the regional lymph nodes; in most cases (71%) this was for subclinical disease in the adjuvant or elective setting, whereas 21 patients (19%) were treated with RT to gross nodal disease. With a median follow-up of 3.7 years, the 2-year and 5-year overall survival rates were 72% and 53%, respectively, and the 2-year locoregional control rate was 75%. The in-field relapse rate was 3% for primary disease, and relapse was significantly lower for patients receiving ≥50Gy (hazard ratio [HR] = 0.22; 95% confidence interval [CI], 0.06-0.86). Surgical margins did not affect the local relapse rate. The in-field relapse rate was 11% for RT to the nodes, with dose being significant for nodal gross disease (HR = 0.24; 95% CI, 0.07-0.87). Patients who did not receive elective nodal RT had a much higher rate of nodal relapse compared with those who did (HR = 6.03; 95% CI, 1.34-27.10). Conclusion: This study indicates a dose-response for subclinical and gross MCC. Doses of ≥50Gy for subclinical disease and ≥55Gy for gross disease should be considered. The draining nodal basin should be treated in all patients.

  13. Electromagnetic energy deposition rate in the polar upper thermosphere derived from the EISCAT Svalbard radar and CUTLASS Finland radar observations

    Directory of Open Access Journals (Sweden)

    H. Fujiwara

    2007-11-01

    Full Text Available From simultaneous observations of the European incoherent scatter Svalbard radar (ESR and the Cooperative UK Twin Located Auroral Sounding System (CUTLASS Finland radar on 9 March 1999, we have derived the height distributions of the thermospheric heating rate at the F region height in association with electromagnetic energy inputs into the dayside polar cap/cusp region. The ESR and CUTLASS radar observations provide the ionospheric parameters with fine time-resolutions of a few minutes. Although the geomagnetic activity was rather moderate (Kp=3+~4, the electric field obtained from the ESR data sometimes shows values exceeding 40 mV/m. The estimated passive energy deposition rates are also larger than 150 W/kg in the upper thermosphere over the ESR site during the period of the enhanced electric field. In addition, enhancements of the Pedersen conductivity also contribute to heating the upper thermosphere, while there is only a small contribution for thermospheric heating from the direct particle heating due to soft particle precipitation in the dayside polar cap/cusp region. In the same period, the CUTLASS observations of the ion drift show the signature of poleward moving pulsed ionospheric flows with a recurrence rate of about 10–20 min. The estimated electromagnetic energy deposition rate shows the existence of the strong heat source in the dayside polar cap/cusp region of the upper thermosphere in association with the dayside magnetospheric phenomena of reconnections and flux transfer events.

  14. Electromagnetic energy deposition rate in the polar upper thermosphere derived from the EISCAT Svalbard radar and CUTLASS Finland radar observations

    Directory of Open Access Journals (Sweden)

    H. Fujiwara

    2007-11-01

    Full Text Available From simultaneous observations of the European incoherent scatter Svalbard radar (ESR and the Cooperative UK Twin Located Auroral Sounding System (CUTLASS Finland radar on 9 March 1999, we have derived the height distributions of the thermospheric heating rate at the F region height in association with electromagnetic energy inputs into the dayside polar cap/cusp region. The ESR and CUTLASS radar observations provide the ionospheric parameters with fine time-resolutions of a few minutes. Although the geomagnetic activity was rather moderate (Kp=3+~4, the electric field obtained from the ESR data sometimes shows values exceeding 40 mV/m. The estimated passive energy deposition rates are also larger than 150 W/kg in the upper thermosphere over the ESR site during the period of the enhanced electric field. In addition, enhancements of the Pedersen conductivity also contribute to heating the upper thermosphere, while there is only a small contribution for thermospheric heating from the direct particle heating due to soft particle precipitation in the dayside polar cap/cusp region. In the same period, the CUTLASS observations of the ion drift show the signature of poleward moving pulsed ionospheric flows with a recurrence rate of about 10–20 min. The estimated electromagnetic energy deposition rate shows the existence of the strong heat source in the dayside polar cap/cusp region of the upper thermosphere in association with the dayside magnetospheric phenomena of reconnections and flux transfer events.

  15. Ascertainment of the effect of differential growth rates of mutants on observed mutant frequencies in X-irradiated mammalian cells

    International Nuclear Information System (INIS)

    Knaap, A.G.A.C.; Simons, J.W.I.M.

    1983-01-01

    As it is not known to what extent differential growth rates of induced mutants lead to over- and under-representation of mutants in treated populations and thereby affect the determination of mutant frequencies, the mutation induction in X-irradiated L5178Y mouse lymphoma cells was determined via two methods. The first method involves the standard protocol which may suffer from the effect of differential growth rates, while the second method is based upon the fluctuation test in which the differential growth rates can be actually measured. It appeared that the standard protocol led to a mutant frequency that was similar to the mutant frequency determined in the fluctuation test. Therefore, the standard protocol appears to lead to only a minor under-estimation if any. Substantial heterogeneity in growth rates of induced mutants was observed, but the mutants with a selective advantage appear largely to compensate for the mutants that are lost because of selective disadvantage. It was calculated that the chance for isolating the same mutant twice from a treated population had been increased 2.2-fold because of the observed differential growth rates. (orig./AJ)

  16. Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses

    Directory of Open Access Journals (Sweden)

    Hammarström Lennart

    2011-08-01

    Full Text Available Abstract Background The primary objective of this study was to investigate if extended antibiotic treatment against bacterial vaginosis (BV together with adjuvant lactobacilli treatment could cure BV and, furthermore, to investigate factors that could cause relapse. Methods In all, 63 consecutive women with bacterial vaginosis diagnosed by Amsel criteria were offered a much more aggressive treatment of BV than used in normal clinical practice with repeated antibiotic treatment with clindamycin and metronidazole together with vaginal gelatine capsules containing different strains of lactobacilli both newly characterised and a commercial one (109 freeze-dried bacteria per capsule. Oral clindamycin treatment was also given to the patient's sexual partner. Results The cure rate was 74.6% after 6 months. The patients were then followed as long as possible or until a relapse. The cure rate was 65.1% at 12 months and 55.6% after 24 months. There was no significant difference in cure rate depending on which Lactobacillus strains were given to the women or if the women were colonised by lactobacilli. The most striking factor was a new sex partner during the follow up period where the Odds Ratio of having a relapse was 9.3 (2.8-31.2 if the patients had a new sex partner during the observation period. Conclusions The study shows that aggressive treatment of the patient with antibiotics combined with specific Lactobacillus strain administration and partner treatment can provide long lasting cure. A striking result of our study is that change of partner is strongly associated with relapse of BV. Trial registration ClinicalTrials.gov: NCT01245322

  17. Phase I clinical study of concurrent chemoradiation with hydroxycamptothecine for unresectable or locally relapsed rectal cancer

    International Nuclear Information System (INIS)

    Li Ning; Jin Jing; Li Yexiong

    2012-01-01

    Objective: To determine the maximal tolerated dose and the dose-limiting toxicity of hydroxycamptothecine (HCPT) concurrently combined with three-dimensional conformal radiotherapy (3DCRT) for unresectable or locally relapsed rectal cancer. Methods: Twenty-two patients with rectal cancer were enrolled into phase I study between 2004 -2007. HCPT was intravenously administered concurrently with 3DCRT weekly, dose given from 6, 8, 10 mg/m 2 or twice a week, dose given from 4, 6, 8, 10 mg/m 2 , respectively. Total radiation dose of 50 Gy was delivered to the whole pelvis at a fraction of 2 Gy per day for 5 weeks, with 10 - 16 Gy subsequent boost to tumor area. Dose-limiting toxicities (DLT) were defined as grade 3 or higher non-hematologic toxicity or grade 4 hematologic toxicity. Results: In the twice a week group, DLTs of grade 3 diarrhea were observed in 2 patient treated at dose of 6 mg/m 2 . In the weekly group, DLTs of grade 3 diarrhea and radiation-induced dermatitis were observed in I patient at dose of 8 mg/m 2 , and were not observed in the next 3 patients at the same dose level. However, at dose of 10 mg/m 2 , 2 patients had grade 3 diarrhea or nausea. The 5-year overall survival rate was 23% and the median survival time was 18 months. Conclusions: HCPT given concurrently with 3DCRT is safe and tolerable for patients with unresectable or locally relapsed rectal cancer. Either 8 mg/m 2 weekly or 4 mg/m 2 twice a week can be recommended for further study. The dose-limiting toxicities are grade 3 diarrhea, nausea and radiation-induced dermatitis. (authors)

  18. CHRONIC ALCOHOL NEUROADAPTATION AND STRESS CONTRIBUTE TO SUSCEPTIBILITY FOR ALCOHOL CRAVING AND RELAPSE

    Science.gov (United States)

    BREESE, GEORGE R.; SINHA, RAJITA; HEILIG, MARKUS

    2010-01-01

    Alcoholism is a chronic relapsing disorder. Major characteristics observed in alcoholics during an initial period of alcohol abstinence are altered physiological functions and a negative emotional state. Evidence suggests that a persistent, cumulative adaptation involving a kindling/allostasis-like process occurs during the course of repeated chronic alcohol exposures that is critical for the negative symptoms observed during alcohol withdrawal. Basic studies have provided evidence for specific neurotransmitters within identified brain sites being responsible for the negative emotion induced by the persistent cumulative adaptation following intermittent-alcohol exposures. After an extended period of abstinence, the cumulative alcohol adaptation increases susceptibility to stress- and alcohol cue-induced negative symptoms and alcohol seeking, both of which can facilitate excessive ingestion of alcohol. In the alcoholic, stressful imagery and alcohol cues alter physiological responses, enhance negative emotion, and induce craving. Brain fMRI imaging following stress and alcohol cues has documented neural changes in specific brain regions of alcoholics not observed in social drinkers. Such altered activity in brain of abstinent alcoholics to stress and alcohol cues is consistent with a continuing ethanol adaptation being responsible. Therapies in alcoholics found to block responses to stress and alcohol cues would presumably be potential treatments by which susceptibility for continued alcohol abuse can be reduced. By continuing to define the neurobiological basis of the sustained alcohol adaptation critical for the increased susceptibility of alcoholics to stress and alcohol cues that facilitate craving, a new era is expected to evolve in which the high rate of relapse in alcoholism is minimized. 250 PMID:20951730

  19. The efficacy of natalizumab in patients with relapsing multiple sclerosis: subgroup analyses of AFFIRM and SENTINEL.

    LENUS (Irish Health Repository)

    Hutchinson, Michael

    2012-02-01

    The AFFIRM and SENTINEL studies showed that natalizumab was effective both as monotherapy and in combination with interferon beta (IFNbeta)-1a in patients with relapsing multiple sclerosis (MS). Further analyses of AFFIRM and SENTINEL data were conducted to determine the efficacy of natalizumab in prespecified patient subgroups according to baseline characteristics: relapse history 1 year before randomization (1, 2, > or = 3), Expanded Disability Status Scale score (< or = 3.5, > 3.5), number of T2 lesions (< 9, > or = 9), presence of gadolinium-enhancing (Gd+) lesions (0, > or = 1), age (< 40, > or = 40) and gender (male, female). A post hoc analysis was conducted to determine the efficacy of natalizumab in patients with highly active disease (i. e., > or = 2 relapses in the year before study entry and > or = 1 Gd+ lesion at study entry). In both AFFIRM and SENTINEL studies natalizumab reduced the annualized relapse rates across all subgroups (except the small subgroups with < 9 baseline T2 lesions) over 2 years. In AFFIRM, natalizumab significantly reduced the risk of sustained disability progression in most subgroups. In SENTINEL, natalizumab significantly reduced the risk of sustained disability progression in the following subgroups: > or = 9 T2 lesions at baseline, > or = 1 Gd+ lesions at baseline, female patients and patients < 40 years of age. Natalizumab reduced the risk of disability progression by 64 % and relapse rate by 81 % in treatment- naive patients with highly active disease and by 58 % and 76 %, respectively, in patients with highly active disease despite IFNbeta-1a treatment. These results indicate that natalizumab is effective in reducing disability progression and relapses in patients with relapsing MS, particularly in patients with highly active disease.

  20. Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

    Directory of Open Access Journals (Sweden)

    McEwen Andy

    2010-07-01

    Full Text Available Abstract Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate. Of these, 58.3% (n = 56 ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%, group (73%, and individual (54%. Just under half (48%, n = 27 offered nicotine replacement therapy (NRT, 21.4% (n = 12 bupropion; 19.6% (n = 11 varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22 believed that the government focus on four-week quit rates, and 42.9% (14 services believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

  1. Life-event stress induced by the Great East Japan Earthquake was associated with relapse in ulcerative colitis but not Crohn's disease: a retrospective cohort study

    Science.gov (United States)

    Shiga, Hisashi; Miyazawa, Teruko; Kinouchi, Yoshitaka; Takahashi, Seiichi; Tominaga, Gen; Takahashi, Hiroki; Takagi, Sho; Obana, Nobuya; Kikuchi, Tatsuya; Oomori, Shinya; Nomura, Eiki; Shiraki, Manabu; Sato, Yuichirou; Takahashi, Shuichiro; Umemura, Ken; Yokoyama, Hiroshi; Endo, Katsuya; Kakuta, Yoichi; Aizawa, Hiroki; Matsuura, Masaki; Kimura, Tomoya; Kuroha, Masatake; Shimosegawa, Tooru

    2013-01-01

    Objective Stress is thought to be one of the triggers of relapses in patients with inflammatory bowel disease (IBD). We examined the rate of relapse in IBD patients before and after the Great East Japan Earthquake. Design A retrospective cohort study. Settings 13 hospitals in Japan. Participants 546 ulcerative colitis (UC) and 357 Crohn's disease (CD) patients who received outpatient and inpatient care at 13 hospitals located in the area that were seriously damaged by the earthquake. Data on patient's clinical characteristics, disease activity and deleterious effects of the earthquake were obtained from questionnaires and hospital records. Primary outcome We evaluated the relapse rate (from inactive to active) across two consecutive months before and two consecutive months after the earthquake. In this study, we defined ‘active’ as conditions with a partial Mayo score=2 or more (UC) or a Harvey-Bradshaw index=6 or more (CD). Results Among the UC patients, disease was active in 167 patients and inactive in 379 patients before the earthquake. After the earthquake, the activity scores increased significantly (p<0.0001). A total of 86 patients relapsed (relapse rate=15.8%). The relapse rate was about twice that of the corresponding period in the previous year. Among the CD patients, 86 patients had active disease and 271 had inactive disease before the earthquake. After the earthquake, the activity indices changed little. A total of 25 patients experienced a relapse (relapse rate=7%). The relapse rate did not differ from that of the corresponding period in the previous year. Multivariate analyses revealed that UC, changes in dietary oral intake and anxiety about family finances were associated with the relapse. Conclusions Life-event stress induced by the Great East Japan Earthquake was associated with relapse in UC but not CD. PMID:23396562

  2. Relapse to cocaine seeking in an invertebrate.

    Science.gov (United States)

    Amaning-Kwarteng, Akua O; Asif-Malik, Aman; Pei, Yue; Canales, Juan J

    2017-06-01

    Addiction is characterised by cycles of compulsive drug taking, periods of abstinence and episodes of relapse. The extinction/reinstatement paradigm has been extensively used in rodents to model human relapse and explore underlying mechanisms and therapeutics. However, relapse to drug seeking behaviour has not been previously demonstrated in invertebrates. Here, we used a cocaine conditioned place preference (CPP) paradigm in the flatworm, planarian, followed by extinction and reinstatement of drug seeking. Once baseline preference was established for one of two distinctly textured environments (i.e. compartments with a coarse or smooth surface), planarian received pairings of cocaine (5μM) in the non-preferred, and vehicle in the most preferred, environment, and were tested for conditioning thereafter. Cocaine produced robust CPP, measured as a significant increase in the time spent in the cocaine-paired compartment. Subsequently, planarian underwent extinction training, reverting back to their original preference within three sessions. Brief exposure to cocaine (5μM) or methamphetamine (5μM) reinstated cocaine-seeking behaviour. By contrast, the high affinity dopamine transporter inhibitor, (N-(n-butyl)-3α-[bis (4-fluorophenyl) methoxy]-tropane) (JHW007), which in rodents exhibits a neurochemical and behavioural profile distinct from cocaine, was ineffective. The present findings demonstrate for the first time reinstatement of extinguished cocaine seeking in an invertebrate model and suggest that the long-term adaptations underlying drug conditioning and relapse are highly conserved through evolution. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Relapsing/remitting type 1 diabetes

    NARCIS (Netherlands)

    van Megen, Kayleigh M.; Spindler, Matthew P.; Keij, Fleur M.; Bosch, Ineke; Sprangers, Fleur; van Royen-Kerkhof, Annet; Nikolic, Tatjana; Roep, Bart O.

    2017-01-01

    Aims/hypothesis: Type 1 diabetes is believed to be an autoimmune disease associated with irreversible loss of insulin secretory function that follows a chronic progressive course. However, it has been speculated that relapsing/remitting disease progression may occur in type 1 diabetes. Methods: We

  4. OBSERVER RATING VERSUS THREE-DIMENSIONAL MOTION ANALYSIS OF LOWER EXTREMITY KINEMATICS DURING FUNCTIONAL SCREENING TESTS: A SYSTEMATIC REVIEW.

    Science.gov (United States)

    Maclachlan, Liam; White, Steven G; Reid, Duncan

    2015-08-01

    Functional assessments are conducted in both clinical and athletic settings in an attempt to identify those individuals who exhibit movement patterns that may increase their risk of non-contact injury. In place of highly sophisticated three-dimensional motion analysis, functional testing can be completed through observation. To evaluate the validity of movement observation assessments by summarizing the results of articles comparing human observation in real-time or video play-back and three-dimensional motion analysis of lower extremity kinematics during functional screening tests. Systematic review. A computerized systematic search was conducted through Medline, SPORTSdiscus, Scopus, Cinhal, and Cochrane health databases between February and April of 2014. Validity studies comparing human observation (real-time or video play-back) to three-dimensional motion analysis of functional tasks were selected. Only studies comprising uninjured, healthy subjects conducting lower extremity functional assessments were appropriate for review. Eligible observers were certified health practitioners or qualified members of sports and athletic training teams that conduct athlete screening. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to appraise the literature. Results are presented in terms of functional tasks. Six studies met the inclusion criteria. Across these studies, two-legged squats, single-leg squats, drop-jumps, and running and cutting manoeuvres were the functional tasks analysed. When compared to three-dimensional motion analysis, observer ratings of lower extremity kinematics, such as knee position in relation to the foot, demonstrated mixed results. Single-leg squats achieved target sensitivity values (≥ 80%) but not specificity values (≥ 50%>%). Drop-jump task agreement ranged from poor ( 80%). Two-legged squats achieved 88% sensitivity and 85% specificity. Mean underestimations as large as 198 (peak knee flexion) were found in

  5. Ultrasound-detected bone erosion is a relapse risk factor after discontinuation of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis whose ultrasound power Doppler synovitis activity and clinical disease activity are well controlled.

    Science.gov (United States)

    Kawashiri, Shin-Ya; Fujikawa, Keita; Nishino, Ayako; Okada, Akitomo; Aramaki, Toshiyuki; Shimizu, Toshimasa; Umeda, Masataka; Fukui, Shoichi; Suzuki, Takahisa; Koga, Tomohiro; Iwamoto, Naoki; Ichinose, Kunihiro; Tamai, Mami; Mizokami, Akinari; Nakamura, Hideki; Origuchi, Tomoki; Ueki, Yukitaka; Aoyagi, Kiyoshi; Maeda, Takahiro; Kawakami, Atsushi

    2017-05-25

    In the present study, we explored the risk factors for relapse after discontinuation of biologic disease-modifying antirheumatic drug (bDMARD) therapy in patients with rheumatoid arthritis (RA) whose ultrasound power Doppler (PD) synovitis activity and clinical disease activity were well controlled. In this observational study in clinical practice, the inclusion criteria were based on ultrasound disease activity and clinical disease activity, set as low or remission (Disease Activity Score in 28 joints based on erythrocyte sedimentation rate Ultrasound was performed in 22 joints of bilateral hands at discontinuation for evaluating synovitis severity and presence of bone erosion. Patients with a maximum PD score ≤1 in each joint were enrolled. Forty patients with RA were consecutively recruited (November 2010-March 2015) and discontinued bDMARD therapy. Variables at the initiation and discontinuation of bDMARD therapy that were predictive of relapse during the 12 months after discontinuation were assessed. The median patient age was 54.5 years, and the median disease duration was 3.5 years. Nineteen (47.5%) patients relapsed during the 12 months after the discontinuation of bDMARD therapy. Logistic regression analysis revealed that only the presence of bone erosion detected by ultrasound at discontinuation was predictive of relapse (OR 8.35, 95% CI 1.78-53.2, p = 0.006). No clinical characteristics or serologic biomarkers were significantly different between the relapse and nonrelapse patients. The ultrasound synovitis scores did not differ significantly between the groups. Our findings are the first evidence that ultrasound bone erosion may be a relapse risk factor after the discontinuation of bDMARD therapy in patients with RA whose PD synovitis activity and clinical disease activity are well controlled.

  6. Potential risk factors associated with risk for drop-out and relapse during and following withdrawal of opioid prescription medication.

    Science.gov (United States)

    Heiwe, Susanne; Lönnquist, Ingeborg; Källmén, Håkan

    2011-10-01

    Withdrawal of opioid medication in patients with chronic pain has a drop-out and relapse problem. To evaluate if depressive symptoms, anxiety and pain intensity are potential risk factors for drop-out or relapse during the withdrawal process. Further, to assess internal consistency of scales for assessment of these potential risk factors. Twenty-nine patients were included. After 2 years 28 of these were followed-up. Those with depressive symptoms at baseline had a significant risk for drop-out from the withdrawal program (odds ratio 1.37) and relapse into use of opioids at follow-up (odds ratio 1.44). Drop-outs rated depressive symptoms significantly higher before detoxification. Those who relapsed rated significantly higher for pain intensity, depressive symptoms and abstinence prior to withdrawal. All scales had high reliability. To avoid drop-out and relapse clinical practice need to screen for depressive symptoms, pain intensity, and abstinence. This article presents significant reliability of scales useful within dependency centers. They can be used to identify these risk factors for drop-out and relapse, respectively, when initiating the withdrawal process. Taking these risk factors into consideration could improve the outcome of the withdrawal process by preventing drop-out and relapse. Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  7. Prognosis of type 1 autoimmune pancreatitis after corticosteroid therapy-induced remission in terms of relapse and diabetes mellitus.

    Directory of Open Access Journals (Sweden)

    Masaki Miyazawa

    Full Text Available Relapse and diabetes mellitus (DM are major problems for the prognosis of autoimmune pancreatitis (AIP. We examined the prognosis of type 1 AIP after corticosteroid therapy (CST-induced remission in terms of relapse and DM.The study enrolled 82 patients diagnosed with type 1 AIP who achieved remission with CST. We retrospectively evaluated the relapse rate in terms of the administration period of CST, clinical factors associated with relapse, and the temporal change in glucose tolerance.During follow-up, 32 patients (39.0% experienced relapse. There was no significant clinical factor that could predict relapse before beginning CST. AIP patients who ceased CST within 2 or 3 years experienced significantly earlier relapse than those who had the continuance of CST (p = 0.050 or p = 0.020. Of the 37 DM patients, 15 patients (40.5% had pre-existing DM, 17 (45.9% showed new-onset DM, and 5 (13.5% developed CST-induced DM. Patients with new-onset DM were significantly more likely to show improvement (p = 0.008 than those with pre-existing DM.It was difficult to predict relapse of AIP based on clinical parameters before beginning CST. Relapse was likely to occur within 3 years after the beginning of CST and maintenance of CST for at least 3 years reduced the risk of relapse. The early initiation of CST for AIP with impaired glucose tolerance is desirable because pre-existing DM is refractory to CST.

  8. Cost-effectiveness of natalizumab vs fingolimod for the treatment of relapsing-remitting multiple sclerosis: analyses in Sweden.

    Science.gov (United States)

    O'Day, Ken; Meyer, Kellie; Stafkey-Mailey, Dana; Watson, Crystal

    2015-04-01

    To assess the cost-effectiveness of natalizumab vs fingolimod over 2 years in relapsing-remitting multiple sclerosis (RRMS) patients and patients with rapidly evolving severe disease in Sweden. A decision analytic model was developed to estimate the incremental cost per relapse avoided of natalizumab and fingolimod from the perspective of the Swedish healthcare system. Modeled 2-year costs in Swedish kronor of treating RRMS patients included drug acquisition costs, administration and monitoring costs, and costs of treating MS relapses. Effectiveness was measured in terms of MS relapses avoided using data from the AFFIRM and FREEDOMS trials for all patients with RRMS and from post-hoc sub-group analyses for patients with rapidly evolving severe disease. Probabilistic sensitivity analyses were conducted to assess uncertainty. The analysis showed that, in all patients with MS, treatment with fingolimod costs less (440,463 Kr vs 444,324 Kr), but treatment with natalizumab results in more relapses avoided (0.74 vs 0.59), resulting in an incremental cost-effectiveness ratio (ICER) of 25,448 Kr per relapse avoided. In patients with rapidly evolving severe disease, natalizumab dominated fingolimod. Results of the sensitivity analysis demonstrate the robustness of the model results. At a willingness-to-pay (WTP) threshold of 500,000 Kr per relapse avoided, natalizumab is cost-effective in >80% of simulations in both patient populations. Limitations include absence of data from direct head-to-head studies comparing natalizumab and fingolimod, use of relapse rate reduction rather than sustained disability progression as the primary model outcome, assumption of 100% adherence to MS treatment, and exclusion of adverse event costs in the model. Natalizumab remains a cost-effective treatment option for patients with MS in Sweden. In the RRMS patient population, the incremental cost per relapse avoided is well below a 500,000 Kr WTP threshold per relapse avoided. In the rapidly

  9. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising......At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well...... as pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline...

  10. Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study.

    Science.gov (United States)

    Kroll, Ryan R; Boyd, J Gordon; Maslove, David M

    2016-09-20

    As the sensing capabilities of wearable devices improve, there is increasing interest in their application in medical settings. Capabilities such as heart rate monitoring may be useful in hospitalized patients as a means of enhancing routine monitoring or as part of an early warning system to detect clinical deterioration. To evaluate the accuracy of heart rate monitoring by a personal fitness tracker (PFT) among hospital inpatients. We conducted a prospective observational study of 50 stable patients in the intensive care unit who each completed 24 hours of heart rate monitoring using a wrist-worn PFT. Accuracy of heart rate recordings was compared with gold standard measurements derived from continuous electrocardiographic (cECG) monitoring. The accuracy of heart rates measured by pulse oximetry (Spo2.R) was also measured as a positive control. On a per-patient basis, PFT-derived heart rate values were slightly lower than those derived from cECG monitoring (average bias of -1.14 beats per minute [bpm], with limits of agreement of 24 bpm). By comparison, Spo2.R recordings produced more accurate values (average bias of +0.15 bpm, limits of agreement of 13 bpm, P<.001 as compared with PFT). Personal fitness tracker device performance was significantly better in patients in sinus rhythm than in those who were not (average bias -0.99 bpm vs -5.02 bpm, P=.02). Personal fitness tracker-derived heart rates were slightly lower than those derived from cECG monitoring in real-world testing and not as accurate as Spo2.R-derived heart rates. Performance was worse among patients who were not in sinus rhythm. Further clinical evaluation is indicated to see if PFTs can augment early warning systems in hospitals. ClinicalTrials.gov NCT02527408; https://clinicaltrials.gov/ct2/show/NCT02527408 (Archived by WebCite at  http://www.webcitation.org/6kOFez3on).

  11. Long lasting second remission and quality of life following brachytherapy of relapsing cancer in preirradiated regions. Experience in 108 patients

    International Nuclear Information System (INIS)

    Schmidt, B.F.; Kwiatkowski, J.

    1996-01-01

    Introduction: In patients with unresectable relapsing malignant tumor following external beam radiotherapy retreatment by brachytherapy gives a second chance of good palliation and even cure. But regardless the great number of tumor relapse reirradiation is given only to few patients due to the impending risks of severe radiation sequelae. Material and method: From January 1st 1992 to December 31st 1995 overall 108 patients with histologically proven local tumor relapses in preirradiated regions were reirradiated by interstitial or intraluminal brachytherapy (192-Iridium sources). The preirradiation dose was 40 to 70 Gray (Gy) in conventional fractionation. The brachytherapy retreatment dose was 30 to 40 Gy at the individually shaped reference isodose shell. In high dose-rate technique (about two third of all patients) mostly single doses of 5 Gy were applied once or twice a week. If low dose-rate techniques were used, a maximum dose of 60 Gy was applied. In some cases a second course of external beam radiotherapy was added. The sites of reirradiation were: ear-nose-throat-yaw areas 76, large airways 24, soft tissues 7, scalp 1. Results: In (23(108)) patients (21 %) complete or partial remission could be achieved lasting at least one year. In (8(23)) patients (overall 7,4 %) the second remission lasted longer than two years. The quality of life in the long time survivors was felt to be good or at least acceptable. Local necroses, not life threatening, occurred in about 20 %. No fatal complication was to be observed. Altogether in about 85 % the reirradiation resulted in effective palliation and was well tolerated. Discussion and conclusion: Retreatment by brachytherapy yields valuable palliation to the vast majority of patients and gives a second chance of long time good quality survival to about 10 % of all retreated patients. Careful selection of patients and experienced realisation of brachytherapy is essential to avoid severe complications

  12. Predictors of Time to Relapse/Recurrence after Electroconvulsive Therapy in Patients with Major Depressive Disorder: A Population-Based Cohort Study

    Directory of Open Access Journals (Sweden)

    Axel Nordenskjöld

    2011-01-01

    Full Text Available Objective. The aim of the study is to define predictors of relapse/recurrence after electroconvulsive therapy, ECT, for patients with major depressive disorder. Methods. A study of all patients (n=486 treated by means of ECT for major depressive disorder was performed. The data were derived from a regional quality register in Sweden. Psychiatric hospitalisation or suicide was used as a marker for relapse/recurrence. Results. The relapse/recurrence rate within one year after ECT was 34%. Factors associated with increased risk of relapse/recurrence included comorbid substance dependence and treatment with benzodiazepines or antipsychotics during the follow-up period. Conclusions. Within the first years after ECT, relapses/recurrences leading to hospitalisation or suicide are common. Treatment with lithium might be beneficial, while benzodiazepines, antipsychotics, or continuation ECT does not seem to significantly reduce the risk of relapse/recurrence.

  13. Comparison of enrofloxacin and ceftiofur sodium for the treatment of relapse of undifferentiated fever/bovine respiratory disease in feedlot cattle

    Science.gov (United States)

    Abutarbush, Sameeh M.; Schunicht, Oliver C.; Wildman, Brian K.; Hannon, Sherry J.; Jim, G. Kee; Ward, Tracy I.; Booker, Calvin W.

    2012-01-01

    This commercial field trial compared the efficacy of enrofloxacin and ceftiofur sodium in beef cattle at high risk of developing undifferentiated fever (UF), also known as bovine respiratory disease (BRD) that received tilmicosin at feedlot arrival, were diagnosed and initially treated for UF with tilmicosin, and subsequently required a second UF treatment (first relapse). Feedlot cattle (n = 463) were randomly assigned to 2 experimental groups: ENRO or CEF. Second UF relapse, 3rd UF relapse, overall case fatality and BRD case fatality rates were lower in the ENRO group than in the CEF group (P enrofloxacin than ceftiofur sodium for treatment of UF relapse. PMID:22753964

  14. LOW FALSE POSITIVE RATE OF KEPLER CANDIDATES ESTIMATED FROM A COMBINATION OF SPITZER AND FOLLOW-UP OBSERVATIONS

    International Nuclear Information System (INIS)

    Désert, Jean-Michel; Brown, Timothy M.; Charbonneau, David; Torres, Guillermo; Fressin, François; Ballard, Sarah; Latham, David W.; Bryson, Stephen T.; Borucki, William J.; Knutson, Heather A.; Batalha, Natalie M.; Deming, Drake; Ford, Eric B.; Fortney, Jonathan J.; Gilliland, Ronald L.; Seager, Sara

    2015-01-01

    NASA’s Kepler mission has provided several thousand transiting planet candidates during the 4 yr of its nominal mission, yet only a small subset of these candidates have been confirmed as true planets. Therefore, the most fundamental question about these candidates is the fraction of bona fide planets. Estimating the rate of false positives of the overall Kepler sample is necessary to derive the planet occurrence rate. We present the results from two large observational campaigns that were conducted with the Spitzer Space Telescope during the the Kepler mission. These observations are dedicated to estimating the false positive rate (FPR) among the Kepler candidates. We select a sub-sample of 51 candidates, spanning wide ranges in stellar, orbital, and planetary parameter space, and we observe their transits with Spitzer at 4.5 μm. We use these observations to measures the candidate’s transit depths and infrared magnitudes. An authentic planet produces an achromatic transit depth (neglecting the modest effect of limb darkening). Conversely a bandpass-dependent depth alerts us to the potential presence of a blending star that could be the source of the observed eclipse: a false positive scenario. For most of the candidates (85%), the transit depths measured with Kepler are consistent with the transit depths measured with Spitzer as expected for planetary objects, while we find that the most discrepant measurements are due to the presence of unresolved stars that dilute the photometry. The Spitzer constraints on their own yield FPRs between 5% and depending on the Kepler Objects of Interest. By considering the population of the Kepler field stars, and by combining follow-up observations (imaging) when available, we find that the overall FPR of our sample is low. The measured upper limit on the FPR of our sample is 8.8% at a confidence level of 3σ. This observational result, which uses the achromatic property of planetary transit signals that is not investigated

  15. LOW FALSE POSITIVE RATE OF KEPLER CANDIDATES ESTIMATED FROM A COMBINATION OF SPITZER AND FOLLOW-UP OBSERVATIONS

    Energy Technology Data Exchange (ETDEWEB)

    Désert, Jean-Michel; Brown, Timothy M. [CASA, Department of Astrophysical and Planetary Sciences, University of Colorado, 389-UCB, Boulder, CO 80309 (United States); Charbonneau, David; Torres, Guillermo; Fressin, François; Ballard, Sarah; Latham, David W. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Bryson, Stephen T.; Borucki, William J. [NASA Ames Research Center, Moffett Field, CA 94035 (United States); Knutson, Heather A. [Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA 91125 (United States); Batalha, Natalie M. [San Jose State University, San Jose, CA 95192 (United States); Deming, Drake [Department of Astronomy, University of Maryland, College Park, MD 20742-2421 (United States); Ford, Eric B. [University of Florida, Gainesville, FL 32611 (United States); Fortney, Jonathan J. [Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA 95064 (United States); Gilliland, Ronald L. [Center for Exoplanets and Habitable Worlds, The Pennsylvania State University, University Park, PA 16802 (United States); Seager, Sara, E-mail: desert@colorado.edu [Massachusetts Institute of Technology, Cambridge, MA 02159 (United States)

    2015-05-01

    NASA’s Kepler mission has provided several thousand transiting planet candidates during the 4 yr of its nominal mission, yet only a small subset of these candidates have been confirmed as true planets. Therefore, the most fundamental question about these candidates is the fraction of bona fide planets. Estimating the rate of false positives of the overall Kepler sample is necessary to derive the planet occurrence rate. We present the results from two large observational campaigns that were conducted with the Spitzer Space Telescope during the the Kepler mission. These observations are dedicated to estimating the false positive rate (FPR) among the Kepler candidates. We select a sub-sample of 51 candidates, spanning wide ranges in stellar, orbital, and planetary parameter space, and we observe their transits with Spitzer at 4.5 μm. We use these observations to measures the candidate’s transit depths and infrared magnitudes. An authentic planet produces an achromatic transit depth (neglecting the modest effect of limb darkening). Conversely a bandpass-dependent depth alerts us to the potential presence of a blending star that could be the source of the observed eclipse: a false positive scenario. For most of the candidates (85%), the transit depths measured with Kepler are consistent with the transit depths measured with Spitzer as expected for planetary objects, while we find that the most discrepant measurements are due to the presence of unresolved stars that dilute the photometry. The Spitzer constraints on their own yield FPRs between 5% and depending on the Kepler Objects of Interest. By considering the population of the Kepler field stars, and by combining follow-up observations (imaging) when available, we find that the overall FPR of our sample is low. The measured upper limit on the FPR of our sample is 8.8% at a confidence level of 3σ. This observational result, which uses the achromatic property of planetary transit signals that is not investigated

  16. Hypnosis for Smoking Relapse Prevention: A Randomized Trial.

    Science.gov (United States)

    Carmody, Timothy P; Duncan, Carol L; Solkowitz, Sharon N; Huggins, Joy; Simon, Joel A

    2017-10-01

    The purpose of this study was to determine whether hypnosis would be more effective than standard behavioral counseling in helping smokers to remain abstinent. A total of 140 current smokers were enrolled in a randomized controlled smoking cessation trial at an urban Veterans Affairs medical center. Participants (n = 102) who were able to quit for at least 3 days received either a hypnosis or behavioral relapse prevention intervention. Both relapse prevention interventions consisted of two 60 min face-to-face sessions and four 20 min follow-up phone calls (two phone calls per week). At 26 weeks, the validate\\d point-prevalence quit rate was 35% for the hypnosis group and 42% for the behavioral counseling group (relative risk = 0.85; 95% confidence interval: 0.52-1.40). At 52 weeks, the validated quit rate was 29% for the hypnosis group and 28% for the behavioral group (relative risk  = 1.03; 95% confidence interval: 0.56-1.91). It was concluded that hypnosis warrants further investigation as an intervention for facilitating maintenance of quitting.

  17. Preventing Relapse to Cigarette Smoking by Behavioral Skill Training.

    Science.gov (United States)

    Hall, Sharon M.; And Others

    1984-01-01

    Crossed two relapse prevention conditions (skills training-vs-discussion control) with two levels of aversive smoking in volunteer subjects (N=123). Results indicated that relapse-prevention skill training did prevent relapse among cigarette smokers. Lighter smokers were more favorably influenced. (LLL)

  18. A classification framework for drug relapse prediction | Salleh ...

    African Journals Online (AJOL)

    mining algorithms, Artificial Intelligence Neural Network (ANN) is one of the best algorithms to predict relapse among drug addicts. This may help the rehabilitation center to predict relapse individually and the prediction result is hoped to prevent drug addicts from relapse. Keywords: classification; artificial neural network; ...

  19. Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study.

    Science.gov (United States)

    van der Kooy, Jacoba; Birnie, Erwin; Denktas, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2017-06-08

    To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000-2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum. Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed. The intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8-11.0 vs. 13.8% 95% CI 13.6-13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75-0.78)). The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25-1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births. The potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs.

  20. PREDICTION OF RELAPSE FROM HYPERTHYROIDISM FOLLOWING ANTITHYROID MEDICATION WITHDRAWAL USING TECHNETIUM THYROID UPTAKE SCANNING.

    Science.gov (United States)

    Nakhjavani, Manouchehr; Abdollahi, Soraya; Farzanefar, Saeed; Abousaidi, Mohammadtagi; Esteghamati, Alireza; Naseri, Maryam; Eftekhari, Mohamad; Abbasi, Mehrshad

    2017-04-02

    Technetium thyroid uptake (TTU) is not inhibited by antithyroid drugs (ATD) and reflects the degree of thyroid stimulation. We intended to predict the relapse rate from hyperthyroidism based on TTU measurement. Out of 44 initially enrolled subjects, 38 patients aged 41.6 ± 14.6 with Graves disease (duration: 84 ± 78 months) completed the study. TTU was performed with 40-second imaging of the neck and mediastinum 20 minutes after injection of 1 mCi technetium-99m pertechnetate. TTU was measured as the percentage of the count of activity accumulated in the thyroidal region minus the mediastinal background uptake to the count of 1 mCi technetium-99m under the same acquisition conditions. Then methimazole was stopped and patients were followed. The optimal TTU cutoff value for Graves relapse prediction was calculated using Youden's J statistic. Hyperthyroidism relapsed in 11 (28.9%) patients 122 ± 96 (range: 15-290) days post-ATD withdrawal. The subjects in remission were followed for 209 ± 81 days (range: 88-390). TTU was significantly higher in patients with forthcoming relapse (12.0 ± 8.0 vs. 3.9 ± 2.0, P = .007). The difference was significant after adjustment for age, sex, history of previous relapse, disease duration, and thyroid-stimulating hormone (TSH) levels before withdrawal. The area under the receiver operative characteristic (ROC) curve was 0.87. The optimal TTU cutoff value for classification of subjects with relapse and remission was 8.7 with sensitivity, specificity, and positive and negative predictive value of 73%, 100%, 100%, and 90%, respectively (odds ratio [OR] = 10.0; 95% confidence interval [CI]: 3.4-29.3). TTU evaluation in hyperthyroid patients receiving antithyroid medication is an accurate and practical method for predicting relapse after ATD withdrawal. ATD = antithyroid drugs RIU = radio-iodine uptake TSH = thyroid-stimulating hormone TSI = thyroid-stimulating immunoglobulin TTU = technetium thyroid uptake.

  1. Socio-economic correlates of relapsed patients admitted in a Nigerian mental health institution.

    Science.gov (United States)

    Gbiri, Caleb A; Badru, Fatai A; Ladapo, Harry T O; Gbiri, Adefolakemi A

    2011-03-01

    Relapse in psychiatric disorders is highly distressing, costly and engenders burn-out syndrome among mental-health workers. To study the socio-economic factors associated with relapse in individual admitted with psychiatric disorders and the pattern of socio-economic impact of relapse in those groups. A cross-sectional survey of all relapsed patients without cognitive deficit admitted into the federal Neuro-Psychiatric Hospital, Lagos, Nigeria between June and October 2007 was conducted using a self-validated Structured Interview Schedule (Relapse Socio-economic Impact Interview Schedule) and Key Informant Interview Guide. Secondary data were elicited from the patient folders, case notes, ward admission registers and nominal rolls. Data were summarised using mean, standard deviation, frequency and percentiles. Pearson's moment correlation coefficient was used to test the association among variables. The Mann-Whitney U-test was used to compare the pre-morbid and the post-morbid states. This study involved 102 respondents. Their mean age was 36.5 ± 9.8 years, mainly of male gender (72.5%) suffering from schizophrenic disorder (37.8%). Relapse and re-admission ranged between 2 and 12. Unemployment rate, marital separation and divorce increased more than 5-fold from pre-morbid to morbid states. Few (4.9%) could still settle their hospital/drug bills on their own, while most (95.1%) depended on family, philanthropist and government/waivers to pay for their bills. Their social relationships were negatively influenced with most of them expressing social isolation and low quality of life. There were significant relationships (Peconomic status, employment status and marital status of the respondents between the pre-morbid and post-morbid periods. The illness significantly affected the emotional status of the participants. Relapse and readmission in psychiatric patients have a negative impact on socio-economic well-being of patients, family and the society. Efforts should

  2. Adjuvant radiotherapy after salvage lymph node dissection because of nodal relapse of prostate cancer versus salvage lymph node dissection only

    International Nuclear Information System (INIS)

    Rischke, Hans Christian; Schultze-Seemann, Wolfgang; Kroenig, Malte; Schlager, Daniel; Jilg, Cordula Annette; Wieser, Gesche; Drendel, Vanessa; Stegmaier, Petra; Henne, Karl; Volegova-Neher, Natalia; Grosu, Anca-Ligia; Krauss, Tobias; Kirste, Simon

    2015-01-01

    Nodal pelvic/retroperitoneal recurrent prostate cancer (PCa) after primary therapy can be treated with salvage lymph node dissection (salvage-LND) in order to delay disease progression and offer cure for a subset of patients. Whether adjuvant radiotherapy (ART) in affected regions improves the outcome by elimination of residual tumour burden remains unclear. A total of 93 patients with exclusively nodal PCa relapse underwent choline-positron-emission tomography-computed-tomography-directed pelvic/retroperitoneal salvage-LND; 46 patients had surgery only and 47 patients received ART in regions with proven lymph node metastases. In case of subsequent prostate specific antigen (PSA) progression, different imaging modalities were performed to confirm next relapse within or outside the treated region (TR). Mean follow-up was 3.2 years. Lymphatic tumour burden was balanced between the two groups. Additional ART resulted in delayed relapse within TR (5-year relapse-free rate 70.7 %) versus surgery only (5-year relapse-free rate 26.3 %, p < 0.0001). In both treatment arms, time to next relapse outside the TR was almost equal (median 27 months versus 29.6 months, p = 0.359). With respect to the detection of the first new lesion, regardless if present within or outside the TR, 5 years after the treatment 34.3 % of patients in the group with additional ART were free of relapse, versus 15.4 % in the surgery only group (p = 0.0122). ART had no influence on the extent of PSA reduction at latest follow-up compared to treatment with surgery only. ART after salvage-LND provides stable local control in TR and results in overall significant improved next-relapse-free survival, compared to patients who received surgery only in case of nodal PCa-relapse. (orig.) [de

  3. Laboratory diagnosis of tick-borne African relapsing fevers: latest developments

    Directory of Open Access Journals (Sweden)

    Aurélien eFotso Fotso

    2015-11-01

    Full Text Available In Africa, relapsing fevers caused by ectoparasite-borne Borrelia species are transmitted by ticks, with the exception of Borrelia recurrentis, which is a louse-borne spirochete. These tropical diseases responsible for mild to deadly spirochetemia. Cultured B. crocidurae, B. duttonii and B. hispanica circulate alongside at least six species which have not yet been cultured in vectors. Direct diagnosis is hindered by the use of non-specific laboratory tools. Indeed, microscopic observation of Borrelia spirochaeta in smears of peripheral blood taken from febrile patients lacks sensitivity and specificity. Although best visualised using dark-field microscopy, the organisms can also be detected using Wright-Giemsa or acridine orange stains.. PCR-based detection of specific sequences in total DNA extracted from a specimen can be used to discriminate different relapsing fever Borreliae. In our laboratory, we developed a multiplex real-time PCR assay for the specific detection of B. duttonii/recurrentis and B. crocidurae: Multispacer Sequence Typing accurately identified cultured relapsing fever borreliae and revealed diversity among them. Other molecular typing techniques, such as multilocus sequence analysis of tick-borne relapsing fever borreliae, showed the potential risk of human infection in Africa. Recent efforts to culture and sequence relapsing fever borreliae have provided new information for reassessment of the diversity of these bacteria. Recently, matrix-assisted laser desorption ionization time-of-flight mass spectrometry has been reported as a means of identifying cultured borreliae and of identifying both vectors and vectorised pathogens such as detecting relapsing fever borreliae directly in ticks. The lack of a rapid diagnosis test restricts the management of such diseases. We produced monoclonal antibodies against Borrelia crocidurae in order to develop cheap assays for the rapid detection of relapsing fever borreliae. In this paper

  4. Longitudinal fluorescence in situ hybridization reveals cytogenetic evolution in myeloma relapsing after autologous transplantation

    Science.gov (United States)

    Merz, Maximilian; Jauch, Anna; Hielscher, Thomas; Mai, Elias K.; Seckinger, Anja; Hose, Dirk; Bertsch, Uta; Neben, Kai; Raab, Marc S.; Salwender, Hans; Blau, Igor W.; Lindemann, Hans-Walter; Schmidt-Wolf, Ingo; Scheid, Christof; Haenel, Mathias; Weisel, Katja; Goldschmidt, Hartmut; Hillengass, Jens

    2017-01-01

    To investigate cytogenetic evolution after upfront autologous stem cell transplantation for newly diagnosed myeloma we retrospectively analyzed fluorescence in situ hybridization results of 128 patients with paired bone marrow samples from the time of primary diagnosis and at relapse. High-risk cytogenetic abnormalities (deletion 17p and/or gain 1q21) occurred more frequently after relapse (odds ratio: 6.33; 95% confidence interval: 1.86–33.42; P<0.001). No significant changes were observed for defined IGH translocations [t(4;14); t(11;14); t(14;16)] or hyperdiploid karyotypes between primary diagnosis and relapse. IGH translocations with unknown partners occurred more frequently at relapse. New deletion 17p and/or gain 1q21 were associated with cytogenetic heterogeneity, since some de novo lesions with different copy numbers were present only in subclones. No distinct baseline characteristics were associated with the occurrence of new high-risk cytogenetic abnormalities after progression. Patients who relapsed after novel agent-based induction therapy had an increased risk of developing high-risk aberrations (odds ratio 10.82; 95% confidence interval: 1.65–127.66; P=0.03) compared to those who were treated with conventional chemotherapy. Survival analysis revealed dismal outcomes regardless of whether high-risk aberrations were present at baseline (hazard ratio, 3.53; 95% confidence interval: 1.53–8.14; P=0.003) or developed at relapse only (hazard ratio, 3.06; 95% confidence interval: 1.09–8.59; P=0.03). Our results demonstrate cytogenetic evolution towards high-risk disease after autologous transplantation and underline the importance of repeated genetic testing in relapsed myeloma (EudraCT number of the HD4 trial: 2004-000944-26). PMID:28495913

  5. Post-relapse survival in patients with Ewing sarcoma.

    Science.gov (United States)

    Ferrari, Stefano; Luksch, Roberto; Hall, Kirsten Sundby; Fagioli, Franca; Prete, Arcangelo; Tamburini, Angela; Tienghi, Amelia; DiGirolamo, Stefania; Paioli, Anna; Abate, Massimo Eraldo; Podda, Marta; Cammelli, Silvia; Eriksson, Mikael; Brach del Prever, Adalberto

    2015-06-01

    Post-relapse survival (PRS) was evaluated in patients with Ewing sarcoma (EWS) enrolled in chemotherapy protocols based on the use of high-dose chemotherapy with busulfan and melfalan (HDT) as a first-line consolidation treatment in high-risk patients. EWS patients enrolled in ISG/SSG III and IV trials who relapsed after complete remission were included in the analysis. At recurrence, chemotherapy based on high-dose ifosfamide was foreseen, and patients who responded but had not received HDT underwent consolidation therapy with HDT. Data from 107 EWS patients were included in the analysis. Median time to recurrence (RFI) was 18 months, and 45 (42%) patients had multiple sites of recurrence. Patients who had previously been treated with HDT had a significantly (P = 0.02) shorter RFI and were less likely to achieve a second complete remission (CR2). CR2 status was achieved by 42 (39%) patients. Fifty patients received high-dose IFO (20 went to consolidation HDT). The 5-year PRS was 19% (95% CI 11 to 27%). With CR2, the 5-year PRS was 48% (95% CI 31 to 64%). Without CR2, median time to death was six months (range 1-45 months). According to the multivariate analysis, patients younger than 15 years, recurrence to the lung only, and RFI longer than 24 months significantly influenced the probability of PRS. Age, pattern of recurrence, RFI, and response to second-line chemotherapy influence post-relapse survival in patients with recurrent Ewing sarcoma. No survival advantage was observed from chemotherapy consolidation with HDT. © 2015 Wiley Periodicals, Inc.

  6. Physician experience and rates of plasma HIV-1 RNA suppression among illicit drug users: an observational study

    Directory of Open Access Journals (Sweden)

    Sangsari Sassan

    2012-01-01

    Full Text Available Abstract Background Despite the availability of antiretroviral therapy (ART, suboptimal treatment outcomes have been observed among HIV-seropositive illicit drug users. As there is an urgent need to improve responses to antiretroviral therapy among this population, we undertook this study to evaluate the role of physician experience on rates of plasma HIV-1 RNA suppression following initiation of ART. Methods Using data from a community-recruited cohort of HIV-positive illicit drug users, we used Cox proportional hazards regression to model the time to plasma viral HIV RNA Results Between May 1996 and December 2008, 267 individuals initiated ART among whom 227 (85% achieved a plasma HIV RNA Conclusions In this setting of universal HIV/AIDS care, illicit drug users with more experienced physicians exhibited faster rates of plasma viral load suppression. These findings argue for specialized services to help optimize HIV treatment outcomes among this population.

  7. Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Fikreyesus, Mahlet; Soboka, Matiwos; Feyissa, Garumma Tolu

    2016-10-20

    Psychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH). Data were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value value higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31). The high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services.

  8. Relapsed childhood acute lymphoblastic leukemia in the Nordic countries

    DEFF Research Database (Denmark)

    Oskarsson, Trausti; Söderhäll, Stefan; Arvidson, Johan

    2016-01-01

    Relapse is the main reason for treatment failure in childhood acute lymphoblastic leukemia. Despite improvements in the up-front therapy, survival after relapse is still relatively poor, especially for high-risk relapses. The aims of this study were to assess outcomes following acute lymphoblastic...... leukemia relapse after common initial Nordic Society of Paediatric Haematology and Oncology protocol treatment; to validate currently used risk stratifications, and identify additional prognostic factors for overall survival. Altogether, 516 of 2735 patients (18.9%) relapsed between 1992 and 2011 and were...

  9. A comparison of the predicted and observed reaction rates of various neutron detectors in a thermal reactor spectrum

    International Nuclear Information System (INIS)

    Hardiman, J.P.; Maunders, E.J.

    1963-08-01

    A number of the detectors commonly used in integral neutron spectrum measurements have been irradiated in the pitch moderator position of a Calder Hall lattice where the detailed energy spectrum is known from time of flight measurements. Predicted and observed reaction rates are generally in good agreement although they are brought into better agreement by a small modification to the spectrum. The predicted cadmium ratios are quite sensitive to the value adopted for the effective cadmium cut off energy, values of which were determined for various detectors using the Ferranti Mercury computer. The values varied over a wide range, although in every case only 40 mil. cadmium filters were used. (author)

  10. Economic costs associated with an MS relapse

    LENUS (Irish Health Repository)

    O'Connell, K.

    2014-09-01

    This was an prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration, expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner\\'s loss of earnings, childcare, meals and travel costs.

  11. The role of family expressed emotion and perceived social support in predicting addiction relapse.

    Science.gov (United States)

    Atadokht, Akbar; Hajloo, Nader; Karimi, Masoud; Narimani, Mohammad

    2015-03-01

    Emotional conditions governing the family and patients' perceived social support play important roles in the treatment or relapse process of the chronic disease. The current study aimed to investigate the role of family expressed emotion and perceived social support in prediction of addiction relapse. The descriptive-correlation method was used in the current study. The study population consisted of the individuals referred to the addiction treatment centers in Ardabil from October 2013 to January 2014. The subjects (n = 80) were randomly selected using cluster sampling method. To collect data, expressed emotion test by Cole and Kazaryan, and Multidimensional Scale of Perceived Social Support (MSPSS) were used, and the obtained data was analyzed using the Pearson's correlation coefficient and multiple regression analyses. Results showed a positive relationship between family expressed emotions and the frequency of relapse (r = 0.26, P = 0.011) and a significant negative relationship between perceived social support and the frequency of relapse (r = -0.34, P = 0.001). Multiple regression analysis also showed that perceived social support from family and the family expressed emotions significantly explained 12% of the total variance of relapse frequency. These results have implications for addicted people, their families and professionals working in addiction centers to use the emotional potential of families especially their expressed emotions and the perceived social support of addicts to increase the success rate of addiction treatment.

  12. Stratospheric mean ages and transport rates from observations of CO{sub 2} and N{sub 2}O

    Energy Technology Data Exchange (ETDEWEB)

    Boering, K A; Wofsy, S C; Daube, B C; Schneider, H R [Harvard Univ., Cambridge, MA (United States). Div. of Engineering and Applied Sciences; Loewenstein, M; Podolske, J R [NASA Ames Research Center, Moffett Field, CA (United States); Conway, T J [National Oceanic and Atmospheric Administration, Boulder, CO (United States)

    1998-12-31

    Measurements of CO{sub 2} and N{sub 2}O concentrations are reported and analyzed to investigate stratospheric transport rates. Temporal variations in tropospheric CO{sub 2} are observed to propagate into the stratosphere, showing that tropospheric air enters the lower tropical stratosphere continuously, ascends, and is transported rapidly (in less than 1 month) to both hemispheres. The mean age of stratospheric air determined from CO{sub 2} data is approximately 5 years in the mid-stratosphere. It is shown that the mean age is mathematically equivalent to a conserved tracer analogous to exhaust from stratospheric aircraft. Comparison of the mean age from models and observations indicates that current model simulations likely underestimate pollutant concentrations from proposed stratospheric aircraft by 25-100%. (author) 36 refs.

  13. Stratospheric mean ages and transport rates from observations of CO{sub 2} and N{sub 2}O

    Energy Technology Data Exchange (ETDEWEB)

    Boering, K.A.; Wofsy, S.C.; Daube, B.C.; Schneider, H.R. [Harvard Univ., Cambridge, MA (United States). Div. of Engineering and Applied Sciences; Loewenstein, M.; Podolske, J.R. [NASA Ames Research Center, Moffett Field, CA (United States); Conway, T.J. [National Oceanic and Atmospheric Administration, Boulder, CO (United States)

    1997-12-31

    Measurements of CO{sub 2} and N{sub 2}O concentrations are reported and analyzed to investigate stratospheric transport rates. Temporal variations in tropospheric CO{sub 2} are observed to propagate into the stratosphere, showing that tropospheric air enters the lower tropical stratosphere continuously, ascends, and is transported rapidly (in less than 1 month) to both hemispheres. The mean age of stratospheric air determined from CO{sub 2} data is approximately 5 years in the mid-stratosphere. It is shown that the mean age is mathematically equivalent to a conserved tracer analogous to exhaust from stratospheric aircraft. Comparison of the mean age from models and observations indicates that current model simulations likely underestimate pollutant concentrations from proposed stratospheric aircraft by 25-100%. (author) 36 refs.

  14. Hematologic Response to Vorinostat Treatment in Relapsed Myeloid Leukemia of Down Syndrome.

    Science.gov (United States)

    Scheer, Carina; Kratz, Christian; Witt, Olaf; Creutzig, Ursula; Reinhardt, Dirk; Klusmann, Jan-Henning

    2016-09-01

    Children with Down syndrome are at high risk to develop myeloid leukemia (ML-DS). Despite their excellent prognosis, children with ML-DS particularly suffer from severe therapy-related toxicities and for relapsed ML-DS the cure rates are very poor. Here we report the clinical course of one child with ML-DS treated with the histone deacetylase (HDAC) inhibitor vorinostat (suberoylanilide hydroxamic acid) after second relapse. The child had previously received conventional chemotherapy and stem cell transplantation, yet showed a remarkable clinical and hematologic response. Thus, HDAC inhibitor may represent an effective class of drugs for the treatment of ML-DS. © 2016 Wiley Periodicals, Inc.

  15. Cost effectiveness and budget impact of natalizumab in patients with relapsing multiple sclerosis.

    Science.gov (United States)

    Chiao, Evelyn; Meyer, Kellie

    2009-06-01

    Disease-modifying therapy (DMT) is the largest single-cost item that contributes to the total per-patient cost of multiple sclerosis (MS), a disabling disorder of the central nervous system. Natalizumab is the most recent DMT to be approved for the treatment of relapsing MS and may be an attractive alternative to interferon beta and glatiramer acetate (GA). To determine from the perspective of a United States payer (1) the incremental cost effectiveness of natalizumab compared with other DMTs and (2) the budgetary impact of utilization of natalizumab for the treatment of relapsing MS. A combined cost effectiveness and budget impact model was developed. Model inputs were drug acquisition costs (wholesale acquisition cost), costs of drug administration and monitoring, costs of treating relapses, anticipated reduction in relapse rates after 2 years of therapy, and estimated market utilization of natalizumab. Outcomes included total 2-year costs of therapy per patient, costs per relapse avoided for each treatment, and overall 2-year costs to the health plan and per member per month (PMPM) costs. Drug acquisition costs are in 2008 US dollars, and all other costs were inflated to 2008 US dollars when necessary. Univariate sensitivity analyses were performed to determine the model inputs with the greatest influence on the cost per relapse avoided for natalizumab. The overall 2-year cost of therapy per patient was $72,120 for natalizumab, $56,790 for intramuscular (IM) interferon beta-1a (IFNbeta-1a), $56,773 for IFNbeta-1b, $57,180 for GA, and $58,538 for subcutaneous (SC) IFNbeta-1a. The cost per relapse avoided was lowest for natalizumab at $56,594, followed by $87,791 for IFNbeta-1b, $93,306 for IM IFNbeta-1a, $96,178 for SC IFNbeta-1a, and $103,665 for GA. The incremental cost-effectiveness ratios of natalizumab relative to IM IFNbeta-1a, IFNbeta-1b, GA, and SC IFNbeta-1a were $23,029, $24,452, $20,671, and $20,403 per additional relapse avoided, respectively. An

  16. Extending prednisolone treatment does not reduce relapses in childhood nephrotic syndrome

    NARCIS (Netherlands)

    Teeninga, N.; Kist-van Holthe, J.E.; Rijswijk, N. van; Mos, N.I. de; Hop, W.C.J.; Wetzels, J.F.M.; Heijden, A.J. van der; Nauta, J.

    2013-01-01

    Prolonged prednisolone treatment for the initial episode of childhood nephrotic syndrome may reduce relapse rate, but whether this results from the increased duration of treatment or a higher cumulative dose remains unclear. We conducted a randomized, double-blind, placebo-controlled trial in 69

  17. Survival after relapse in patients with endometrial cancer : results from a randomized trial

    NARCIS (Netherlands)

    Creutzberg, CL; van Putten, WLJ; Koper, PC; Lybeert, MLM; Jobsen, JJ; Warlam-Rodenhuis, CC; De Winter, KAJ; Lutgens, LCHW; van den Bergh, ACM; van der Steen-Banasik, E; Beerman, H; van Lent, M

    Objective. The aim of this study was to determine the rates of local control and survival after relapse in patients with stage I endometrial cancer treated in the multicenter randomized PORTEC trial. Methods, The PORTEC trial included 715 patients with stage I endometrial cancer, either grade I or 2

  18. Impact of side-effects of atypical antipsychotics on non-compliance, relapse and cost.

    Science.gov (United States)

    Mortimer, A; Williams, P; Meddis, D

    2003-01-01

    Atypical antipsychotics generally have milder side-effects than conventional antipsychotics, but also differ among themselves in this respect. This study aimed to compare the impact of different side-effect profiles of individual atypical antipsychotics on non-compliance, relapse and cost in schizophrenia. A state-transition model was built using literature data supplemented by expert opinion. The model found that quetiapine and ziprasidone were similar in estimated non-compliance and relapse rates. Olanzapine and risperidone had higher estimated non-compliance and relapse rates, and incremental, 1-year, per-patient direct costs, using US-based cost data, of approximately $530 (95% confidence interval [CI] approximately $275, $800), and approximately $485 (95% CI approximately $235, $800), respectively, compared with quetiapine. Incremental costs attributable to different side-effect profiles were highly significant. This study shows that differing side-effect profiles of the newer antipsychotic agents are likely to lead to different compliance rates, and consequent variation in relapse rates. The cost implications of these heterogenous clinical outcomes are substantial.

  19. Tuberculosis relapse in Vietnam is significantly associated with Mycobacterium tuberculosis Beijing genotype infections

    NARCIS (Netherlands)

    Huyen, Mai N. T.; Buu, Tran N.; Tiemersma, Edine; Lan, Nguyen T. N.; Dung, Nguyen H.; Kremer, Kristin; Soolingen, Dick V.; Cobelens, Frank G. J.

    2013-01-01

    In Vietnam, the Mycobacterium tuberculosis Beijing genotype is associated with multi-drug resistance and is emerging. A possible explanation for this genotype's success is an increased rate of relapse. In a prospective cohort study, isolates from patients with smear-positive tuberculosis were

  20. The Effectiveness of Cognitive-Behavioral Stress Management on Relapse Prevention in Substance Dependent Men

    Directory of Open Access Journals (Sweden)

    Negar Karimian

    2012-02-01

    Full Text Available Introduction: The purpose of this study is to investigate the effectiveness of cognitive-behavioral stress management on relapse prevention in men who are substance dependent. Method: In a experimental study, 30 individuals who settled in Esfahan therapeutic community center were accidently divided in to an experimental (15 subjects and a control (15 subjects group. The experimental group underwent ten 90 minutes sessions of cognitive-behavioral stress management and the control group didn't receive any particular treatment. All participants underwent urine tests at the beginning of the study, completion of treatment and three months following the completion of treatment. Data were analyzed using descriptive statistics and X2 test. Findings: results showed significant difference in relapse rates of two groups in the following stage. Conclusion: Cognitive-behavioral stress management is effective in relapse prevention in men who are substance dependent.

  1. Prolonged Survival of Acute Lymphoblastic Leukemia with Intrathecal Treatments for Isolated Central Nervous System Relapse

    Directory of Open Access Journals (Sweden)

    Elan Gorshein

    2018-01-01

    Full Text Available Acute lymphoblastic leukemia is commonly cured when diagnosed in the pediatric population. It portends a poorer prognosis if present in adult patients. Although adults frequently achieve complete remission, relapse rates are substantial, particularly among the elderly and high-risk populations. In the absence of prophylactic intrathecal chemotherapy, more than half of patients may develop CNS involvement or relapse, which is associated with significant risk for systemic illness. This report describes a patient with acute lymphoblastic leukemia with repeated isolated CNS relapses. This case should remind clinicians that isolated CNS disease in the absence of systemic recurrence could successfully respond to intrathecal therapy and offer patients a favorable quality of life.

  2. Possible Association between Serum Matrix Metalloproteinase-9 (MMP-9) Levels and Relapse in Depressed Patients following Electroconvulsive Therapy (ECT).

    Science.gov (United States)

    Shibasaki, Chiyo; Itagaki, Kei; Abe, Hiromi; Kajitani, Naoto; Okada-Tsuchioka, Mami; Takebayashi, Minoru

    2018-03-01

    Matrix metalloproteinases are involved in neuroinflammatory processes, which could underlie depression. Serum levels of MMP-9 and MMP-2 in depressed patients are significantly altered following electroconvulsive therapy, but an association between altered matrix metalloproteinases after successful ECT and possible relapse has yet to be investigated. Serum was obtained twice, before and immediately after a course of electroconvulsive therapy, from 38 depressed patients. Serum was also collected, once, from two groups of age- and gender-matched healthy controls, 40 volunteers in each group. Possible associations between levels of matrix metalloproteinases and relapse during a 1-year follow-up period were analyzed. Excluding patients who did not respond to electroconvulsive therapy and patients lost to follow-up, data from 28 patients were evaluated. Eighteen of the patients (64.3%) relapsed within 1 year. In the group that did not relapse, serum levels of MMP-9 were significantly decreased after a course of electroconvulsive therapy, but not in the group that relapsed. No association between MMP-2 and relapse was observed. The degree of change in serum MMP-9 change could be associated with relapse following electroconvulsive therapy in depressed patients. © The Author 2017. Published by Oxford University Press on behalf of CINP.

  3. Heart rate and leukocytes after air and ground transportation in artificially ventilated neonates: a prospective observational study.

    Science.gov (United States)

    Grosek, Stefan; Mlakar, Gorazd; Vidmar, Ivan; Ihan, Alojz; Primozic, Janez

    2009-01-01

    To evaluate the effect of interhospital air and ground transportation of artificially ventilated neonates on heart rate and peripheral blood leukocyte counts. Prospective, observational study. Level III multidisciplinary Neonatal and Pediatric Intensive Care Unit. Fifty-eight near-term artificially ventilated transported neonates between May 2006 and April 2007. Day-helicopter, day- and night-ground transportation. Heart rate at retrieval, on admission to the ICU and 1 h later, and peripheral blood leukocyte counts on admission and 1 d later were compared. Fifteen neonates were transported by helicopter during the daytime (D-HEL), 20 by daytime ground and 23 by nighttime ground transportation (D-GROUND, N-GROUND). No differences in delivery mode, birth weight, gestational age, gender, primary diagnoses for transportation, response time and duration of transportation were found between the groups. Similarly, no differences in pH, pCO(2), blood pressure and skin temperature at retrieval and on admission to the ICU were found between the three groups. The mean heart rate at retrieval did not differ significantly, while on arrival in the ICU and 1 h later the D-GROUND group of patients showed a significantly higher mean heart rate compared to the D-HEL and N-GROUND groups. Moreover, leukocyte counts on arrival in the ICU showed significantly higher leukocyte counts in the D-GROUND group of patients compared to the D-HEL group of patients. These results demonstrate that there is an association between daytime ground transportation and higher heart rate and peripheral blood leukocytes.

  4. An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence.

    Science.gov (United States)

    Dimidjian, Sona; Goodman, Sherryl H; Felder, Jennifer N; Gallop, Robert; Brown, Amanda P; Beck, Arne

    2015-02-01

    Pregnant women with histories of depression are at high risk of depressive relapse/recurrence during the perinatal period, and options for relapse/recurrence prevention are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among general populations but has not been studied among at-risk pregnant women to prevent depression. We examined the feasibility, acceptability, and clinical outcomes of depression symptom severity and relapse/recurrence associated with MBCT adapted for perinatal women (MBCT-PD). Pregnant women with depression histories were recruited from obstetrics clinics in a large health maintenance organization at two sites and enrolled in MBCT-PD (N = 49). Self-reported depressive symptoms and interview-based assessments of depression relapse/recurrence status were measured at baseline, during MBCT-PD, and through 6-months postpartum. Pregnant women reported interest, engagement, and satisfaction with the program. Retention rates were high, as were rates of completion of daily homework practices. Intent to treat analyses indicated a significant improvement in depression symptom levels and an 18 % rate of relapse/recurrence through 6 months postpartum. MBCT-PD shows promise as an acceptable, feasible, and clinically beneficial brief psychosocial prevention option for pregnant women with histories of depression. Randomized controlled trials are needed to examine the efficacy of MBCT-PD for the prevention of depressive relapse/recurrence during pregnancy and postpartum.

  5. Daclizumab for the treatment of relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Herwerth, Marina; Hemmer, Bernhard

    2017-06-01

    Multiple sclerosis (MS) is a common inflammatory disease of the central nervous system. Over the last two decades, the number of therapeutic options for the treatment of relapsing remitting MS (RRMS) has been constantly growing, providing new treatment options to patients. Areas covered: Herein, the authors review the recently approved monoclonal antibody daclizumab for the treatment of RRMS. Based on original articles, they discuss its mode of action and evaluate its efficacy and safety profile compared to other available agents. Expert opinion: The IL-2 receptor modulator daclizumab is a new highly effective agent for the treatment of RRMS with novel immunomodulatory properties. Compared to interferon-beta i.m., daclizumab is more effective in reducing relapse rates and MRI activity. However, its use is limited by the risk of autoimmune disorders and hepatotoxicity. Similar to other monoclonal antibodies for RRMS, therapy with daclizumab needs a strict preselection and monitoring of patients based on individual risk benefit assessment. Given its substantial effectiveness, daclizumab can be an attractive option for patients with highly active MS.

  6. Factors Associated with Long-Term Risk of Relapse after Unrelated Cord Blood Transplantation in Children with Acute Lymphoblastic Leukemia in Remission.

    Science.gov (United States)

    Page, Kristin M; Labopin, Myriam; Ruggeri, Annalisa; Michel, Gerard; Diaz de Heredia, Cristina; O'Brien, Tracey; Picardi, Alessandra; Ayas, Mouhab; Bittencourt, Henrique; Vora, Ajay J; Troy, Jesse; Bonfim, Carmen; Volt, Fernanda; Gluckman, Eliane; Bader, Peter; Kurtzberg, Joanne; Rocha, Vanderson

    2017-08-01

    For pediatric patients with acute lymphoblastic leukemia (ALL), relapse is an important cause of treatment failure after unrelated cord blood transplant (UCBT). Compared with other donor sources, relapse is similar or even reduced after UCBT despite less graft-versus-host disease (GVHD). We performed a retrospective analysis to identify risk factors associated with the 5-year cumulative incidence of relapse after UCBT. In this retrospective, registry-based study, we examined the outcomes of 640 children (leukemia-free survival (LFS), and relapse were 59%, 52%, and 23%, respectively. In multivariate analysis (MVA), acute GVHD (grades II to IV) and TBI protected against relapse. In patients in CR2, rates of 5-year OS, LFS, and the cumulative incidence of relapse were 46%, 44%, and 28%, respectively. In MVA, longer duration from diagnosis to UCBT (≥30 months) and TBI were associated with decreased relapse risk. Importantly, receiving a fully HLA matched graft was a strong risk factor for increased relapse in MVA. An exploratory analysis of all 640 patients supported the important association between the presence of acute GVHD and less relapse but also demonstrated an increased risk of nonrelapse mortality. In conclusion, the impact of GVHD as a graft-versus-leukemia marker is evident in pediatric ALL after UCBT. Strategies that promote graft-versus-leukemia while harnessing GVHD should be further investigated. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  7. Laboratory observations of temperature and humidity dependencies of nucleation and growth rates of sub-3 nm particles

    Science.gov (United States)

    Yu, Huan; Dai, Liang; Zhao, Yi; Kanawade, Vijay P.; Tripathi, Sachchida N.; Ge, Xinlei; Chen, Mindong; Lee, Shan-Hu

    2017-02-01

    Temperature and relative humidity (RH) are the most important thermodynamic parameters in aerosol formation, yet laboratory studies of nucleation and growth dependencies on temperature and RH are lacking. Here we report the experimentally observed temperature and RH dependences of sulfuric acid aerosol nucleation and growth. Experiments were performed in a flow tube in the temperature range from 248 to 313 K, RH from 0.8% to 79%, and relative acidity (RA) of sulfuric acid from 6 × 10-5 to 0.38 (2 × 107-109 cm-3). The impurity levels of base compounds were determined to be NH3 nucleation at fixed sulfuric acid concentration but impede nucleation when RA is fixed. It is also shown that binary nucleation of sulfuric acid and water is negligible in planetary boundary layer temperature and sulfuric acid ranges. An empirical algorithm was derived to correlate the nucleation rate with RA, RH, and temperature together. Collision-limited condensation of free-sulfuric acid molecules fails to predict the observed growth rate in the sub-3 nm size range, as well as its dependence on temperature and RH. This suggests that evaporation, sulfuric acid hydration, and possible involvement of other ternary molecules should be considered for the sub-3 nm particle growth.

  8. Usefulness of Measuring Thyroid Stimulating Antibody at the Time of Antithyroid Drug Withdrawal for Predicting Relapse of Graves Disease

    Directory of Open Access Journals (Sweden)

    Hyemi Kwon

    2016-06-01

    Full Text Available BackgroundHyperthyroidism relapse in Graves disease after antithyroid drug (ATD withdrawal is common; however, measuring the thyrotropin receptor antibody (TRAb at ATD withdrawal in order to predict outcomes is controversial. This study compared measurement of thyroid stimulatory antibody (TSAb and thyrotropin-binding inhibitory immunoglobulin (TBII at ATD withdrawal to predict relapse.MethodsThis retrospective study enrolled patients with Graves disease who were treated with ATDs and whose serum thyroid-stimulating hormone levels were normal after receiving low-dose ATDs. ATD therapy was stopped irrespective of TRAb positivity after an additional 6 months of receiving the minimum dose of ATD therapy. Patients were followed using thyroid function tests and TSAb (TSAb group; n=35 or TBII (TBII group; n=39 every 3 to 6 months for 2 years after ATD withdrawal.ResultsTwenty-eight patients (38% relapsed for a median follow-up of 21 months, and there were no differences in baseline clinical characteristics between groups. In the TSAb group, relapse was more common in patients with positive TSAb at ATD withdrawal (67% than patients with negative TSAb (17%; P=0.007. Relapse-free survival was shorter in TSAb-positive patients. In the TBII group, there were no differences in the relapse rate and relapse-free survivals according to TBII positivity. For predicting Graves disease relapse, the sensitivity and specificity of TSAb were 63% and 83%, respectively, whereas those of TBII were 28% and 65%.ConclusionTSAb at ATD withdrawal can predict the relapse of Graves hyperthyroidism, but TBII cannot. Measuring TSAb at ATD withdrawal can assist with clinical decisions making for patients with Graves disease.

  9. Usefulness of Measuring Thyroid Stimulating Antibody at the Time of Antithyroid Drug Withdrawal for Predicting Relapse of Graves Disease

    Science.gov (United States)

    Kwon, Hyemi; Jang, Eun Kyung; Kim, Mijin; Park, Suyeon; Jeon, Min Ji; Kim, Tae Yong; Ryu, Jin-Sook; Shong, Young Kee; Kim, Won Bae

    2016-01-01

    Background Hyperthyroidism relapse in Graves disease after antithyroid drug (ATD) withdrawal is common; however, measuring the thyrotropin receptor antibody (TRAb) at ATD withdrawal in order to predict outcomes is controversial. This study compared measurement of thyroid stimulatory antibody (TSAb) and thyrotropin-binding inhibitory immunoglobulin (TBII) at ATD withdrawal to predict relapse. Methods This retrospective study enrolled patients with Graves disease who were treated with ATDs and whose serum thyroid-stimulating hormone levels were normal after receiving low-dose ATDs. ATD therapy was stopped irrespective of TRAb positivity after an additional 6 months of receiving the minimum dose of ATD therapy. Patients were followed using thyroid function tests and TSAb (TSAb group; n=35) or TBII (TBII group; n=39) every 3 to 6 months for 2 years after ATD withdrawal. Results Twenty-eight patients (38%) relapsed for a median follow-up of 21 months, and there were no differences in baseline clinical characteristics between groups. In the TSAb group, relapse was more common in patients with positive TSAb at ATD withdrawal (67%) than patients with negative TSAb (17%; P=0.007). Relapse-free survival was shorter in TSAb-positive patients. In the TBII group, there were no differences in the relapse rate and relapse-free survivals according to TBII positivity. For predicting Graves disease relapse, the sensitivity and specificity of TSAb were 63% and 83%, respectively, whereas those of TBII were 28% and 65%. Conclusion TSAb at ATD withdrawal can predict the relapse of Graves hyperthyroidism, but TBII cannot. Measuring TSAb at ATD withdrawal can assist with clinical decisions making for patients with Graves disease. PMID:27118279

  10. Site of relapse after chemotherapy alone for stage I and II Hodgkin's disease

    International Nuclear Information System (INIS)

    Shahidi, Mehdi; Kamangari, Nahid; Ashley, Sue; Cunningham, David; Horwich, Alan

    2006-01-01

    Background: Short course chemotherapy followed by radiotherapy is a standard treatment for early Hodgkin's disease. There is yet no consensus regarding the appropriate radiotherapy portal following chemotherapy. A good guide to the adjuvant radiotherapy field is the site of relapse in patients treated with chemotherapy alone. Patients and methods: From 1980 to 1996, 61 patients with stage I and II supradiaphragmatic Hodgkin's disease were treated with chemotherapy alone at the Royal Marsden Hospital. We undertook a retrospective review and failure analysis to define the pattern of recurrence. Results: After a median follow-up of 6.5 years, 24 patients had relapsed giving a 5-year relapse rate of 40%. The 5 and 10-year actuarial survival rates were 94 and 89%, respectively with cause-sepecific survival being 94% at 5 and 10 years. Two-thirds of the relapses were nodal and supradiaphragmatic. Twenty patients (83%) relapsed in the initially involved sites of disease and this was the sole site of recurrence in 11 (45%) of patients. In retrospect, it appeared that at least 12 recurrences could have been prevented by involved field radiotherapy. Review of detailed imaging data (available in 9 out of 11 patients with recurrences in initial sites of disease) showed that the relapses were always in the initially involved nodes. Conclusion: After chemotherapy alone in early stage HD most initial recurrences are nodal. Loco-regional recurrences are in the originally involved nodes. Based on limited data it appears that involved nodal RT is equivalent to involved field radiotherapy and may halve the risk of recurrence

  11. Estimating radar reflectivity - snowfall rate relationships and their uncertainties over Antarctica by combining disdrometer and radar observations

    Science.gov (United States)

    Souverijns, Niels; Gossart, Alexandra; Lhermitte, Stef; Gorodetskaya, Irina; Kneifel, Stefan; Maahn, Maximilian; Bliven, Francis; van Lipzig, Nicole

    2017-04-01

    The Antarctic Ice Sheet (AIS) is the largest ice body on earth, having a volume equivalent to 58.3 m global mean sea level rise. Precipitation is the dominant source term in the surface mass balance of the AIS. However, this quantity is not well constrained in both models and observations. Direct observations over the AIS are also not coherent, as they are sparse in space and time and acquisition techniques differ. As a result, precipitation observations stay mostly limited to continent-wide averages based on satellite radar observations. Snowfall rate (SR) at high temporal resolution can be derived from the ground-based radar effective reflectivity factor (Z) using information about snow particle size and shape. Here we present reflectivity snowfall rate relations (Z = aSRb) for the East Antarctic escarpment region using the measurements at the Princess Elisabeth (PE) station and an overview of their uncertainties. A novel technique is developed by combining an optical disdrometer (NASA's Precipitation Imaging Package; PIP) and a vertically pointing 24 GHz FMCW micro rain radar (Metek's MRR) in order to reduce the uncertainty in SR estimates. PIP is used to obtain information about snow particle characteristics and to get an estimate of Z, SR and the Z-SR relation. For PE, located 173 km inland, the relation equals Z = 18SR1.1. The prefactor (a) of the relation is sensitive to the median diameter of the particles. Larger particles, found closer to the coast, lead to an increase of the value of the prefactor. More inland locations, where smaller snow particles are found, obtain lower values for the prefactor. The exponent of the Z-SR relation (b) is insensitive to the median diameter of the snow particles. This dependence of the prefactor of the Z-SR relation to the particle size needs to be taken into account when converting radar reflectivities to snowfall rates over Antarctica. The uncertainty on the Z-SR relations is quantified using a bootstrapping approach

  12. Further Insight into the Effectiveness of a Behavioral Teacher Program Targeting ADHD Symptoms Using Actigraphy, Classroom Observations and Peer Ratings.

    Science.gov (United States)

    Veenman, Betty; Luman, Marjolein; Oosterlaan, Jaap

    2017-01-01

    Objective: The Positivity and Rules program (PR program), a low-level behavioral teacher program targeting symptoms of attention-deficit/hyperactivity disorder (ADHD), has shown positive effects on teacher-rated ADHD symptoms and social functioning. This study aimed to assess whether program effects could be confirmed by instruments assessing classroom behavior other than teacher-ratings, given teachers' involvement with the training. Methods: Participants were 114 primary school children (age = 6-13) displaying ADHD symptoms in the classroom, who were randomly assigned to the treatment ( n = 58) or control group ( n = 65). ADHD symptoms were measured using classroom observations and actigraphy, and peer acceptance was measured using peer ratings. Intention-to-treat multilevel analyses were conducted to assess program effects. Results: No beneficial program effects were found for any of the measures. Conclusion: The earlier beneficial program effects on both ADHD symptoms and social functioning reported by teachers, may be explained by a change in the perception of teachers rather than changes in the child's behavior. Other methodological explanations are also discussed, such as differences between instruments in the sensitivity to program-related changes. The current study underlines the importance of using different measures of classroom behavior to study program effects. ClinicalTrials.gov registration number: NCT02518711.

  13. Phase I trial of verubulin (MPC-6827) plus carboplatin in patients with relapsed glioblastoma multiforme.

    Science.gov (United States)

    Grossmann, Kenneth F; Colman, Howard; Akerley, Wallace A; Glantz, Michael; Matsuoko, Yuko; Beelen, Andrew P; Yu, Margaret; De Groot, John F; Aiken, Robert D; Olson, Jeffrey J; Olsen, Jeffery J; Evans, Brent A; Jensen, Randy L

    2012-11-01

    Verubulin (MPC-6827) is a microtubule-destabilizing agent that achieves high concentrations in the brain. Verubulin disrupts newly formed blood vessels in xenografts. We determined the safety and tolerability of verubulin administered in combination with carboplatin in patients with relapsed glioblastoma multiforme (GBM). Three pre-selected doses of verubulin were tested: 2.1, 2.7, and 3.3 mg/m(2) in a standard "3+3" design. Verubulin was given every second week of a 6-week cycle in the 2.1 mg/m(2) cohort or weekly for 3 weeks of a 4-week cycle in subsequent cohorts. Carboplatin was administered intravenously at an area under the curve (AUC) dosage 4 every 2 weeks for the 2.1 mg/m(2) cohort or on day 1 of each 4-week cycle in subsequent cohorts. Nineteen patients with GBM in first or second relapse were enrolled. Four patients (21 %) experienced a grade 3 or greater verubulin- or carboplatin-related adverse event, including hypesthesia, cerebral ischemia, anemia, and thrombocytopenia. The mean plasma half life of verubulin was 3.2 h (SD = 0.82). Two patients achieved at least a partial response by Macdonald criteria. One of these patients remains progression free and off treatment more than 24 months beyond his initiation of verubulin. Five patients had stable disease. Median progression-free survival (PFS) across all patients was 8 weeks, and the 6-month PFS rate was 21 %. The combination of verubulin at the previously determined single-agent maximum tolerated dose of 3.3 mg/m(2) with carboplatin in patients with recurrent/refractory GBM is safe and well tolerated. In this patient population with a highly vascularized tumor, no cerebral hemorrhage was observed.

  14. Onset and relapse of psychiatric disorders following early breast cancer: a case-control study.

    Science.gov (United States)

    Gandubert, Catherine; Carrière, Isabelle; Escot, Chantal; Soulier, Maryvonne; Hermès, Aziz; Boulet, Patrick; Ritchie, Karen; Chaudieu, Isabelle

    2009-10-01

    Our objective is to evaluate the mental status of primary early breast cancer survivors according to DSM-IV criteria, distinguishing new psychiatric diagnosis, which started after the cancer diagnosis from relapse. A comparative study of 144 breast cancer survivors and 125 women without previous history of cancer was carried out. Neuropsychiatric symptomatology was assessed retrospectively using standardized psychiatric examinations (Mini International Neuropsychiatric Interview, Watson's Post-Traumatic Stress Disorder Inventory) over three successive periods, 'before cancer' (from childhood to 3 years before the interview), 'around the cancer event' (the last 3 years including the time of diagnosis and treatment), and 'currently' (the last 2 weeks). Increased rates of anxiety and mood disorders were observed following a diagnosis of breast cancer compared with controls (generalized anxiety disorder (GAD) and major depressive disorder (MDD); 10.4 vs 1.6% and 19.4 vs 8.8%, respectively). The cancer disease promoted the development of dysthymia (n=4 new cases/6 two-year prevalent cases) and PTSD (7/7) and the re-emergence of MDD (n=21 relapses/28 three-year prevalent cases) and GAD (10/15). No improvement in serious mood disorders such as MDD (16.0 vs 7.2%) and dysthymia (4.2 vs 0%) was reported at the time of interview, more than 1.75 years (median time) after the cancer surgery, the prevalence being 2-4 times greater in breast cancer survivors than in controls. Despite significant advances in treatment, a diagnosis of breast cancer is highly associated with various forms of psychopathology, regardless of psychiatric history, with symptoms persisting after treatment. These results may assist clinicians in planning mental healthcare for women with breast cancer.

  15. Usefulness of a rapid faecal calprotectin test to predict relapse in Crohn's disease patients on maintenance treatment with adalimumab.

    Science.gov (United States)

    Ferreiro-Iglesias, Rocio; Barreiro-de Acosta, Manuel; Lorenzo-Gonzalez, Aurelio; Dominguez-Muñoz, Juan Enrique

    2016-01-01

    Predicting relapse in Crohn's disease (CD) patients by measuring non-invasive biomarkers could allow for early changes of treatment. Data are scarce regarding the utility of monitoring calprotectin to predict relapse. The aim of the study was to evaluate the predictive value of a rapid test of faecal calprotectin (FC) to predict for flares in CD patients on maintenance treatment with adalimumab (ADA). A prospective, observational cohort study was designed. Inclusion criteria were CD patients in clinical remission on a standard dose of ADA therapy. Fresh FC was measured using a rapid test. Thirty patients were included (median age 38 years, 56.7% female). After the 4 months follow-up, 70.0% patients remained in clinical remission and 30.0% had a relapse. FC concentration at inclusion was significantly higher in those patients who relapsed during the follow-up (625 μg/g) compared to those who stayed in remission (45 μg/g). The optimal cut-off for FC to predict relapse was 204 μg/g. The area under the receiver-operating characteristic curve was 0.968. Sensitivity, specificity, positive, and negative predictive value of FC to predict relapse were 100%, 85.7%, 74.1%, and 100%, respectively. In CD patients on ADA maintenance therapy, FC levels measured with a rapid test allow relapse over the following months to be predicted with high accuracy. Low FC levels exclude relapse within at least 4 months after testing, whereas high levels are associated with relapse in three out of every four patients.

  16. Kalman Filtering and Smoothing of the Van Allen Probes Observations to Estimate the Radial, Energy and Pitch Angle Diffusion Rates

    Science.gov (United States)

    Podladchikova, T.; Shprits, Y.; Kellerman, A. C.

    2015-12-01

    The Kalman filter technique combines the strengths of new physical models of the Earth's radiation belts with long-term spacecraft observations of electron fluxes and therefore provide an extremely useful method for the analysis of the state and evolution of the electron radiation belts. However, to get the reliable data assimilation output, the Kalman filter application is confronted with a set of fundamental problems. E.g., satellite measurements are usually limited to a single location in space, which confines the reconstruction of the global evolution of the radiation environment. The uncertainties arise from the imperfect description of the process dynamics and the presence of observation errors, which may cause the failure of data assimilation solution. The development of adaptive Kalman filter that combines the Van Allen Probes data and 3-D VERB code, its accurate customizations in the reconstruction of model describing the phase space density (PSD) evolution, extension of the possibilities to use measurement information, and the model adjustment by developing the identification techniques of model and measurement errors allowed us to reveal hidden and implicit regularities of the PSD dynamics and obtain quantitative and qualitative estimates of radial, energy and pitch angle diffusion characteristics from satellite observations. In this study we propose an approach to estimate radial, energy and pitch angle diffusion rates, as well as the direction of their propagation.

  17. Predicting relapse of Graves' disease following treatment with antithyroid drugs

    Science.gov (United States)

    LIU, LIN; LU, HONGWEN; LIU, YANG; LIU, CHANGSHAN; XUN, CHU

    2016-01-01

    The aim of the present study was to monitor long term antithyroid drug treatments and to identify prognostic factors for Graves' disease (GD). A total of 306 patients with GD who were referred to the Endocrinology Clinic at Weifang People's Hospital (Weifang, China) between August 2005 and June 2009 and treated with methimazole were included in the present study. Following treatment, patients were divided into non-remission, including recurrence and constant treatment subgroups, and remission groups. Various prognosis factors were analyzed and compared, including: Patient age, gender, size of thyroid prior to and following treatment, thyroid hormone levels, disease relapse, hypothyroidism and drug side-effects, and states of thyrotropin suppression were observed at 3, 6 and 12 months post-treatment. Sixty-five patients (21.2%) were male, and 241 patients (78.8%) were female. The mean age was 42±11 years, and the follow-up was 31.5±6.8 months. Following long-term treatment, 141 patients (46%) demonstrated remission of hyperthyroidism with a mean duration of 18.7±1.9 months. The average age at diagnosis was 45.6±10.3 years in the remission group, as compared with 36.4±8.8 years in the non-remission group (t=3.152; P=0.002). Free thyroxine (FT)3 levels were demonstrated to be 25.2±8.9 and 18.7±9.4 pmol/l in the non-remission and remission groups, respectively (t=3.326, P=0.001). The FT3/FT4 ratio and thyrotrophin receptor antibody (TRAb) levels were both significantly higher in the non-remission group (t=3.331, 3.389, P=0.001), as compared with the remission group. Logistic regression analysis demonstrated that elevated thyroid size, FT3/FT4 ratio and TRAb at diagnosis were associated with poor outcomes. The ratio of continued thyrotropin suppression in the recurrent subgroup was significantly increased, as compared with the remission group (P=0.001), as thyroid function reached euthyroid state at 3, 6 and 12 months post-treatment. Patients with GD exhibiting

  18. Louse-borne relapsing fever among East African refugees in Europe.

    Science.gov (United States)

    Antinori, Spinello; Mediannikov, Oleg; Corbellino, Mario; Raoult, Didier

    2016-01-01

    Louse-borne relapsing fever a neglected and forgotten disease by western physicians has recently re-emerged among East African migrants seeking asylum in Europe. We review here the cases observed so far together with a critical reappraisal of several issues regarding clinical presentation, diagnosis and treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. The Fukushima releases: an inverse modelling approach to assess the source term by using gamma dose rate observations

    Science.gov (United States)

    Saunier, Olivier; Mathieu, Anne; Didier, Damien; Tombette, Marilyne; Quélo, Denis; Winiarek, Victor; Bocquet, Marc

    2013-04-01

    The Chernobyl nuclear accident and more recently the Fukushima accident highlighted that the largest source of error on consequences assessment is the source term estimation including the time evolution of the release rate and its distribution between radioisotopes. Inverse modelling methods have proved to be efficient to assess the source term due to accidental situation (Gudiksen, 1989, Krysta and Bocquet, 2007, Stohl et al 2011, Winiarek et al 2012). These methods combine environmental measurements and atmospheric dispersion models. They have been recently applied to the Fukushima accident. Most existing approaches are designed to use air sampling measurements (Winiarek et al, 2012) and some of them use also deposition measurements (Stohl et al, 2012, Winiarek et al, 2013). During the Fukushima accident, such measurements are far less numerous and not as well distributed within Japan than the dose rate measurements. To efficiently document the evolution of the contamination, gamma dose rate measurements were numerous, well distributed within Japan and they offered a high temporal frequency. However, dose rate data are not as easy to use as air sampling measurements and until now they were not used in inverse modelling approach. Indeed, dose rate data results from all the gamma emitters present in the ground and in the atmosphere in the vicinity of the receptor. They do not allow one to determine the isotopic composition or to distinguish the plume contribution from wet deposition. The presented approach proposes a way to use dose rate measurement in inverse modeling approach without the need of a-priori information on emissions. The method proved to be efficient and reliable when applied on the Fukushima accident. The emissions for the 8 main isotopes Xe-133, Cs-134, Cs-136, Cs-137, Ba-137m, I-131, I-132 and Te-132 have been assessed. The Daiichi power plant events (such as ventings, explosions…) known to have caused atmospheric releases are well identified in

  20. Radioimmunotherapy for first-line and relapse treatment of aggressive B-cell non-Hodgkin lymphoma: an analysis of 215 patients registered in the international RIT-Network

    Energy Technology Data Exchange (ETDEWEB)

    Hohloch, Karin; Lankeit, H.K.; Truemper, L. [Georg August University, Hematology and Oncology, Goettingen (Germany); Zinzani, P.L. [University of Bologna, Institute of Hematology and Medical Oncology ' ' L. e A. Seragnoli' ' , Bologna (Italy); Scholz, C.W. [Charite, University Berlin, Hematology, Oncology and Tumor Immunology, Berlin (Germany); Lorsbach, M.; Windemuth-Kieselbach, C. [Alcedis GmbH, Giessen (Germany)

    2014-08-15

    Very few reliable clinical data about the use of radioimmunotherapy in aggressive B-cell lymphoma exist. Patients with aggressive B-cell lymphoma registered in the international RIT-Network were analysed with regard to prior treatment, response and side effects. The RIT-Network is a web-based registry that collects observational data from radioimmunotherapy-treated patients with malignant lymphoma across 13 countries. This analysis included 215 with aggressive B-cell lymphoma out of 232 patients registered in the RIT-Network. Histological subtypes were as follows: 190 diffuse large B-cell, 15 primary mediastinal, 9 anaplastic large cell, and 1 intravascular lymphoma. The median age of the patients was 62 years (range 17 - 88), with 27 % above the age of 70 years. Radioimmunotherapy was mainly used as consolidation after first-line or second-line chemotherapy (56.1 %), as part of third-line to eighth-line therapy for relapse (16.4 %), and in refractory disease (12.2 %). Grade IV neutropenia and thrombopenia and grade III anaemia were observed. The median time to recovery of blood count was 81 days (range 0 - 600 days). The overall response rate was 63.3 %. The complete response rate was 76.4 % in patients treated as part of first-line therapy, and 44.3 % in patients with relapse. Mean overall survival in first-line therapy patients was 32.7 months and 14.0 months in patients with relapse or refractory disease, respectively. Most patients with aggressive B-cell lymphoma in the RIT-Network received radioimmunotherapy as consolidation after first-line therapy with excellent complete remission and overall survival rates compared to published data. In relapsed aggressive B-cell lymphoma, radioimmunotherapy is a safe and feasible treatment leading to satisfactory response rates with acceptable toxicity. (orig.)

  1. Dynamics of myeloid cell populations during relapse-preventive immunotherapy in acute myeloid leukemia.

    Science.gov (United States)

    Rydström, Anna; Hallner, Alexander; Aurelius, Johan; Sander, Frida Ewald; Bernson, Elin; Kiffin, Roberta; Thoren, Fredrik Bergh; Hellstrand, Kristoffer; Martner, Anna

    2017-08-01

    Relapse of leukemia in the postchemotherapy phase contributes to the poor prognosis and survival in patients with acute myeloid leukemia (AML). In an international phase IV trial (ClinicalTrials.gov; NCT01347996), 84 patients with AML in first complete remission who had not undergone transplantation received immunotherapy with histamine dihydrochloride (HDC) and low-dose IL-2 with the aim of preventing relapse. The dynamics of myeloid cell counts and expression of activation markers was assessed before and after cycles of immunotherapy and correlated with clinical outcome in terms of relapse risk and survival. During cycles, a pronounced increase in blood eosinophil counts was observed along with a reduction in monocyte and neutrophil counts. A strong reduction of blood monocyte counts during the first HDC/IL-2 treatment cycle predicted leukemia-free survival. The HDC component of the immunotherapy exerts agonist activity at histamine type 2 receptors (H2Rs) that are expressed by myeloid cells. It was observed that the density of H 2 R expression in blood monocytes increased during cycles of immunotherapy and that high monocyte H 2 R expression implied reduced relapse risk and improved overall survival. Several other activation markers, including HLA-DR, CD86, and CD40, were induced in monocytes and dendritic cells during immunotherapy but did not predict clinical outcome. In addition, expression of HLA-ABC increased in all myeloid populations during therapy. A low expression of HLA-ABC was associated with reduced relapse risk. These results suggest that aspects of myeloid cell biology may impact clinical benefit of relapse-preventive immunotherapy in AML. © Society for Leukocyte Biology.

  2. Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review.

    Science.gov (United States)

    Kalincik, Tomas

    2015-01-01

    Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies. © 2015 S. Karger AG, Basel.

  3. A multicentre phase-II feasibility study evaluating gemcitabine /vinorelbine / prednisolone combination chemotherapy in relapsed / refractory hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Naqi, N.; Ahmad, S.; Shah, I.; Khattak, J.

    2013-01-01

    Objective: To determine the efficacy and toxicity of Gemcitabine, Vinorelbine and Prednisolone (GVP) salvage chemotherapy in relapsed / refractory Hodgkin's Lymphoma (HL). Study Design: A phase-II non-randomized single arm study. Place and Duration of Study: This study was conducted at Combined Military Hospital and Medical College Lahore, Mayo Hospital, King Edward Medical University, Lahore, Allied Hospital, Punjab Medical College, Faisalabad and Combined Military Hospital, Rawalpindi, from January 2007 to December 2007. Methodology: Fifty adult patients with relapsed/refractory HL, adequate marrow reserve, hepatorenal and pulmonary functions, with radiological measurable disease and Karnofsky performance status of 0 - 2 non-candidates for stem cell transplantation, were enrolled. Four 28 days cycles of GVP (Gemcitabine 1000 mg/m2, Vinorelbine 30 mg/m2 on day 1 and 8 intravenously with oral Prednisolone 100 mg/day on day 1 - 5) were given. Response evaluation done according to Cotswolds meeting recommendations and toxicity was evaluated with NCI-CTC (National Cancer Institute - Common Terminology Criteria for adverse events v 3.0). Results: Forty patients completing 4 cycles of GVP, 14 refractory/early relapse and 26 late relapsed (one year postprimary treatment with ABVD) were available for evaluation. The overall response (CRu+PR) rate was 77.5% with better response 85% in late relapsed patients. Haematological toxicity was most common and seen in 70% of cases. Conclusion: GVP is well-tolerated regimen with high response rate and needs to be tested in late relapsed HL. (author)

  4. Treatment strategies in patients with AML or high-risk myelodysplastic syndrome relapsed after Allo-SCT.

    Science.gov (United States)

    Sauer, T; Silling, G; Groth, C; Rosenow, F; Krug, U; Görlich, D; Evers, G; Albring, J; Besoke, R; Mesters, R M; Müller-Tidow, C; Kessler, T; Büchner, T; Berdel, W E; Stelljes, M

    2015-04-01

    Non-relapse mortality after Allo-SCT has significantly decreased over the last years. Nevertheless, relapse remains a major cause for post SCT mortality in patients with AML and high-risk myelodysplastic syndrome (MDS). In this retrospective single-center analysis, we have analyzed the treatment outcomes of 108 patients with AML or MDS, who relapsed after Allo-SCT. Seventy of these patients (65%) were treated with salvage therapies containing chemotherapy alone, allogeneic cell-based treatment or the combination of both. Thirty-eight patients (35%) received palliative treatment. Median OS after diagnosis of relapse was 130 days. Compared with patients who received chemotherapy alone, response to salvage therapy was significantly improved in patients treated with a combination of chemo- and allogeneic cell-based therapy (CR rate 57% vs 13%, P=0.002). Among risk factors concerning pretreatment characteristics, disease status before first Allo-SCT, and details of transplantation, only the time interval from Allo-SCT to relapse was an independent predictor of response to salvage therapy and OS. These data confirmed that time to relapse after transplantation is an important prognostic factor. Up to now, only patients eligible for treatment regimens containing allogeneic cell-based interventions achieved relevant response rates.

  5. Incidence and risk factors for central nervous system relapse in children and adolescents with acute lymphoblastic leukemia

    Science.gov (United States)

    Cancela, Camila Silva Peres; Murao, Mitiko; Viana, Marcos Borato; de Oliveira, Benigna Maria

    2012-01-01

    Background Despite all the advances in the treatment of childhood acute lymphoblastic leukemia, central nervous system relapse remains an important obstacle to curing these patients. This study analyzed the incidence of central nervous system relapse and the risk factors for its occurrence in children and adolescents with acute lymphoblastic leukemia. Methods This study has a retrospective cohort design. The studied population comprised 199 children and adolescents with a diagnosis of acute lymphoblastic leukemia followed up at Hospital das Clinicas, Universidade Federal de Minas Gerais (HC-UFMG) between March 2001 and August 2009 and submitted to the Grupo Brasileiro de Tratamento de Leucemia da Infância - acute lymphoblastic leukemia (GBTLI-LLA-99) treatment protocol. Results The estimated probabilities of overall survival and event free survival at 5 years were 69.5% (± 3.6%) and 58.8% (± 4.0%), respectively. The cumulative incidence of central nervous system (isolated or combined) relapse was 11.0% at 8 years. The estimated rate of isolated central nervous system relapse at 8 years was 6.8%. In patients with a blood leukocyte count at diagnosis ≥ 50 x 109/L, the estimated rate of isolated or combined central nervous system relapse was higher than in the group with a count 50 x 109/L at diagnosis seems to be a significant prognostic factor for a higher incidence of central nervous system relapse in childhood acute lymphoblastic leukemia. PMID:23323068

  6. Probability and predictors of cannabis use disorders relapse: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

    Science.gov (United States)

    Flórez-Salamanca, Ludwing; Secades-Villa, Roberto; Budney, Alan J; García-Rodríguez, Olaya; Wang, Shuai; Blanco, Carlos

    2013-09-01

    This study aims to estimate the odds and predictors of Cannabis Use Disorders (CUD) relapse among individuals in remission. Analyses were done on the subsample of individuals with lifetime history of a CUD (abuse or dependence) who were in full remission at baseline (Wave 1) of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n=2350). Univariate logistic regression models and hierarchical logistic regression model were implemented to estimate odds of relapse and identify predictors of relapse at 3 years follow up (Wave 2). The relapse rate of CUD was 6.63% over an average of 3.6 year follow-up period. In the multivariable model, the odds of relapse were inversely related to time in remission, whereas having a history of conduct disorder or a major depressive disorder after Wave 1 increased the risk of relapse. Our findings suggest that maintenance of remission is the most common outcome for individuals in remission from a CUD. Treatment approaches may improve rates of sustained remission of individuals with CUD and conduct disorder or major depressive disorder. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. The outbreak fingolimod cardiovascular side effects in relapsing-remitting multiple sclerosis patient: A longitudinal study in an Iranian population

    Directory of Open Access Journals (Sweden)

    Morteza Abdar

    2017-03-01

    Full Text Available BACKGROUND: Fingolimod (FTY-720 has shown efficacy in relapsing multiple sclerosis (MS, while some side effects of this drug have been recognized that the most important is cardiovascular side effects. The aim of this study was to evaluate the cardiovascular side effects of FTY-720. However, the effect of fingolimod on cardiac has not been well recognized. This study was designed to evaluate the cardiovascular side effects of fingolimod in relapsing-remitting multiple sclerosis (RRMS patient in an Iranian population. METHODS: This prospective clinical trial study was performed on 200 RRMS patients. The patients received a single daily oral dose of fingolimod 0.5 mg. During the first 6 hours after the first fingolimod dose, the patients’ vital signs and electrocardiographic traces were continuously monitored. Moreover, the patients followed up over 6 months after receiving fingolimod. RESULTS: The results showed that pulse rate (P < 0.001, systolic blood pressure (BP (P < 0.001, and diastolic BP (P < 0.001 were decreased significantly during 6 hours after receiving the first dose of fingolimod. The most reduction in vital sign was observed in 3 hours. Arrhythmia, bradycardia, and dizziness were the other complications of fingolimod, which were detected in our study. CONCLUSION: All the side effects such as hypotension and bradycardia were happened in first 3 hours after receiving the fingolimod. Indeed, we advise clinicians to monitor the patients for first 6 hours after initiation of fingolimod to decrease worse side effects. 

  8. Inter-observer variation in estimates by nuclear angiography of left ventricular ejection fraction and ejection rate

    International Nuclear Information System (INIS)

    Young, K.C.; Railton, R.

    1980-01-01

    The recent decline in the cost of computing has led to the introduction of data processing of gamma-camera images in many medical centres, allowing the development and widespread use of radionuclide techniques for assessing left ventricular performance. Methods such as ECG-gated blood-pool imaging have the advantage of being less invasive than contrast ventriculography and do not rely on geometrical assumptions about the shape of the ventricle. A study has been made of the inter-observer variation in estimates of ejection fraction and average and maximum systolic contraction rates using a micro-computer (VIP-450 Video Image Processor, Ohio-Nuclear Limited, Rugby) to analyse gated blood-pool images of the left ventricle. (author)

  9. Climatology of the Occurrence Rate and Amplitudes of Local Time Distinguished Equatorial Plasma Depletions Observed by Swarm Satellite

    Science.gov (United States)

    Wan, Xin; Xiong, Chao; Rodriguez-Zuluaga, Juan; Kervalishvili, Guram N.; Stolle, Claudia; Wang, Hui

    2018-04-01

    In this study, we developed an autodetection technique for the equatorial plasma depletions (EPDs) and their occurrence and depletion amplitudes based on in situ electron density measurements gathered by Swarm A satellite. For the first time, comparisons are made among the detected EPDs and their amplitudes with the loss of Global Positioning System (GPS) signal of receivers onboard Swarm A, and the Swarm Level-2 product, Ionospheric Bubble Index (IBI). It has been found that the highest rate of EPD occurrence takes place generally between 2200 and 0000 magnetic local time (MLT), in agreement with the IBI. However, the largest amplitudes of EPD are detected earlier at about 1900-2100 MLT. This coincides with the moment of higher background electron density and the largest occurrence of GPS signal loss. From a longitudinal perspective, the higher depletion amplitude is always witnessed in spatial bins with higher background electron density. At most longitudes, the occurrence rate of postmidnight EPDs is reduced compared to premidnight ones; while more postmidnight EPDs are observed at African longitudes. CHAMP observations confirm this point regardless of high or low solar activity condition. Further by comparing with previous studies and the plasma vertical drift velocity from ROCSAT-1, we suggest that while the F region vertical plasma drift plays a key role in dominating the occurrence of EPDs during premidnight hours, the postmidnight EPDs are the combined results from the continuing of former EPDs and newborn EPDs, especially during June solstice. And these newborn EPDs during postmidnight hours seem to be less related to the plasma vertical drift.

  10. The relationship between experimental geometry, heat rate, and ultrasound wave speed measurement while observing phase changes in highly attenuative materials

    Science.gov (United States)

    Moore, David G.; Stair, Sarah L.; Jack, David A.

    2018-04-01

    Ultrasound techniques are capable of monitoring changes in the time-of-flight as a material is exposed to different thermal environments. The focus of the present study is to identify the phase of a material via ultrasound compression wave measurements in a through transmission experimental setup as the material is heated from a solid to a liquid and then allowed to re-solidify. The present work seeks to expand upon the authors' previous research, which proved this through transmission phase monitoring technique was possible, by considering different experimental geometries. The relationship between geometry, the measured speed of sound, and the temperature profile is presented. The use of different volumes helps in establishing a baseline understanding of which aspects of the experiment are geometry dependent and which are independent. The present study also investigates the relationship between the heating rate observed in the experiment and the measured speed of sound. The trends identified between the experimental geometry, heat rate and ultrasound wave speed measurement assist in providing a baseline understanding of the applicability of this technique to various industries, including the polymer industry and the oil industry.

  11. The Rates of Type I X-ray Bursts from Transients Observed with RXTE: Evidence for Black Hole Event Horizons

    Science.gov (United States)

    Remillard, R. A.; Lin, D.; Cooper, R. L.; Narayan, R.

    2005-12-01

    We measure the rates of type I X-ray bursts from a likely complete sample of 37 non-pulsing Galactic X-ray transients observed with the RXTE ASM during 1996-2004. Our strategy is to test the prevailing paradigms for these sources, which are well-categorized in the literature as either neutron-star systems or black hole candidates. Burst rates are measured as a function of the bolometric luminosity, and the results are compared with burst models for neutron stars and for heavy compact objects with a solid surface. We use augmented versions of the models developed by Narayan & Heyl (2002; 2003). For a given mass, we consider a range of conditions in both the radius and the temperature at the boundary below the accretion layer. We find 135 type I bursts in 3.7 Ms of PCA light curves for the neutron-star group, and the burst rate function is generally consistent with the model predictions for bursts from accreting neutron stars. On the other hand, none of the (20) bursts candidates passed spectral criteria for type I bursts in 6.5 Ms of PCA light curves for black-hole binaries and candidates. The burst function upper limits are inconsistent with the predictions of the burst model for heavy compact objects with a solid surface. The consistency probability is found to be below 10-7 for dynamical black-hole binaries, falling to below 10-13 for the additional exposures of black-hole candidates. These results provide indirect evidence that black holes do have event horizons. This research was supported, in part, by NASA science programs.

  12. Investigating the Effect of Emotional Intelligence on the Addiction Relapse after Quitting

    Directory of Open Access Journals (Sweden)

    Zeinab Raisjouyan

    2014-03-01

    Full Text Available Background: Addiction is multi-dimensional medical problem and psychologic defects have a major role on its establishment. This study was designed to determine the effect of emotional quotient (EQ on the rate of addiction relapse after quitting. Methods: This was a prospective cross-sectional study on 22 to 51 year old subjects who were being treated at chemical dependency rehabilitation centers in Mashhad, Iran, during December 2012 to May 2013. For assessment of EQ, the Persian version of Bar-On EQ questionnaire was employed at first visit of each patient. During the rehabilitation therapy, the subjects were visited monthly. The data of patients were collected during the first 6 months post-quitting. Results: One-hundred sixty subjects were studied which 87% of them were men. Mean (SD score of patients' EQ was 11.9 (2.8. The mean number of addiction relapses was 2.1 (2.8. Data analysis showed that there was a significant inverse correlation between EQ score and the number of relapses (r = -0.82, P = 0.05. In addition, it was found that the EQ score had a direct significant relationship with age (r = 0.33, P = 0.05. No significant correlation between type of abused substance and the number of relapses was found. Conclusion: EQ has a positive impact on preventing addiction relapse. Increasing EQ through educational programs can be used as a preventive measure for treating addict persons.   How to cite this article: Raisjouyan Z, Talebi M, Ghasimi Shahgaldi F, Abdollahian E. Investigating the Effect of Emotional Intelligence on the Addiction Relapse after Quitting. Asia Pac J Med Toxicol 2014;3:27-30.

  13. Remitting - Relapsing Polyneuropathy In Juvenile Metachromatic Leukodystrophy

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    Taly AB

    2004-01-01

    Full Text Available A five-year-old girl manifested with acute relapsing polyradiculo-neuropathy. Elevated cerebrospinal fluid proteins, electro-physiological evidence of conduction block and remitting course suggested possible acquired demyelinating radiculoneuropathy. However, intellectual deterioration during follow up, evidence of extensive, symmetrical and periventricular demyelination on MRI of brain and metachromatic on sural nerve biopsy led to the diagnosis of metachromatic leukodystrophy (MLD. Inherited neuropathies such as MLD may occasionally present atypically in the early stages. Recognition of this variation has considerable therapeutic and prognostic significance.

  14. Breast cancer relapse stage I and II

    International Nuclear Information System (INIS)

    Perez Braojos, Ines; Diaz Gestoso, Yadira; Franco Odio, Sonia; Samuel Gonzalez, Victor

    2009-01-01

    Breast cancer has always been the most common malignancy in women and is the leading cause of death in women, study relapses Stages I and II therapeutic guidelines applied in the service Mastology the 1985 - 1989, was our first objective, the database used was Clinical history, which gave us all the material necessary, treatments were: In tumors up to 3 cm node-conserving surgery plus treatment N0 with ionizing radiation on the breast tangential C0G0 in tumors greater than 3 cm or less with N1 was modified radical mastectomy according to node status for the study of the part and the receiver adjuvant treatment conducted. (Author)

  15. Transcranial magnetic stimulation is effective in the treatment of relapse of depression.

    Science.gov (United States)

    Dannon, P N; Schreiber, S; Dolberg, O T; Shemer, L; Grunhaus, L

    2000-01-01

    The aim of this preliminary report is to demonstrate the efficacy of rapid transcranial magnetic stimulation (rTMS) in the treatment of relapsed major depressive disorder (MDD) patients. Four patients with major depressive disorder who were successfully treated with rTMS received a second course of rTMS treatment. Patients were evaluated with the Hamilton Depression Rating Scale - 21 items, the Brief Psychiatric Rating Scale, the Global Depression Scale and the Global Assessment Scale in both trials. The statistical analysis was performed with paired t-tests and chi squares. Clinical ratings demonstrated a significant improvement at the end of both trials. No significant differences were found between the ratings at the end of the treatment courses. rTMS was successfully used in the treatment of relapsed MDD patients who had previously responsed to rTMS. ( Int J Psych Clin Pract 2000; 4: 223 - 226).

  16. Fingolimod for the Treatment of Relapsing-Remitting Multiple Sclerosis

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    Burcu Altunrende

    2017-12-01

    Full Text Available Multiple sclerosis (MS is a chronic autoimmune disease of the central nervous system and is characterized by inflammation, demyelination, and axonal loss. Fingolimod is the first oral drug for the treatment of MS approved by the United States Food and Drug Administration, European Union countries, and various other countries. The compound exerts its effect via interaction with lysophospholipid receptors known as sphingosine-1 phosphate receptors. Although fingolimod has a very convenient daily oral dosing, it may cause development of bradycardia at the first dose, macular edema, infection, all of which require attention. Randomized double-blind clinical trials have shown that fingolimod significantly reduces relapse rates and is beneficial in brain magnetic resonance imaging measures when compared with both placebo and intramuscular interferon β-1a. This review describes the characteristics of fingolimod concerning its efficacy, safety, and tolerability in the clinical context of the management of MS

  17. Second and third responses to the same induction regimen in relapsing patients with multiple myeloma.

    Science.gov (United States)

    Paccagnella, A; Chiarion-Sileni, V; Soesan, M; Baggio, G; Bolzonella, S; De Besi, P; Casara, D; Frizzarin, M; Salvagno, L; Favaretto, A

    1991-09-01

    From September 1975 to December 1986, 115 consecutive previously untreated patients with multiple myeloma (MM) were treated with combination chemotherapy consisting of BCNU, cyclophosphamide, melphalan, vincristine, and prednisone (M-2). No patients were excluded or lost during follow-up. Forty-three percent of the patients were Stage I plus II, and 57% were Stage III. Thirty-eight patients (33%) had blood urea nitrogen greater than or equal to 40 mg/dl (substage B). Reaching an objective response treatment was stopped, generally after 1 year, and restarted at relapse. After induction therapy, 94 patients (82%) responded and had a median duration of response (MDR) of 22 months. After first relapse, 26 of 38 patients (69%) responded again to the same regimen and had an MDR of 11 months. This response rate and MDR are significantly lower than the ones achieved in induction chemotherapy. After second relapse, 7 of 16 patients (44%) again responded with an MDR of 3.5 months. The median survival time (MST) was 50.5 months for all patients. The most relevant side effect was leukopenia. No case of secondary leukemia was noticed. The authors conclude that patients with MM can be treated safely without maintenance therapy after reaching remission because a high response rate can be obtained in first and even second relapse. The planned treatment pause at remission does not adversely affect the survival time. Secondary leukemia is infrequent after this policy. Quality of life improves during the treatment pause.

  18. Relapse Prevention in Major Depressive Disorder: Mindfulness-Based Cognitive Therapy Versus an Active Control Condition

    Science.gov (United States)

    Shallcross, Amanda J.; Gross, James J.; Visvanathan, Pallavi D.; Kumar, Niketa; Palfrey, Amy; Ford, Brett Q.; Dimidjian, Sona; Shirk, Stephen; Holm-Denoma, Jill; Goode, Kari M.; Cox, Erica; Chaplin, William; Mauss, Iris B.

    2015-01-01

    Objective We evaluated the comparative effectiveness of Mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. Method Ninety-two participants in remission from Major Depressive Disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for non-specific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. Results Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (group x time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction post-intervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. Conclusions MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions. PMID:26371618

  19. Second allogeneic hematopoietic SCT for relapsed ALL in children.

    Science.gov (United States)

    Kato, M; Horikoshi, Y; Okamoto, Y; Takahashi, Y; Hasegawa, D; Koh, K; Takita, J; Inoue, M; Kigasawa, H; Ogawa, A; Sasahara, Y; Kawa, K; Yabe, H; Sakamaki, H; Suzuki, R; Kato, K

    2012-10-01

    A second SCT is generally accepted as the only potentially curative approach for ALL patients that relapse after SCT, but the role of second SCT for pediatric ALL is not fully understood. We performed a retrospective analysis of 171 pediatric patients who received a second allo-SCT for relapsed ALL after allo-SCT. OS at 2 years was 29.4 ± 3.7%, the cumulative incidence of relapse was 44.1 ± 4.0% and non-relapse mortality was 18.8 ± 3.5%. Relapse occurred faster after the second SCT than after the first SCT (117 days vs 164 days, P=0.04). Younger age (9 years or less), late relapse (180 days or more after first SCT), CR at the second SCT, and myeloablative conditioning were found to be related to longer survival. Neither acute GVHD nor the type of donor influenced the outcome of second SCT. Multivariate analysis showed that younger age and late relapse were associated with better outcomes. Our analysis suggests that second SCT for relapsed pediatric ALL is an appropriate treatment option for patients that have achieved CR, which is associated with late relapse after the first SCT.

  20. Durable responses to ibrutinib in patients with relapsed CLL after allogeneic stem cell transplantation.

    Science.gov (United States)

    Link, C S; Teipel, R; Heidenreich, F; Rücker-Braun, E; Schmiedgen, M; Reinhardt, J; Oelschlägel, U; von Bonin, M; Middeke, J M; Muetherig, A; Trautmann-Grill, K; Platzbecker, U; Bornhäuser, M; Schetelig, J

    2016-06-01

    Ibrutinib, a recently approved inhibitor of Bruton's tyrosine kinase (BTK), has shown great efficacy in patients with high-risk CLL. Nevertheless, there are few data regarding its use in patients who relapsed after allogeneic stem cell transplantation (alloSCT). We report clinical data from five CLL patients treated with ibrutinib for relapse after first or even second allogeneic transplantation. Additionally, we performed analyses on cytokine levels and direct measuring of CD4 Th1 and CD4 Th2 cells to evaluate possible clinically relevant immunomodulatory effects of ibrutinib. All patients achieved partial responses including one minimal residual disease (MRD)-negative remission. Within 1 year of follow-up, no relapse was observed. One patient died of severe pneumonia while on ibrutinib treatment. Beside this, no unexpected adverse events were observed. Flow cytometry and analyses of T cell-mediated cytokine levels (IL10 and TNFα) did not reveal substantial changes in T-cell distribution in favor of a CD4 Th1 T-cell shift in our patients. No acute exacerbation of GvHD was reported. In conclusion, these results support further evaluation of ibrutinib in CLL patients relapsing after alloSCT.

  1. Regional nodal relapse in surgically staged Merkel cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hoeller, Ulrike; Mueller, Thomas; Schubert, Tina; Budach, Volker; Ghadjar, Pirus [Charite Universitaetsmedizin Berlin, Department of Radiation Oncology, Berlin (Germany); Brenner, Winfried [Charite Universitaetsmedizin Berlin, Department of Nuclear Medicine, Berlin (Germany); Kiecker, Felix [Charite Universitaetsmedizin Berlin, Department of Dermatology, Berlin (Germany); Schicke, Bernd [Tumor Center Berlin, Berlin (Germany); Haase, Oliver [Charite Universitaetsmedizin Berlin, Department of Surgery, Berlin (Germany)

    2014-10-08

    The nodal relapse pattern of surgically staged Merkel cell carcinoma (MCC) with/without elective nodal radiotherapy (RT) was studied in a single institution. A total of 51 patients with MCC, 33 % UICC stage I, 14 % II, 53 % III (4 lymph node metastases of unknown primary) were eligible. All patients had surgical staging: 23 patients sentinel node biopsy (SNB), 22 patients SNB followed by lymphadenectomy (LAD) and 6 patients LAD. In all, 94 % of the primary tumors (PT) were completely resected; 57 % of patients received RT, 51 % of known PT sites, 33 % (8/24 patients) regional RT to snN0 nodes and 68 % (17/27 patients) to pN+ nodes, mean reference dose 51.5 and 50 Gy, respectively. Mean follow-up was 6 years (range 2-14 years). A total of 22 % (11/51) patients developed regional relapses (RR); the 5-year RR rate was 27 %. In snN0 sites (stage I/II), relapse occurred in 5 of 14 nonirradiated vs. none of 8 irradiated sites (p = 0.054), resulting in a 5-year RR rate of 33 % versus 0 % (p = 0.16). The crude RR rate was lower in stage I (12 %, 2/17 patients) than for stage II (43 %, 3/7 patients). In stage III (pN+), RR appeared to be less frequent in irradiated sites (18 %, 3/14 patients) compared with nonirradiated sites (33 %, 3/10 patients, p = 0.45) with 5-year RR rates of 23 % vs. 34 %, respectively. Our data suggest that adjuvant nodal RT plays a major role even if the sentinel nodes were negative. Adjuvant RT of the lymph nodes in patients with stage IIa tumors and RT after LAD in stage III tumors is proposed and should be evaluated prospectively. (orig.) [German] Untersucht wurde das regionaere Rezidivmuster des Merkelzell-Karzinoms (MCC) nach chirurgischem Staging und stadienadaptierter Therapie. Eingeschlossen wurden 51 Patienten mit lokalisiertem MCC: 33 % hatten UICC-Stadium-I-, 14 % -II-, 53 % -III-Tumoren (davon 4 Lymphknotenmetastasen eines unbekannten Primaertumors). Alle Patienten erhielten ein chirurgisches Staging: 23 Waechterlymphknotenbiopsien (SNB

  2. Prefrontal gamma-aminobutyric acid type A receptor insertion controls cue-induced relapse to nicotine seeking.

    Science.gov (United States)

    Lubbers, Bart R; van Mourik, Yvar; Schetters, Dustin; Smit, August B; De Vries, Taco J; Spijker, Sabine

    2014-11-01

    Current smoking cessation therapies offer limited success, as relapse rates remain high. Nicotine, which is the major component of tobacco smoke, is thought to be primarily responsible for the addictive properties of tobacco. However, little is known about the molecular mechanisms underlying nicotine relapse, hampering development of more effective therapies. The objective of this study was to elucidate the role of medial prefrontal cortex (mPFC) glutamatergic and gamma-aminobutyric acid (GABA)ergic receptors in controlling relapse to nicotine seeking. Using an intravenous self-administration model, we studied glutamate and gamma-aminobutyric acid receptor regulation in the synaptic membrane fraction of the rat mPFC following extinction and cue-induced relapse to nicotine seeking. Subsequently, we locally intervened at the level of GABAergic signaling by using a mimetic peptide of the GABA receptor associated protein-interacting domain of GABA type A (GABAA) receptor subunit γ2 (TAT-GABAγ2) and muscimol, a GABAA receptor agonist. Alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid and N-methyl-D-aspartate receptors were not regulated after the 30-min relapse test. However, GABAA receptor subunits α1 and γ2 were upregulated, and interference with GABAA receptor insertion in the cell membrane using the TAT-GABAγ2 peptide in the dorsal mPFC, but not the ventral mPFC, significantly increased responding during relapse. Increasing GABAA transmission with muscimol in the dorsal and ventral mPFC attenuated relapse. These data indicate that cue-induced relapse entails a GABAergic plasticity mechanism that limits nicotine seeking by restoring inhibitory control in the dorsal mPFC. GABAA receptor-mediated neurotransmission in the dorsal mPFC constitutes a possible future therapeutic target for maintaining smoking abstinence. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  3. Relapses from acute malnutrition and related factors in a community-based management programme in Burkina Faso.

    Science.gov (United States)

    Somassè, Yassinmè Elysée; Dramaix, Michèle; Bahwere, Paluku; Donnen, Philippe

    2016-10-01

    Community-based management of acute malnutrition (CMAM) is effective in treating acute malnutrition. However, post-discharge follow-up often lacks. We aimed at assessing the relapse rate and the associated factors in a CMAM programme in Burkina Faso. Discharged children from the community nutrition centre were requested to return at least every 3 months for follow-up. The data of recovered children (weight-for-height z-score ≥-2) who were discharged between July 2010 and June 2011 were collected in 45 villages, randomly selected out of 210 in January 2012. Sociodemographic data, economic variables, information on household food availability and the child's food consumption in the last 24 h were collected from the parents. A multivariate Cox proportional hazards regression was used to identify the factors associated to relapse. Of the 637 children, 14 (2.2%) died and 218 (34.2%) were lost to follow-up. The relapse rate [95% confidence interval] among the children who returned for follow-up was 15.4 [11.8-19.0] per 100 children-years. The associated factors to relapses in multivariate Cox regression model were mid-upper arm circumference (MUAC) at discharge below 125 mm, no oil/fat consumption during the last 24 h and incomplete vaccination. To limit relapses, CMAM programmes should avoid premature discharge before a MUAC of at least 125 mm. Nutrition education should emphasize fat/oil as inexpensive energy source for children. Promoting immunization is essential to promote child growth. Periodic monitoring of discharged children should be organized to detect earlier those who are at risk of relapse. The relapse rate should be a CMAM effectiveness indicator. © 2015 John Wiley & Sons Ltd.

  4. Clinical trial: factors associated with freedom from relapse of heartburn in patients with healed reflux oesophagitis--results from the maintenance phase of the EXPO study.

    Science.gov (United States)

    Labenz, J; Armstrong, D; Zetterstrand, S; Eklund, S; Leodolter, A

    2009-06-01

    Ability to predict freedom from heartburn relapse during maintenance therapy for healed reflux oesophagitis may facilitate optimal treatment choices for individual patients. To determine factors predicting freedom from heartburn relapse during maintenance proton pump inhibitor therapy in patients with healed reflux oesophagitis. This post-hoc analysis used data from the maintenance phase of the EXPO study (AstraZeneca study code: SH-NEG-0008); 2766 patients with healed reflux oesophagitis and resolved heartburn received once-daily esomeprazole 20 mg or pantoprazole 20 mg for 6 months. Multiple logistic regression analysis determined factors associated with freedom from heartburn relapse. Heartburn relapse rates were lower with esomeprazole than pantoprazole in all subgroups analysed. Esomeprazole treatment was the factor most strongly associated with freedom from heartburn relapse (odds ratio 2.08; P heartburn relapse were Helicobacter pylori infection, greater age, non-obesity, absence of epigastric pain at baseline, pre-treatment nonsevere heartburn and GERD symptom duration heartburn relapse during maintenance proton pump inhibitor therapy for healed reflux oesophagitis, the strongest being choice of proton pump inhibitor. These findings outline the importance of optimizing acid control and identifying predictors of relapse for effective long-term symptom management in reflux oesophagitis patients.

  5. Engaging Parents Who Quit Smoking in Antismoking Socialization of Children: A Novel Approach to Relapse Prevention

    Science.gov (United States)

    Hayes, Kim A.; Dickinson, Denise M.

    2016-01-01

    Abstract Introduction: Data from a randomized controlled trial designed primarily to test the effect of an antismoking socialization parenting program on child initiation of smoking were used to test the subsidiary hypothesis that providing antismoking socialization to children would lower the odds of relapse within a sub-sample of parents who had recently quit smoking. Methods: Over 13 months, 11 state Quitlines provided contact information for callers who were parents of 8- to 10-year-old children. Of 1604 parents enrolled in the trial, 689 (344 treatment; 345 control) had quit smoking cigarettes for at least 24 hours after calling a Quitline. Their data were used to test for group differences in 30-day abstinence measured using telephone interviews conducted 7 and 12 months post-baseline. Analyses of parents with complete follow-up data and intent-to-treat analyses incorporating parents lost to follow-up are presented. Results: Among 465 parents with complete follow-up data, treatment group parents had twice the odds of being abstinent 12 months post-baseline (adjusted OR = 2.01; P = .001) relative to controls. Intent-to-treat analysis with all 689 parents, in which those lost to follow-up were coded as having relapsed, showed a smaller though significant treatment effect on 30-day abstinence at 12 months (adjusted OR = 1.58; P = .017). Conclusions: This study is the first to observe that engaging parents who have quit smoking in antismoking socialization of children can lower their odds of relapse. Additional research is needed to replicate this finding and to identify the psychological mechanisms underlying the observed effect. Implications: There is a clear the need for research to develop new relapse prevention strategies. This study is the first to observe that engaging parents who have quit smoking in antismoking socialization of children can lower their odds of relapse. PMID:26416824

  6. Observation of temperatures and emission rates from the OH and O 2 nightglow over a southern high latitude station

    Science.gov (United States)

    Chung, J.-K.; Kim, Y. H.; Won, Y.-I.; Moon, B. K.; Oh, T. H.

    2006-01-01

    A Spectral Airglow Temperature Imager (SATI) was operated at King Sejong Station (62°13'S, 58°47'W), Korea Antarctic Research Station during the period of March, 2002-September, 2003. We analyze rotational temperatures and emission rates of the O 2 (0-1) and OH (6-2) nightglows obtained at 67 nights with clear sky lasting more than 4 h. A spectral analysis of the dataset shows two dominant oscillations with periods of 4 and 6 h. The 6-h oscillations have a nearly constant phase, whereas the 4-h oscillations have nearly random phases. Although the harmonic periods of both oscillations are suggestive of tidal origin, the 4-h oscillation may have interference by other sources such as gravity waves. The 6-h oscillations could be interpreted as zonally symmetric non-migrating tides because migrating tides except high order modes have very weak amplitudes at high latitudes according to the classical tidal theory. For most cases of the observed oscillations the temperature peak leads the intensity peak, which is consistent with theoretical models for zonally symmetric tides, but contrary to other theoretical models for waves. It is needed to resolve among theoretical models whether or not zonally symmetric tide cause temperature variation prior to intensity variation in mesospheric airglows.

  7. Testing initiatives increase rates of HIV diagnosis in primary care and community settings: an observational single-centre cohort study.

    Directory of Open Access Journals (Sweden)

    Prini Mahendran

    Full Text Available The primary objective was to examine trends in new HIV diagnoses in a UK area of high HIV prevalence between 2000 and 2012 with respect to site of diagnosis and stage of HIV infection.Single-centre observational cohort study.An outpatient HIV department in a secondary care UK hospital.1359 HIV-infected adults.Demographic information (age, gender, ethnicity, and sexual orientation, site of initial HIV diagnosis (Routine settings such as HIV/GUM clinics versus Non-Routine settings such as primary care and community venues, stage of HIV infection, CD4 count and seroconversion symptoms were collated for each participant.There was a significant increase in the proportion of new HIV diagnoses made in Non-Routine settings (from 27.0% in 2000 to 58.8% in 2012; p<0.001. Overall there was a decrease in the rate of late diagnosis from 50.7% to 32.9% (p=0.001. Diagnosis of recent infection increased from 23.0% to 47.1% (p=0.001. Of those with recent infection, significantly more patients were likely to report symptoms consistent with a seroconversion illness over the 13 years (17.6% to 65.0%; p<0.001.This is the first study, we believe, to demonstrate significant improvements in HIV diagnosis and a shift in diagnosis of HIV from HIV/GUM settings to primary practice and community settings due to multiple initiatives.

  8. SU-E-T-144: Bayesian Inference of Local Relapse Data Using a Poisson-Based Tumour Control Probability Model

    Energy Technology Data Exchange (ETDEWEB)

    La Russa, D [The Ottawa Hospital Cancer Centre, Ottawa, ON (Canada)

    2015-06-15

    Purpose: The purpose of this project is to develop a robust method of parameter estimation for a Poisson-based TCP model using Bayesian inference. Methods: Bayesian inference was performed using the PyMC3 probabilistic programming framework written in Python. A Poisson-based TCP regression model that accounts for clonogen proliferation was fit to observed rates of local relapse as a function of equivalent dose in 2 Gy fractions for a population of 623 stage-I non-small-cell lung cancer patients. The Slice Markov Chain Monte Carlo sampling algorithm was used to sample the posterior distributions, and was initiated using the maximum of the posterior distributions found by optimization. The calculation of TCP with each sample step required integration over the free parameter α, which was performed using an adaptive 24-point Gauss-Legendre quadrature. Convergence was verified via inspection of the trace plot and posterior distribution for each of the fit parameters, as well as with comparisons of the most probable parameter values with their respective maximum likelihood estimates. Results: Posterior distributions for α, the standard deviation of α (σ), the average tumour cell-doubling time (Td), and the repopulation delay time (Tk), were generated assuming α/β = 10 Gy, and a fixed clonogen density of 10{sup 7} cm−{sup 3}. Posterior predictive plots generated from samples from these posterior distributions are in excellent agreement with the observed rates of local relapse used in the Bayesian inference. The most probable values of the model parameters also agree well with maximum likelihood estimates. Conclusion: A robust method of performing Bayesian inference of TCP data using a complex TCP model has been established.

  9. Cortical thickness, surface area, and volume of the brain reward system in alcohol dependence: relationships to relapse and extended abstinence.

    Science.gov (United States)

    Durazzo, Timothy C; Tosun, Duygu; Buckley, Shannon; Gazdzinski, Stefan; Mon, Anderson; Fryer, Susanna L; Meyerhoff, Dieter J

    2011-06-01

    a greater magnitude of post-treatment alcohol consumption. Results suggest relapsers demonstrated morphological abnormalities in regions involved in the "top down" regulation/modulation of internal drive states, emotions, reward processing, and behavior, which may impart increased risk for the relapse/remit cycle that afflicts many with an alcohol use disorder. Results also highlight the importance of examining both cortical thickness and surface area to better understand the nature of regional volume loss frequently observed in alcohol use disorders. Results from this report are consistent with previous research implicating plastic neurobiological changes in the BRS in the maintenance of addictive disorders. Copyright © 2011 by the Research Society on Alcoholism.

  10. Efficacy of etanercept in preventing relapse of uveitis controlled by methotrexate.

    Science.gov (United States)

    Foster, C Stephen; Tufail, Fehma; Waheed, Nadia Khalida; Chu, David; Miserocchi, Elisabetta; Baltatzis, Stefanos; Vredeveld, Cindy M

    2003-04-01

    To evaluate the efficacy of etanercept vs placebo in preventing relapses of uveitis in patients taking methotrexate with control of uveitis and whose methotrexate dosage was being tapered. Patients with chronic or recurrent noninfectious uveitis with inflammation controlled by low-dose methotrexate were randomized to either the drug or placebo group in a double-masked manner, given a methotrexate taper schedule, and followed for 24 weeks. The main outcome measures were control of inflammation, visual acuity, and adverse reactions. Data were analyzed both as an attempt-to-treat analysis and an analysis only of those patients who completed the study. A total of 20 patients were randomized to the drug and placebo groups. Relapse of uveitis occurred in 3 of 10 patients in the treatment group and 5 of 10 patients in the control group. Two patients in the treatment group withdrew prematurely from the study due to adverse effects. There was no significant difference between the treatment and placebo groups with regard to the rate of relapse and the final visual acuity. No patient suffered from any irreversible, long-term morbidity or mortality. Etanercept has no significant efficacy over placebo in preventing relapses of uveitis in patients being tapered from methotrexate.

  11. Review of interferon beta-1b in the treatment of early and relapsing multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Damiano Paolicelli

    2009-07-01

    Full Text Available Damiano Paolicelli, Vita Direnzo, Maria TrojanoDepartment of Neurological and Psychiatric Sciences, University of Bari, Bari, ItalyAbstract: Multiple sclerosis (MS is the most common autoimmune illness of the central nervous system. For many years the inflammatory manifestations of MS were treated using only corticosteroids. Since the 1990s the results of several clinical trials with immunomodulatory agents have changed the therapeutic approach to this disease. Interferon beta (IFNβ-1b represents the pioneer of those therapies. There is growing evidence from clinical trials on relapsing-remitting MS and clinically isolated syndromes suggestive of MS that IFNβ-1b reduces the frequency and severity of relapses and the development of new and active brain lesions as assessed by magnetic resonance imaging. Long-term data suggest a persistent efficacy of IFNβ-1b on disease activity and a positive effect in slowing disability worsening. Furthermore a reduction of relapse rate and a slight positive effect on the progression were demonstrated when IFNβ-1b was administered to still-active secondary progressive MS. IFNβ-1b therapy is well tolerated and relatively free of long-term side effects. In spite of the emergence of new agents for the treatment of MS, IFNβ-1b still remains a first-line therapy with a fundamental role in all stages of the disease.Keywords: interferon beta-1b, relapsing-remitting multiple sclerosis, clinically isolated syndromes, efficacy, safety, neutralizing antibodies

  12. Persistence, switch rates, drug consumption and costs of biological treatment of rheumatoid arthritis: an observational study in Italy.

    Science.gov (United States)

    Degli Esposti, Luca; Favalli, Ennio Giulio; Sangiorgi, Diego; Di Turi, Roberta; Farina, Giuseppina; Gambera, Marco; Ravasio, Roberto

    2017-01-01

    The aim of this analysis was to provide an estimate of drug utilization indicators (persistence, switch rate and drug consumption) on biologics and the corresponding costs (drugs, admissions and specialist care) incurred by the Italian National Health Service in the management of adult patients with rheumatoid arthritis (RA). We conducted an observational retrospective cohort analysis using the administrative databases of three local health units. We considered all patients aged ≥18 years with a diagnosis of RA and at least one biologic drug prescription between January 2010 and December 2012 (recruitment period). Persistence was defined as maintenance over the last 3 months of the follow-up period of the same biological therapy administered at the index date. A switch was defined as the presence of a biological therapy other than that administered at the index date during the last 3 months of the follow-up period. Hospital admissions (with a diagnosis of RA or other RA-related diagnoses), specialist outpatient services, instrumental diagnostics and pharmaceutical consumption were assessed. The drug utilization analysis took into account only biologics with at least 90 patients on treatment at baseline (adalimumab n=144, etanercept n=236 and infliximab n=94). In each year, etanercept showed better persistence with initial treatment than adalimumab or infliximab. Etanercept was characterized by the lowest number of patients increasing the initial drug consumption (2.6%) and by the highest number of patients reducing the initial drug consumption (10.5%). The mean cost of treatment for a patient persisting with the initial treatment was €12,388 (€14,182 for adalimumab, €12,103 for etanercept and €11,002 for infliximab). The treatment costs for patients switching from initial treatment during the first year of follow-up were higher than for patients who did not switch (€12,710 vs. €11,332). Persistence, switch rate and drug consumption seem to directly

  13. Melphalan, prednisone, thalidomide and defibrotide in relapsed/refractory multiple myeloma: results of a multicenter phase I/II trial.

    Science.gov (United States)

    Palumbo, Antonio; Larocca, Alessandra; Genuardi, Mariella; Kotwica, Katarzyna; Gay, Francesca; Rossi, Davide; Benevolo, Giulia; Magarotto, Valeria; Cavallo, Federica; Bringhen, Sara; Rus, Cecilia; Masini, Luciano; Iacobelli, Massimo; Gaidano, Gianluca; Mitsiades, Constantine; Anderson, Kenneth; Boccadoro, Mario; Richardson, Paul

    2010-07-01

    Defibrotide is a novel orally bioavailable polydisperse oligonucleotide with anti-thrombotic and anti-adhesive effects. In SCID/NOD mice, defibrotide showed activity in human myeloma xenografts. This phase I/II study was conducted to identify the most appropriate dose of defibrotide in combination with melphalan, prednisone and thalidomide in patients with relapsed and relapsed/refractory multiple myeloma, and to determine its safety and tolerability as part of this regimen. This was a phase I/II, multicenter, dose-escalating, non-comparative, open label study. Oral melphalan was administered at a dose of 0.25 mg/kg on days 1-4, prednisone at a dose of 1.5 mg/kg also on days 1-4 and thalidomide at a dose of 50-100 mg/day continuously. Defibrotide was administered orally at three dose-levels: 2.4, 4.8 or 7.2 g on days 1-4 and 1.6, 3.2, or 4.8 g on days 5-35. Twenty-four patients with relapsed/refractory multiple myeloma were enrolled. No dose-limiting toxicity was observed. In all patients, the complete response plus very good partial response rate was 9%, and the partial response rate was 43%. The 1-year progression-free survival and 1-year overall survival rates were 34% and 90%, respectively. The most frequent grade 3-4 adverse events included neutropenia, thrombocytopenia, anemia and fatigue. Deep vein thrombosis was reported in only one patient. This combination of melphalan, prednisone and thalidomide together with defibrotide showed anti-tumor activity with a favorable tolerability. The maximum tolerated dose of defibrotide was identified as 7.2 g p.o. on days 1-4 followed by 4.8 g p.o. on days 5-35. Further trials are needed to confirm the role of this regimen and to evaluate the combination of defibrotide with new drugs.

  14. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis.

    NARCIS (Netherlands)

    Rudick, R.A.; Stuart, W.H.; Calabresi, P.A.; Confavreux, C.; Galetta, S.L.; Radue, E.W.; Lublin, F.D.; Weinstock-Guttman, B.; Wynn, D.R.; Lynn, F.; Panzara, M.A.; Sandrock, A.W.

    2006-01-01

    BACKGROUND: Interferon beta is used to modify the course of relapsing multiple sclerosis. Despite interferon beta therapy, many patients have relapses. Natalizumab, an alpha4 integrin antagonist, appeared to be safe and effective alone and when added to interferon beta-1a in preliminary studies.

  15. Anca associated vasculitis : occurrence, prediction, prevention, and outcome of relapses

    NARCIS (Netherlands)

    Boomsma, Maarten Michiel

    2001-01-01

    During follow-up, relapses of disease activity occur in the majority of patients with ANCA associated vasculitis. The general objective brought together in this thesis was to further elucidate the characteristics and consequences of these relapses. Investigated items are the occurrence, the

  16. Frequency of relapse among Nigerian children with steroid‑sensitive ...

    African Journals Online (AJOL)

    Background: The clinical course of steroid‑sensitive nephrotic syndrome (SSNS) among Nigerian children has rarely been reported; this makes prognostication difficult. Objectives: The objective was to determine the frequency of relapses including frequent relapses (FR) and steroid‑dependence (SD) in a cohort of Nigerian ...

  17. Predictors of Exercise Relapse in a College Population.

    Science.gov (United States)

    Sullum, Julie; Clark, Matthew M.; King, Teresa K.

    2000-01-01

    Investigated factors that predicted exercise relapse among college students. Physically active undergraduates completed questionnaires measuring Prochaska's 10 processes for change of exercise, self-efficacy, and decisional balance. Exercise levels were assessed at baseline and 8 weeks later. At baseline, relapsers had significantly lower…

  18. Symptomatic relapse of HIV-associated cryptococcal meningitis in ...

    African Journals Online (AJOL)

    Objectives. Cryptococcal meningitis is the most common cause of adult meningitis in southern Africa. Much of this disease burden is thought to be due to symptomatic relapse of previously treated infection. We studied the contribution of inadequate secondary fluconazole prophylaxis to symptomatic relapses of cryptococcal ...

  19. Power2: Relapse Management with Adolescents Who Stutter.

    Science.gov (United States)

    Blood, Gordon W.

    1995-01-01

    This article describes a cognitive-behavioral treatment package for relapse management in adolescents who stutter. The package includes game-based training techniques in problem solving, communication skills, and assertiveness; coping responses for stuttering episodes; and realistic expectations for fluency and relapse. Follow-up results with…

  20. Factors associated with relapse in schizophrenia | Kazadi | South ...

    African Journals Online (AJOL)

    Aim. Early identification and prevention of relapse in patients with schizophrenia has significant therapeutic and socioeconomic implications. The aim of this study was to determine the factors, if any, that may be associated with relapse in a group of patients in Johannesburg. Method. Patients were recruited from mental ...

  1. An Integrative Ambient Agent Model for Unipolar Depression Relapse Prevention

    NARCIS (Netherlands)

    Aziz, A.A.; Klein, M.C.A.; Treur, J.

    2010-01-01

    One of the challenges for persons with a history of unipolar depression is to stay healthy throughout their lifetime. In principle, having more severe prior onset cases escalates the risk to fall into a relapse. In this article, first a domain model of the process of depression, recovery and relapse

  2. Relapse and craving in alcohol-dependent individuals

    NARCIS (Netherlands)

    van de Mheen, H,; Snelleman, M.; Schoenmakers, T.M.

    2018-01-01

    Background: Negative affective states and alcohol-related stimuli increase risk of relapse in alcohol dependence. In research and in clinical practice, craving is often used as another important indicator of relapse, but this lacks a firm empirical foundation. Objectives: The goal of the present

  3. Relapse prevention in patients with schizophrenia : A nursing intervention study

    NARCIS (Netherlands)

    Meijel, Berno van

    2003-01-01

    This thesis describes a study into the development and testing of a nursing intervention with a view to preventing psychotic relapses in patients suffering from schizophrenia or a related disorder. The purpose of the intervention is to recognise the early signs of an oncoming psychotic relapse. If

  4. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma

    NARCIS (Netherlands)

    P.G. Richardson (Paul Gerard); P. Sonneveld (Pieter); M.W. Schuster (Michael); D. Irwin (David); E.A. Stadtmauer (Edward); T. Facon (Thierry); J-L. Harousseau (Jean-Luc); D. Ben-Yehuda (Dina); S. Lonial (Sagar); H. Goldschmidt (Hartmut); D. Reece (Donna); J.F. San Miguel (Jesús Fernando); J. Bladé (Joan); M. Boccadoro (Mario); J. Cavenagh (Jamie); W. Dalton (William); A.L. Boral (Anthony); D.-L. Esseltine (Dixie-Lee); J.B. Porter (Jane); D. Schenkein (David); K.C. Anderson (Kenneth)

    2005-01-01

    textabstractBACKGROUND: This study compared bortezomib with high-dose dexamethasone in patients with relapsed multiple myeloma who had received one to three previous therapies. METHODS: We randomly assigned 669 patients with relapsed myeloma to receive either an intravenous bolus of bortezomib (1.3

  5. Extinction of relapsed fear does not require the basolateral amygdala.

    Science.gov (United States)

    Lingawi, Nura W; Westbrook, R Frederick; Laurent, Vincent

    2017-03-01

    It is well established that extinguished fears are restored with the passage of time or a change in physical context. These fear restoration phenomena are believed to mimic the conditions under which relapse occurs in patients that have been treated for anxiety disorders by means of cue-exposure therapy. Here, we used a rodent model to extinguish relapsed fear and assess whether this new extinction prevents further relapse. We found that activity in the basolateral amygdala (BLA) is required to initially extinguish conditioned fear, but this activity was not necessary to subsequently extinguish relapsed fear. That is, extinction of spontaneously recovered or renewed fear was spared by BLA inactivation. Yet, this BLA-independent learning of extinction did not protect against further relapse: extinction of relapsed fear conducted without BLA activity was still likely to return after the passage of time or a shift in physical context. These findings have important clinical implications. They indicate that pharmacological agents with anxiolytic properties may disrupt initial cue-exposure therapy but may be useful when therapy is again needed due to relapse. However, they also suggest that these agents will not protect against further relapse, implying the need for developing drugs that target other brain regions involved in fear inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. New-onset ascites as a manifestation of virologic relapse in patients with hepatitis C cirrhosis

    Directory of Open Access Journals (Sweden)

    Chua DL

    2014-01-01

    Full Text Available Deborah Lim Chua, Thomas Hahambis, Samuel H SigalDivision of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, NY, USABackground: Chronic hepatitis C is the most common cause of cirrhosis in industrialized countries. Successful treatment of chronic hepatitis C in patients with advanced fibrosis or cirrhosis has significant benefits, including improvements in inflammation, fibrosis, and portal hypertension, with prevention of esophageal varices and clinical decompensation.Case: In this report, we present two patients with well-compensated hepatitis C cirrhosis who achieved an end-of-treatment response on a direct-acting antiviral therapy-based triple regimen for hepatitis C virus, but subsequently presented with new-onset ascites associated with virologic relapse.Conclusion: We propose that the development of ascites in this setting is due to the adverse impact of inflammation of the virologic relapse on portal hypertension. Our observation that ascites formation can be a manifestation of virologic relapse has potentially important clinical implications, as it highlights not only the importance of close monitoring of cirrhotic patients after achieving end-of-treatment response but also the impact of active inflammation on the severity of portal hypertension.Keywords: chronic hepatitis C, cirrhosis, virologic relapse, portal hypertension, ascites

  7. Relapse prevention in anorexia nervosa: Experiences of patients and parents.

    Science.gov (United States)

    Berends, Tamara; van de Lagemaat, Marleen; van Meijel, Berno; Coenen, Jasmijn; Hoek, Hans W; van Elburg, Annemarie A

    2018-03-24

    One of the main aims of treatment after successful recovery from anorexia nervosa (AN) is to prevent a relapse. The Guideline Relapse Prevention (GRP) Anorexia Nervosa offers a structured approach to relapse prevention. This study explores how patients and their parents experience working with the guideline. It also describes the factors that support or hinder successful application of the guideline. A descriptive qualitative research design was chosen involving in-depth interviews with seventeen patients with anorexia nervosa and six sets of parents. Patients and family members were generally satisfied with the support provided by the GRP. It contributed significantly to a better understanding of the personal process of relapse. Patients and families valued being able to keep in touch with their professional during the aftercare programme. The GRP supports the patient's use of self-management strategies for relapse prevention. © 2018 Australian College of Mental Health Nurses Inc.

  8. Increased multiple sclerosis relapses related to lower prevalence of pain

    Directory of Open Access Journals (Sweden)

    José Vinícius Martins da Silva

    2015-07-01

    Full Text Available Objective The study aims to investigate the presence of pain amongst multiple sclerosis (MS patients. Method One hundred MS patients responded to questionnaires evaluating neuropathic and nociceptive pain, depression and anxiety. Statistical analysis was performed using the Mann–Whitney U, Chi-Square and two-tailed Fisher’s exact tests and multivariate logistic regression. Results Women had a statistically higher prevalence of pain (p = 0.037, and chances of having pain after the age of 50 reduced. Women with pain had a statistically significant lower number of relapses (p = 0.003, restricting analysis to those patients with more than one relapse. After the second relapse, each relapse reduced the chance of having pain by 46%. Presence of pain was independent of Expanded Disability Status Scale (EDSS anxiety, and depression. Conclusion Our findings suggest a strong inverse association between relapses and pain indicating a possible protective role of focal inflammation in the control of pain.

  9. Predictive factors for relapse in patients on buprenorphine maintenance.

    Science.gov (United States)

    Ferri, Michael; Finlayson, Alistair J Reid; Wang, Li; Martin, Peter R

    2014-01-01

    Despite the dramatic increase in the use of buprenorphine for the treatment of opioid dependence, clinical outcomes of this treatment approach continue to need evaluation. This study examines factors associated with relapse and retention during buprenorphine treatment in a sample of opioid dependent outpatients. In a retrospective chart review of 62 patients with opioid dependence, relapse was determined by self-report, urine toxicology screens, and by checking the state controlled substance monitoring database. Data was analyzed using two-way tests of association and logistic regression. Patients with comorbid anxiety disorders, active benzodiazepine use (contrary to clinic policy), or active alcohol abuse, were significantly more likely to relapse. Patients who relapsed were also more likely to be on a higher buprenorphine maintenance dose. This study identifies relapse risk factors during buprenorphine treatment for opioid dependence. Future research is needed to determine whether modifying these factors may lead to improved treatment outcomes. © American Academy of Addiction Psychiatry.

  10. An Examination of the Change in the Earth's Rotation Rate From Ancient Chinese Observations of Lunar Occultations of the Planets

    National Research Council Canada - National Science Library

    Hilton, James L; Seidelmann, P. Kenneth; Ciyuan, Liu

    1992-01-01

    ...., a period with no other known observations useful for Earth rotation studies. The observations are compared to topocentric ephemerides computed using Bretagnon's planetary theories VSOP82 and the Chapront-Touze lunar theory ELP2000-85...

  11. Personality Stability from Childhood to Midlife: Relating Teachers’ Assessments in Elementary School to Observer- and Self-Ratings 40 Years Later

    Science.gov (United States)

    Edmonds, Grant W.; Goldberg, Lewis R.; Hampson, Sarah E.; Barckley, Maureen

    2013-01-01

    We report on the longitudinal stability of personality traits across an average 40 years in the Hawaii Personality and Health Cohort relating childhood teacher assessments of personality to adult self- and observer- reports. Stabilities based on self-ratings in adulthood were compared to those measured by the Structured Interview for the Five-Factor Model (SIFFM; Trull & Widiger, 1997), and trait ratings completed by interviewers. Although convergence between self-reports and observer-ratings was modest, childhood traits demonstrated similar levels of stability across methods in adulthood. Extraversion and Conscientiousness generally showed higher stabilities, whereas Neuroticism showed none. For Agreeableness and Intellect/Openness, stability was highest when assessed with observer-ratings. These findings are discussed in terms of differences in trait evaluativeness and observability across measurement methods. PMID:24039315

  12. Estimated medical cost reductions for paliperidone palmitate vs placebo in a randomized, double-blind relapse-prevention trial of patients with schizoaffective disorder.

    Science.gov (United States)

    Joshi, K; Lin, J; Lingohr-Smith, M; Fu, D J

    2015-01-01

    The objective of this economic model was to estimate the difference in medical costs among patients treated with paliperidone palmitate once-monthly injectable antipsychotic (PP1M) vs placebo, based on clinical event rates reported in the 15-month randomized, double-blind, placebo-controlled, parallel-group study of paliperidone palmitate evaluating time to relapse in subjects with schizoaffective disorder. Rates of psychotic, depressive, and/or manic relapses and serious and non-serious treatment-emergent adverse events (TEAEs) were obtained from the long-term paliperidone palmitate vs placebo relapse prevention study. The total annual medical cost for a relapse from a US payer perspective was obtained from published literature and the costs for serious and non-serious TEAEs were based on Common Procedure Terminology codes. Total annual medical cost differences for patients treated with PP1M vs placebo were then estimated. Additionally, one-way and Monte Carlo sensitivity analyses were conducted. Lower rates of relapse (-18.3%) and serious TEAEs (-3.9%) were associated with use of PP1M vs placebo as reported in the long-term paliperidone palmitate vs placebo relapse prevention study. As a result of the reduction in these clinical event rates, the total annual medical cost was reduced by $7140 per patient treated with PP1M vs placebo. One-way sensitivity analysis showed that variations in relapse rates had the greatest impact on the estimated medical cost differences (range: -$9786, -$4670). Of the 10,000 random cycles of Monte Carlo simulations, 100% showed a medical cost difference schizoaffective disorder was associated with a significantly lower rate of relapse and a reduction in medical costs compared to placebo. Further evaluation in the real-world setting is warranted.

  13. In search of the optimal platform for Post-Allogeneic SCT immunotherapy in relapsed multiple myeloma: a systematic review.

    Science.gov (United States)

    Oostvogels, R; Uniken Venema, S M; de Witte, M; Raymakers, R; Kuball, J; Kröger, N; Minnema, M C

    2017-09-01

    Allogeneic stem cell transplantation (allo-SCT) has the potential to induce sustained remissions in patients with multiple myeloma (MM). Currently, allo-SCT is primarily performed in high-risk MM patients, most often in the setting of early relapse after first-line therapy with autologous SCT. However, the implementation of allo-SCT for MM is jeopardized by high treatment-related mortality (TRM) rates as well as high relapse rates. In this systematic review, we aimed to identify a safe allo-SCT strategy that has optimal 1-year results regarding mortality, relapse and severe GvHD, creating opportunities for post-transplantation strategies to maintain remissions in the high-risk group of relapsed MM patients. Eleven studies were included. Median PFS ranged from 5.2 to 36.8 months and OS was 13.0 to 63.0 months. The relapse related mortality at 1 year varied between 0 and 50% and TRM between 8 and 40%. Lowest GvHD incidences were reported for conditioning regimens with T-cell depletion using ATG or graft CD34+ selection. Similar strategies could lay the foundation for a post-transplant immune platform, this should be further evaluated in prospective clinical trials.

  14. Persistence, switch rates, drug consumption and costs of biological treatment of rheumatoid arthritis: an observational study in Italy

    Directory of Open Access Journals (Sweden)

    Degli Esposti L

    2016-12-01

    Full Text Available Luca Degli Esposti,1 Ennio Giulio Favalli,2 Diego Sangiorgi,1 Roberta Di Turi,3 Giuseppina Farina,4 Marco Gambera,5 Roberto Ravasio,6 1CliCon S.r.l. – Health, Economics & Outcomes Research, Ravenna, 2Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, 3Local Pharmaceutical and Supplementary Assistance Unit, Roma Local Health Authority D, Rome, 4Internal Management Control Unit – Pharmaceutical Spending Control Sector, Caserta Local Health Authority, Caserta, 5Local Pharmaceutical Service, Bergamo Local Health Authority, Bergamo, 6Health Publishing & Services Srl, Milan, Italy Objectives: The aim of this analysis was to provide an estimate of drug utilization indicators (persistence, switch rate and drug consumption on biologics and the corresponding costs (drugs, admissions and specialist care incurred by the Italian National Health Service in the management of adult patients with rheumatoid arthritis (RA.Methods: We conducted an observational retrospective cohort analysis using the administrative databases of three local health units. We considered all patients aged ≥18 years with a diagnosis of RA and at least one biologic drug prescription between January 2010 and December 2012 (recruitment period. Persistence was defined as maintenance over the last 3 months of the follow-up period of the same biological therapy administered at the index date. A switch was defined as the presence of a biological therapy other than that administered at the index date during the last 3 months of the follow-up period. Hospital admissions (with a diagnosis of RA or other RA-related diagnoses, specialist outpatient services, instrumental diagnostics and pharmaceutical consumption were assessed.Results: The drug utilization analysis took into account only biologics with at least 90 patients on treatment at baseline (adalimumab n=144, etanercept n=236 and infliximab n=94. In each year, etanercept showed better persistence with initial

  15. Planned home compared with planned hospital births: Mode of delivery and Perinatal mortality rates, an observational study

    NARCIS (Netherlands)

    Kooy, J. (Jacoba); E. Birnie (Erwin); S. Denktaş (Semiha); E.A.P. Steegers (Eric); G.J. Bonsel (Gouke)

    2017-01-01

    textabstractBackground: To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. Methods: Intervention and perinatal mortality rates were obtained for 679,952 low-risk

  16. SUPPLEMENT: "THE RATE OF BINARY BLACK HOLE MERGERS INFERRED FROM ADVANCED LIGO OBSERVATIONS SURROUNDING GW150914" (2016, ApJL, 833, L1)

    NARCIS (Netherlands)

    Abbott, B. P.; Abbott, R.; Abbott, T. D.; Abernathy, M. R.; Acernese, F.; Ackley, K.; Adams, C.; Phythian-Adams, A.T.; Addesso, P.; Adhikari, R. X.; Adya, V. B.; Affeldt, C.; Agathos, M.; Agatsuma, K.; Aggarwal, N.T.; Aguiar, O. D.; Aiello, L.; Ain, A.; Ajith, P.; Allen, B.; Allocca, A.; Altin, P. A.; Anderson, S. B.; Anderson, W. G.; Arai, K.; Araya, M. C.; Arceneaux, C. C.; Areeda, J. S.; Arnaud, N.; Arun, K. G.; Ascenzi, S.; Ashton, G.; Ast, M.; Aston, S. M.; Astone, P.; Aufmuth, P.; Aulbert, C.; Babak, S.; Bacon, P.; Bader, M. K. M.; Baker, P. T.; Baldaccini, F.; Ballardin, G.; Ballmer, S. W.; Barayoga, J. C.; Barclay, S. E.; Barish, B. C.; Barker, R.D.; Barone, F.; Barr, B.; Barsotti, L.; Barsuglia, M.; Barta, D.; Bartlett, J.; Bartos, I.; Bassiri, R.; Basti, A.; Batch, J. C.; Baune, C.; Bavigadda, V.; Bazzan, M.; Behnke, B.; Bejger, M.; Bell, A. S.; Bell, C. J.; Berger, B. K.; Bergman, J.; Bergmann, G.; Berry, C. P. L.; Bersanetti, D.; Bertolini, A.; Betzwieser, J.; Bhagwat, S.; Bhandare, R.; Bilenko, I. A.; Billingsley, G.; Birch, M.J.; Birney, R.; Biscans, S.; Bisht, A.; Bitossi, M.; Biwer, C.; Bizouard, M. A.; Blackburn, J. K.; Blair, C. D.; Blair, D. G.; Blair, R. M.; Bloemen, A.L.S.; Bock, O.; Bodiya, T. P.; Boer, M.; Bogaert, J.G.; Bogan, C.; Bohe, A.; Bojtos, P.; Bond, T.C; Bondu, F.; Bonnand, R.; Boom, B. A.; Bork, R.; Boschi, V.; Bose, S.; Bouffanais, Y.; Bozzi, A.; Bradaschia, C.; Brady, P. R.; Braginsky, V. B.; Branchesi, M.; Brau, J. E.; Briant, T.; Brillet, A.; Brinkmann, M.; Brisson, V.; Brockill, P.; Brooks, A. F.; Brown, A.D.; Brown, D.; Brown, N. M.; Buchanan, C. C.; Buikema, A.; Bulik, T.; Bulten, H. J.; Buonanno, A.; Buskulic, D.; Buy, C.; Byer, R. L.; Cadonati, L.; Cagnoli, G.; Cahillane, C.; Calderon Bustillo, J.; Callister, T. A.; Calloni, E.; Camp, J. B.; Cannon, K. C.; Cao, J.; Capano, C. D.; Capocasa, E.; Carbognani, F.; Caride, S.; Diaz, J. Casanueva; Casentini, C.; Caudill, S.; Cavaglia, M.; Cavalier, F.; Cavalieri, R.; Cella, G.; Cepeda, C. B.; Baiardi, L. Cerboni; Cerretani, G.; Cesarini, E.; Chakraborty, R.; Chalermsongsak, T.; Chamberlin, S. J.; Chan, M.; Chao, D. S.; Charlton, P.; Chassande-Mottin, E.; Chen, H. Y.; Chen, Y; Cheng, C.; Chincarini, A.; Chiummo, A.; Cho, H. S.; Cho, M.; Chow, J. H.; Christensen, N.; Chu, Qian; Chua, S. E.; Chung, E.S.; Ciani, G.; Clara, F.; Clark, J. A.; Cleva, F.; Coccia, E.; Cohadon, P. -F.; Colla, A.; Collette, C. G.; Cominsky, L.; Constancio, M., Jr.; Conte, A.; Conti, L.; Cook, D.; Corbitt, T. R.; Cornish, N.; Corsi, A.; Cortese, S.; Costa, A.C.; Coughlin, M. W.; Coughlin, S. B.; Coulon, J. -P.; Countryman, S. T.; Couvares, P.; Cowan, E. E.; Coward, D. M.; Cowart, M. J.; Coyne, D. C.; Coyne, R.; Craig, K.; Creighton, J. D. E.; Cripe, J.; Crowder, S. G.; Cumming, A.; Cunningham, A.L.; Cuoco, E.; Dal Canton, T.; Danilishin, S. L.; D'Antonio, S.; Danzmann, K.; Darman, N. S.; Dattilo, V.; Dave, I.; Daveloza, H. P.; Davier, M.; Davies, G. S.; Daw, E. J.; Day, R.; De, S.; Debra, D.; Debreczeni, G.; Degallaix, J.; De laurentis, M.; Deleglise, S.; Del Pozzo, W.; Denker, T.; Dent, T.; Dereli, H.; Dergachev, V.A.; Rosa, R.; DeRosa, R. T.; DeSalvo, R.; Dhurandhar, S.; Diaz, M. C.; Di Fiore, L.; Giovanni, M.G.; Di Lieto, A.; Di Pace, S.; Di Palma, I.; Di Virgilio, A.; Dojcinoski, G.; Dolique, V.; Donovan, F.; Dooley, K. L.; Doravari, S.; Douglas, R.; Downes, T. P.; Drago, M.; Drever, R. W. P.; Driggers, J. C.; Du, Z.; Ducrot, M.; Dwyer, S. E.; Edo, T. B.; Edwards, M. C.; Effler, A.; Eggenstein, H. -B.; Ehrens, P.; Eichholz, J.; Eikenberry, S. S.; Engels, W.; Essick, R. C.; Etzel, T.; Evans, T. M.; Evans, T. M.; Everett, R.; Factourovich, M.; Fafone, V.; Fair, H.; Fairhurst, S.; Fan, X.M.; Fang, Q.; Farinon, S.; Farr, B.; Farr, W. M.; Favata, M.; Fays, M.; Fehrmann, H.; Fejer, M. M.; Ferrante, I.; Ferreira, E. C.; Ferrini, F.; Fidecaro, F.; Fiori, I.; Fiorucci, D.; Fisher, R. P.; Flaminio, R.; Fletcher, M; Fong, H.; Fournier, J. -D.; Franco, S; Frasca, S.; Frasconi, F.; Frei, Z.; Freise, A.; Frey, R.; Frey, V.; Fricke, T. T.; Fritschel, P.; Frolov, V. V.; Fulda, P.; Fyffe, M.; Gabbard, H. A. G.; Gair, J. R.; Gammaitoni, L.; Gaonkar, S. G.; Garufi, F.; Gatto, A.; Gaur, G.; Gehrels, N.; Gemme, G.; Gendre, B.; Genin, E.; Gennai, A.; George, J.; Gergely, L.; Germain, V.; Ghosh, Archisman; Ghosh, S.; Giaime, J. A.; Giardina, K. D.; Giazotto, A.; Gill, K.P.; Glaefke, A.; Goetz, E.; Goetz, R.; Gondan, L.; Gonzalez, R.G.; Castro, J. M. Gonzalez; Gopakumar, A.; Gordon, A; Gorodetsky, M. L.; Gossan, S. E.; Lee-Gosselin, M.; Gouaty, R.; Graef, C.; Graff, P. B.; Granata, M.; Grant, A.; Gras, S.; Gray, C.M.; Greco, G.; Green, A. C.; Groot, P.; Grote, H.; Grunewald, S.; Guidi, G. M.; Guo, X.; Gupta, A.; Gupta, M. K.; Gushwa, K. E.; Gustafson, E. K.; Gustafson, R.; Hacker, J. J.; Buffoni-Hall, R.; Hall, E. D.; Hammond, G.L.; Haney, M.; Hanke, M. M.; Hanks, J.; Hanna, C.; Hannam, M. D.; Hanson, P.J.; Hardwick, T.; Harms, J.; Harry, G. M.; Harry, I. W.; Hart, M. J.; Hartman, M. T.; Haster, C. -J.; Haughian, K.; Heidmann, A.; Heintze, M. C.; Heitmann, H.; Hello, P.; Hemming, G.; Hendry, M.; Heng, I. S.; Hennig, J.; Heptonstall, A. W.; Heurs, M.; Hild, S.; Hoak, D.; Hodge, K. A.; Hofman, D.; Hollitt, S. E.; Holt, K.; Holz, D. E.; Hopkins, P.; Hosken, D. J.; Hough, J.; Houston, E. A.; Howell, E. J.; Hu, Y. M.; Huang, S.; Huerta, E. A.; Huet, D.; Hughey, B.; Husa, S.; Huttner, S. H.; Huynh-Dinh, T.; Idrisy, A.; Indik, N.; Ingram, D. R.; Inta, R.; Isa, H. N.; Isac, J. -M.; Isi, M.; Islas, G.; Isogai, T.; Iyer, B. R.; Izumi, K.; Jacqmin, T.; Jang, D.H.; Jani, K.; Jaranowski, P.; Jawahar, S.; Jimenez-Forteza, F.; Johnson, W.; Jones, I.D.; Jones, R.; Jonker, R. J. G.; Ju, L.; Haris, K.; Kalaghatgi, C. V.; Kalogera, V.; Kandhasamy, S.; Kang, G.H.; Kanner, J. B.; Karki, S.; Kasprzack, M.; Katsavounidis, E.; Katzman, W.; Kaufer, S.; Kaur, T.; Kawabe, K.; Kawazoe, F.; Kefelian, F.; Kehl, M. S.; Keitel, D.; Kelley, D. B.; Kells, W.; Kennedy, R.E.; Key, J. S.; Khalaidovski, A.; Khalili, F. Y.; Khan, I.; Khan., S.; Khan, Z.; Khazanov, E. A.; Kijbunchoo, N.; Kim, C.; Kim, J.; Kim, K.; Kim, Nam-Gyu; Kim, Namjun; Kim, Y.M.; King, E. J.; King, P. J.; Kinzel, D. L.; Kissel, J. S.; Kleybolte, L.; Klimenko, S.; Koehlenbeck, S. M.; Kokeyama, K.; Koley, S.; Kondrashov, V.; Kontos, A.; Korobko, M.; Korth, W. Z.; Kowalska, I.; Kozak, D. B.; Kringel, V.; Krishnan, B.; Krolak, A.; Krueger, C.; Kuehn, G.; Kumar, P.; Kuo, L.; Kutynia, A.; Lackey, B. D.; Landry, M.; Lange, J.; Lantz, B.; Lasky, P. D.; Lazzarini, A.; Lazzaro, C.; Leaci, P.; Leavey, S.; Lebigot, E. O.; Lee, C.H.; Lee, K.H.; Lee, M.H.; Lee, K.; Lenon, A.; Leonardi, M.; Leong, J. R.; Leroy, N.; Letendre, N.; Levin, Y.; Levine, B. M.; Li, T. G. F.; Libson, A.; Littenberg, T. B.; Lockerbie, N. A.; Logue, J.; Lombardi, A. L.; Lord, J. E.; Lorenzini, M.; Loriette, V.; Lormand, M.; Losurdo, G.; Lough, J. D.; Lueck, H.; Lundgren, A. P.; Luo, J.; Lynch, R.; Ma, Y.; MacDonald, T.T.; Machenschalk, B.; MacInnis, M.; Macleod, D. M.; Magana-Sandoval, F.; Magee, R. M.; Mageswaran, M.; Majorana, E.; Maksimovic, I.; Malvezzi, V.; Man, N.; Mandel, I.; Mandic, V.; Mangano, V.; Mansell, G. L.; Manske, M.; Mantovani, M.; Marchesoni, F.; Marion, F.; Marka, S.; Marka, Z.; Markosyan, A. S.; Maros, E.; Martelli, F.; Martellini, L.; Martin, I. W.; Martin, R.M.; Martynov, D. V.; Marx, J. N.; Mason, K.; Masserot, A.; Massinger, T. J.; Masso-Reid, M.; Matichard, F.; Matone, L.; Mavalvala, N.; Mazumder, N.; Mazzolo, G.; McCarthy, R.; McClelland, D. E.; McCormick, S.; McGuire, S. C.; McIntyre, G.; McIver, J.; McManus, D. J.; McWilliams, S. T.; Meacher, D.; Meadors, G. D.; Meidam, J.; Melatos, A.; Mendell, G.; Mendoza-Gandara, D.; Mercer, R. A.; Merilh, E. L.; Merzougui, M.; Meshkov, S.; Messenger, C.; Messick, C.; Meyers, P. M.; Mezzani, F.; Miao, H.; Michel, C.; Middleton, H.; Mikhailov, E. E.; Milano, L.; Miller, J.; Millhouse, M.; Minenkov, Y.; Ming, J.; Mirshekari, S.; Mishra, C.; Mitra, S.; Mitrofanov, V. P.; Mitselmakher, G.; Mittleman, R.; Moggi, A.; Mohan, M.; Mohapatra, S. R. P.; Montani, M.; Moore, B.C.; Moore, J.C.; Moraru, D.; Gutierrez Moreno, M.; Morriss, S. R.; Mossavi, K.; Mours, B.; Mow-Lowry, C. M.; Mueller, C. L.; Mueller, G.; Muir, A. W.; Mukherjee, Arunava; Mukherjee, S.D.; Mukherjee, S.; Mukund, N.; Mullavey, A.; Munch, J.; Murphy, D. J.; Murray, P.G.; Mytidis, A.; Nardecchia, I.; Naticchioni, L.; Nayak, R. K.; Necula, V.; Nedkova, K.; Nelemans, G.; Gutierrez-Neri, M.; Neunzert, A.; Newton-Howes, G.; Nguyen, T. T.; Nielsen, A. B.; Nissanke, S.; Nitz, A.; Nocera, F.; Nolting, D.; Normandin, M. E. N.; Nuttall, L. K.; Oberling, J.; Ochsner, E.; O'Dell, J.; Oelker, E.; Ogin, G. H.; Oh, J.; Oh, S. H.; Ohme, F.; Oliver, M. B.; Oppermann, P.; Oram, Richard J.; O'Reilly, B.; O'Shaughnessy, R.; Ottaway, D. J.; Ottens, R. S.; Overmier, H.; Owen, B. J.; Pai, A.; Pai, S. A.; Palamos, J. R.; Palashov, O.; Palomba, C.; Pal-Singh, A.; Pan, H.; Pankow, C.; Pannarale, F.; Pant, B. C.; Paoletti, F.; Paoli, A.; Papa, M. A.; Paris, H. R.; Parker, W.S; Pascucci, D.; Pasqualetti, A.; Passaquieti, R.; Passuello, D.; Patricelli, B.; Patrick, Z.; Pearlstone, B. L.; Pedraza, M.; Pedurand, R.; Pekowsky, L.; Pele, A.; Penn, S.; Perreca, A.; Phelps, M.; Piccinni, O. J.; Pichot, M.; Piergiovanni, F.; Pierro, V.; Pillant, G.; Pinard, L.; Pinto, I. M.; Pitkin, M.; Poggiani, R.; Popolizio, P.; Porter, E. K.; Post, A.; Powell, J.; Prasad, J.; Predoi, V.; Premachandra, S. S.; Prestegard, T.; Price, L. R.; Prijatelj, M.; Principe, M.; Privitera, S.; Prodi, G. A.; Prokhorov, L. G.; Puncken, O.; Punturo, M.; Puppo, P.; Puerrer, M.; Qi, H.; Qin, J.; Quetschke, V.; Quintero, E. A.; Quitzow-James, R.; Raab, F. J.; Rabeling, D. S.; Radkins, H.; Raffai, P.; Raja, S.; Rakhmanov, M.; Rapagnani, P.; Raymond, V.; Razzano, M.; Re, V.; Read, J.; Reed, C. M.; Regimbau, T.; Rei, L.; Reid, S.; Reitze, D. H.; Rew, H.; Reyes, S. D.; Ricci, F.; Riles, K.; Robertson, N. A.; Robie, R.; Robinet, F.; Rocchi, A.; Rolland, L.; Rollins, J. G.; Roma, V. J.; Romano, R.; Romanov, G.; Romie, J. H.; Rosinska, D.; Rowan, S.; Ruediger, A.; Ruggi, P.; Ryan, K.A.; Sachdev, P.S.; Sadecki, T.; Sadeghian, L.; Salconi, L.; Saleem, M.; Salemi, F.; Samajdar, A.; Sammut, L.; Sampson, L. M.; Sanchez, E. J.; Sandberg, V.; Sandeen, B.; Sanders, J. R.; Sassolas, B.; Sathyaprakash, B. S.; Saulson, P. R.; Sauter, O.; Savage, R. L.; Sawadsky, A.; Schale, P.; Schilling, R.; Schmidt, J; Schmidt, P.; Schnabel, R.B.; Schofield, R. M. S.; Schoenbeck, A.; Schreiber, K.E.C.; Schuette, D.; Schutz, B. F.; Scott, J.; Scott, M.S.; Sellers, D.; Sengupta, A. S.; Sentenac, D.; Sequino, V.; Sergeev, A.; Serna, G.; Setyawati, Y.; Sevigny, A.; Shaddock, D. A.; Shah, S.; Shahriar, M. S.; Shaltev, M.; Shao, Z.M.; Shapiro, B.; Shawhan, P.; Sheperd, A.; Shoemaker, D. H.; Shoemaker, D. M.; Siellez, K.; Siemens, X.; Sigg, D.; Silva, António Dias da; Simakov, D.; Singer, A; Singer, L. P.; Singh, A.; Singh, R.; Singhal, A.; Sintes, A. M.; Slagmolen, B. J. J.; Smith, R. J. E.; Smith, N.D.; Smith, R. J. E.; Son, E. J.; Sorazu, B.; Sorrentino, F.; Souradeep, T.; Srivastava, A. K.; Staley, A.; Steinke, M.; Steinlechner, J.; Steinlechner, S.; Steinmeyer, D.; Stephens, B. C.; Stevenson-Moore, P.; Stone, J.R.; Strain, K. A.; Straniero, N.; Stratta, G.; Strauss, N. A.; Strigin, S. E.; Sturani, R.; Stuver, A. L.; Summerscales, T. Z.; Sun, L.; Sutton, P. J.; Swinkels, B. L.; Szczepanczyk, M. J.; Tacca, M.D.; Talukder, D.; Tanner, D. B.; Tapai, M.; Tarabrin, S. P.; Taracchini, A.; Taylor, W.R.; Theeg, T.; Thirugnanasambandam, M. P.; Thomas, E. G.; Thomas, M.; Thomas, P.; Thorne, K. A.; Thorne, K. S.; Thrane, E.; Tiwari, S.; Tiwari, V.; Tokmakov, K. V.; Tomlinson, C.; Tonelli, M.; Torres, C. V.; Torrie, C. I.; Toyra, D.; Travasso, F.; Traylor, G.; Trifiro, D.; Tringali, M. C.; Trozzo, L.; Tse, M.; Turconi, M.; Tuyenbayev, D.; Ugolini, D.; Unnikrishnan, C. S.; Urban, A. L.; Usman, S. A.; Vahlbruch, H.; Vajente, G.; Valdes, G.; Vallisneri, M.; van Bakel, N.; van Beuzekom, M.G.; van den Brand, J. F. J.; Van Den Broeck, C.F.F.; Vander-Hyde, D. C.; van der Schaaf, L.; van Heijningen, J. V.; van Veggel, A. A.; Vardaro, M.; Vass, S.; Vasuth, M.; Vaulin, R.; Vecchio, A.; Vedovato, G.; Veitch, J.; Veitch, P.J.; Venkateswara, K.; Verkindt, D.; Vetrano, F.; Vicere, A.; Vinciguerra, S.; Vine, D. J.; Vinet, J. -Y.; Vitale, S.; Vo, T.; Vocca, H.; Vorvick, C.; Voss, D. V.; Vousden, W. D.; Vyatchanin, S. P.; Wade, A. R.; Wade, L. E.; Wade, MT; Walker, M.; Wallace, L.; Walsh, S.; Wang, G.; Wang, H.; Wang, M.; Wang, X.; Wang, Y.; Ward, R. L.; Warner, J.; Was, M.; Weaver, B.; Wei, L. -W.; Weinert, M.; Weinstein, A. J.; Weiss, R.; Welborn, T.; Wen, L.M.; Wesels, P.; Westphal, T.; Wette, K.; Whelan, J. T.; White, D. J.; Whiting, B. F.; Williams, D.R.; Williamson, A. R.; Willis, J. L.; Willke, B.; Wimmer, M. H.; Winkler, W.; Wipf, C. C.; Wittel, H.; Woan, G.; Worden, J.; Wright, J.L.; Wu, G.; Yablon, J.; Yam, W.; Yamamoto, H.; Yancey, C. C.; Yap, M. J.; Yu, H.; Yvert, M.; Zadrozny, A.; Zangrando, L.; Zanolin, M.; Zendri, J. -P.; Zevin, M.; Zhang, F.; Zhang, L.; Zhang, M.; Zhang, Y.; Zhao, C.; Zhou, M.; Zhou, Z.; Zhu, X. J.; Zucker, M. E.; Zuraw, S. E.

    2016-01-01

    This article provides supplemental information for a Letter reporting the rate of (BBH) coalescences inferred from 16 days of coincident Advanced LIGO observations surrounding the transient (GW) signal GW150914. In that work we reported various rate estimates whose 90% confidence intervals fell in

  17. Treatment effectiveness of alemtuzumab compared with natalizumab, fingolimod, and interferon beta in relapsing-remitting multiple sclerosis: a cohort study.

    Science.gov (United States)

    Kalincik, Tomas; Brown, J William L; Robertson, Neil; Willis, Mark; Scolding, Neil; Rice, Claire M; Wilkins, Alastair; Pearson, Owen; Ziemssen, Tjalf; Hutchinson, Michael; McGuigan, Christopher; Jokubaitis, Vilija; Spelman, Tim; Horakova, Dana; Havrdova, Eva; Trojano, Maria; Izquierdo, Guillermo; Lugaresi, Alessandra; Prat, Alexandre; Girard, Marc; Duquette, Pierre; Grammond, Pierre; Alroughani, Raed; Pucci, Eugenio; Sola, Patrizia; Hupperts, Raymond; Lechner-Scott, Jeannette; Terzi, Murat; Van Pesch, Vincent; Rozsa, Csilla; Grand'Maison, François; Boz, Cavit; Granella, Franco; Slee, Mark; Spitaleri, Daniele; Olascoaga, Javier; Bergamaschi, Roberto; Verheul, Freek; Vucic, Steve; McCombe, Pamela; Hodgkinson, Suzanne; Sanchez-Menoyo, Jose Luis; Ampapa, Radek; Simo, Magdolna; Csepany, Tunde; Ramo, Cristina; Cristiano, Edgardo; Barnett, Michael; Butzkueven, Helmut; Coles, Alasdair

    2017-04-01

    Alemtuzumab, an anti-CD52 antibody, is proven to be more efficacious than interferon beta-1a in the treatment of relapsing-remitting multiple sclerosis, but its efficacy relative to more potent immunotherapies is unknown. We compared the effectiveness of alemtuzumab with natalizumab, fingolimod, and interferon beta in patients with relapsing-remitting multiple sclerosis treated for up to 5 years. In this international cohort study, we used data from propensity-matched patients with relapsing-remitting multiple sclerosis from the MSBase and six other cohorts. Longitudinal clinical data were obtained from 71 MSBase centres in 21 countries and from six non-MSBase centres in the UK and Germany between Nov 1, 2015, and June 30, 2016. Key inclusion criteria were a diagnosis of definite relapsing-remitting multiple sclerosis, exposure to one of the study therapies (alemtuzumab, interferon beta, fingolimod, or natalizumab), age 65 years or younger, Expanded Disability Status Scale (EDSS) score 6·5 or lower, and no more than 10 years since the first multiple sclerosis symptom. The primary endpoint was annualised relapse rate. The secondary endpoints were cumulative hazards of relapses, disability accumulation, and disability improvement events. We compared relapse rates with negative binomial models, and estimated cumulative hazards with conditional proportional hazards models. Patients were treated between Aug 1, 1994, and June 30, 2016. The cohorts consisted of 189 patients given alemtuzumab, 2155 patients given interferon beta, 828 patients given fingolimod, and 1160 patients given natalizumab. Alemtuzumab was associated with a lower annualised relapse rate than interferon beta (0·19 [95% CI 0·14-0·23] vs 0·53 [0·46-0·61], pmultiple sclerosis. Alemtuzumab seems superior to fingolimod and interferon beta in mitigating relapse activity. Natalizumab seems superior to alemtuzumab in enabling recovery from disability. Both natalizumab and alemtuzumab seem highly

  18. Diagnosis of central nervous system relapse of pediatric acute lymphoblastic leukemia: Impact of routine cytological CSF analysis at the time of intrathecal chemotherapy.

    Science.gov (United States)

    Gassas, Adam; Krueger, Joerg; Alvi, Saima; Sung, Lillian; Hitzler, Johanne; Lieberman, Lani

    2014-12-01

    Despite the success of central nervous system (CNS) directed therapy in pediatric acute lymphoblastic leukemia (ALL), relapse involving the CNS continues to be observed in 5-10% of children when utilizing standard intrathecal prophylactic chemotherapy. While most pediatric ALL treatment protocols mandate regular lumbar punctures (LP) for the intrathecal injection of chemotherapy, the value of routine cytological analysis of cerebrospinal fluid (CSF) during therapy is unknown. Our objective was to assess the diagnostic value of routine CSF analysis during ALL therapy. To allow for at least 10 years of follow up from ALL diagnosis, children (0-18 years) with ALL diagnosed and treated at SickKids, Toronto, Canada between 1994-2004 were studied. Medical records of patients with CNS relapse were examined to determine whether CNS relapse was diagnosed based on cytology of a routinely obtained CSF sample, a CSF sample obtained because of signs and symptoms or a CSF sample obtained after the diagnosis of a bone marrow relapse. Of 494 children treated for ALL, 31 (6.6%) developed a relapse of ALL involving the CNS. Twenty-two had an isolated CNS relapse and nine had a combined bone marrow and CNS relapse. Among patients with isolated CNS relapse, 73% (16/22) were diagnosed based on routine CSF samples obtained from asymptomatic children. Conversely, 89% (8/9) of children with combined bone marrow and CNS relapse presented with symptoms and signs that prompted CSF examination. Routine CSF examination at the time of LP for intrathecal chemotherapy is useful in detecting CNS relapse. © 2014 Wiley Periodicals, Inc.

  19. Phonological Fluency Strategy of Switching Differentiates Relapsing-Remitting and Secondary Progressive Multiple Sclerosis Patients

    OpenAIRE

    Messinis, L.; Kosmidis, M. H.; Vlahou, C.; Malegiannaki, A. C.; Gatzounis, G.; Dimisianos, N.; Karra, A.; Kiosseoglou, G.; Gourzis, P.; Papathanasopoulos, P.

    2013-01-01

    The strategies used to perform a verbal fluency task appear to be reflective of cognitive abilities necessary for successful daily functioning. In the present study, we explored potential differences in verbal fluency strategies (switching and clustering) used to maximize word production by patients with relapsing-remitting multiple sclerosis (RRMS) versus patients with secondary progressive multiple sclerosis (SPMS). We further assessed impairment rates and potential differences in the sensi...

  20. The budget impact of introducing delayed-release dimethyl fumarate for treatment of relapse-remitting multiple sclerosis in Canada.

    Science.gov (United States)

    Dorman, Emily; Kansal, Anuraag R; Sarda, Sujata

    2015-01-01

    Multiple sclerosis (MS) causes significant disability globally and is especially prevalent in Canada. Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) is an orally administered disease-modifying treatment (DMT) for patients with relapsing-remitting MS (RRMS) that is currently on the market in the US, Australia, Canada, and Europe. A budget impact model (BIM) was developed to assess the financial consequences of introducing DMF for treatment of RRMS in Canada. A BIM calculated the financial consequences of introducing DMF in Canada over 3 years based on RRMS prevalence, treatment market share, and clinical effects. RRMS prevalence in Canada was derived from published literature and natural relapse rates, and disease state distribution from clinical trial data. It was conservatively assumed that 100% of RRMS patients were treated with a DMT. DMF was assumed to absorb market share proportionally from the following current treatments: interferon beta-1a-IM, interferon beta-1a-SC, interferon beta-1b, and glatiramer acetate. Treatment efficacy, in terms of relapse rate reductions and treatment discontinuation rates, was determined from mixed treatment comparison. Treatment costs (including costs of acquisition, monitoring, and administration) and cost of relapse were considered. Deterministic one-way sensitivity analyses were conducted to assess the most sensitive input parameters. Over 3 years, the introduction of DMF resulted in an average annual increase of CAD417 per treated patient per year, with reductions in costs associated with relapses (CAD192/patient/year) partially offsetting increased drug acquisition costs (CAD602/patient/year). On a population level, the average annual cost increase was CAD24,654,237, a CAD 0.68 increase per population covered by the Canadian healthcare system. The main drivers of budget impact were drop-out rates, proportion of RRMS patients treated, and market share assumptions. The acquisition costs of DMF for

  1. Safety and tolerability of ibrutinib monotherapy in Japanese patients with relapsed/refractory B cell malignancies.

    Science.gov (United States)

    Tobinai, Kensei; Ogura, Michinori; Ishizawa, Kenichi; Suzuki, Tatsuya; Munakata, Wataru; Uchida, Toshiki; Aoki, Tomohiro; Morishita, Takanobu; Ushijima, Yoko; Takahara, Satoko

    2016-01-01

    In this phase I dose-escalation study we evaluated the safety, tolerability, pharmacokinetics, and antitumor activity of ibrutinib, an oral covalent inhibitor of Bruton's tyrosine kinase (BTK, in Japanese patients with relapsed/refractory B cell malignancies (RRBCM). Fifteen patients aged 42-78 years were enrolled to one of three cohorts. Cohort 1 (n = 3) consisted of two phases, a single-dose (140 and 280 mg) phase and a multiple-dose (420 mg) phase of ibrutinib; cohort 2 (n = 6) included multiple doses of ibrutinib 560 mg; and cohort 3 (n = 6) included only patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) dosed at ibrutinib 420 mg. One patient (CLL/SLL cohort) experienced grade 3 pneumonia and sepsis, which were considered dose-limiting toxicities. No deaths were reported. The most common (≥ 20% patients) adverse events were neutropenia, anemia, nasopharyngitis, increased bilirubin, and rash. Dose-dependent increase in maximum plasma concentration and area under the concentration from 0 to the last quantifiable time was observed, while time to reach maximum plasma concentration and elimination half-life was similar between doses. The overall response rate was 73.3% (11/15) for all cohorts combined. Overall, ibrutinib (420 and 560 mg) was tolerable with acceptable safety profiles and effective for Japanese patients with RRBCM including CLL/SLL. NCT01704963.

  2. Quantifying risk of early relapse in patients with first demyelinating events: Prediction in clinical practice.

    Science.gov (United States)

    Spelman, Tim; Meyniel, Claire; Rojas, Juan Ignacio; Lugaresi, Alessandra; Izquierdo, Guillermo; Grand'Maison, Francois; Boz, Cavit; Alroughani, Raed; Havrdova, Eva; Horakova, Dana; Iuliano, Gerardo; Duquette, Pierre; Terzi, Murat; Grammond, Pierre; Hupperts, Raymond; Lechner-Scott, Jeannette; Oreja-Guevara, Celia; Pucci, Eugenio; Verheul, Freek; Fiol, Marcela; Van Pesch, Vincent; Cristiano, Edgardo; Petersen, Thor; Moore, Fraser; Kalincik, Tomas; Jokubaitis, Vilija; Trojano, Maria; Butzkueven, Helmut

    2017-09-01

    Characteristics at clinically isolated syndrome (CIS) examination assist in identification of patient at highest risk of early second attack and could benefit the most from early disease-modifying drugs (DMDs). To examine determinants of second attack and validate a prognostic nomogram for individualised risk assessment of clinical conversion. Patients with CIS were prospectively followed up in the MSBase Incident Study. Predictors of clinical conversion were analysed using Cox proportional hazards regression. Prognostic nomograms were derived to calculate conversion probability and validated using concordance indices. A total of 3296 patients from 50 clinics in 22 countries were followed up for a median (inter-quartile range (IQR)) of 1.92 years (0.90, 3.71). In all, 1953 (59.3%) patients recorded a second attack. Higher Expanded Disability Status Scale (EDSS) at baseline, first symptom location, oligoclonal bands and various brain and spinal magnetic resonance imaging (MRI) metrics were all predictors of conversion. Conversely, older age and DMD exposure post-CIS were associated with reduced rates. Prognostic nomograms demonstrated high concordance between estimated and observed conversion probabilities. This multinational study shows that age at CIS onset, DMD exposure, EDSS, multiple brain and spinal MRI criteria and oligoclonal bands are associated with shorter time to relapse. Nomogram assessment may be useful in clinical practice for estimating future clinical conversion.

  3. Relapse after methylprednisolone oral minipulse therapy in childhood vitiligo: A 12-month follow-up study

    Directory of Open Access Journals (Sweden)

    Imran Majid

    2013-01-01

    Full Text Available Background: Oral minipulse (OMP therapy with methylprednisolone is presently one of the most common oral treatments used for progressive vitiligo in children. The treatment is usually given for a period of 6 months during which majority of patients are reported to go into remission. However, there are no follow-up studies to comment upon what happens to the disease after OMP therapy is withdrawn. Aim of the study: To document the incidence of relapse over a period of 1 year after OMP therapy is stopped in children with vitiligo. Materials and Methods: The study was conducted in 180 patients of childhood vitiligo (<15 years of age who had been on OMP therapy with oral methylprednisolone for at least 6 months and who had achieved a complete remission of their disease during the treatment period. The enrolled patients were followed up for a period of 1 year and examined clinically for any sign of reactivation of their disease over either the old lesions or at any new area of the body. Results: Forty-two patients were lost and could not complete the follow-up period of 1 year. Out of the 138 patients available at the end of 1 year, relapse was observed in 48 patients (34.8%. Rest of 90 patients remained in remission over the follow-up period of 1 year. Relapse was more common in patients below 10 years of age (47.4% as compared with older children (25.9%. Conclusion: Relapse after using methylprednisolone OMP therapy in children with vitiligo is quite common especially in younger age groups. Studies are needed to see whether these relapses could be avoided by giving the treatment for a period longer than 6 months.

  4. MRI diagnosis of bone marrow relapse in children with ALL

    International Nuclear Information System (INIS)

    Kan, J.H.; Hernanz-Schulman, Marta; Frangoul, Haydar A.; Connolly, Susan A.

    2008-01-01

    Diffuse marrow replacement in acute leukemia is well known, but there are few reports describing the MRI features of pediatric leukemic relapse. Our purpose was to describe the MRI appearance of pediatric leukemic relapse. A total of 53 consecutive children with a history of ALL were referred for musculoskeletal MRI from 1 January 1998 to 28 February 2007 at one center, and from 1 January 2000 to 2 May 2007 at a second center. From this group, 14 children seen at initial diagnosis of leukemia and 2 children who underwent MRI after therapy for relapse were excluded. The remaining 37 children, 8 with relapse and 29 in remission, were studied. Images of patients with relapse and in remission were reviewed for type and configuration of marrow infiltration; coexisting marrow alterations including osteonecrosis or stress reaction were also reviewed. All eight children with relapse demonstrated nodular lesions with well-defined margins. Coexisting osteonecrosis was present in three children (38%) and pathologic fracture in one. Among the 29 children in remission, 9 showed stress reaction/fracture, 14 showed osteonecrosis and 9 showed ill-defined nodules, and in 5 the marrow was completely normal. Well-defined nodules in all patients with leukemic relapse suggest that this appearance is characteristic and distinct from the published findings of diffuse marrow replacement in acute leukemia. (orig.)

  5. MRI diagnosis of bone marrow relapse in children with ALL

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H.; Hernanz-Schulman, Marta [Vanderbilt University, Department of Radiology and Radiological Sciences, Vanderbilt Children' s Hospital, Nashville, TN (United States); Frangoul, Haydar A. [Vanderbilt University, Department of Pediatric Hematology-Oncology, Vanderbilt Children' s Hospital, Nashville, TN (United States); Connolly, Susan A. [Harvard Medical School, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States)

    2008-01-15

    Diffuse marrow replacement in acute leukemia is well known, but there are few reports describing the MRI features of pediatric leukemic relapse. Our purpose was to describe the MRI appearance of pediatric leukemic relapse. A total of 53 consecutive children with a history of ALL were referred for musculoskeletal MRI from 1 January 1998 to 28 February 2007 at one center, and from 1 January 2000 to 2 May 2007 at a second center. From this group, 14 children seen at initial diagnosis of leukemia and 2 children who underwent MRI after therapy for relapse were excluded. The remaining 37 children, 8 with relapse and 29 in remission, were studied. Images of patients with relapse and in remission were reviewed for type and configuration of marrow infiltration; coexisting marrow alterations including osteonecrosis or stress reaction were also reviewed. All eight children with relapse demonstrated nodular lesions with well-defined margins. Coexisting osteonecrosis was present in three children (38%) and pathologic fracture in one. Among the 29 children in remission, 9 showed stress reaction/fracture, 14 showed osteonecrosis and 9 showed ill-defined nodules, and in 5 the marrow was completely normal. Well-defined nodules in all patients with leukemic relapse suggest that this appearance is characteristic and distinct from the published findings of diffuse marrow replacement in acute leukemia. (orig.)

  6. Outcome following late marrow relapse in childhood acute lymphoblastic leukemia

    International Nuclear Information System (INIS)

    Chessells, J.; Leiper, A.; Rogers, D.

    1984-01-01

    Thirty-four children with acute lymphoblastic leukemia, who developed bone marrow relapse after treatment was electively stopped, received reinduction, consolidation, continuing therapy, and intrathecal (IT) methotrexate (MTX). Sixteen children who relapsed within six months of stopping treatment had a median second-remission duration of 26 weeks; all next relapses occurred in the bone marrow. In 18 children who relapsed later, the median duration of second remission was in excess of two years, but after a minimum of four years follow-up, 16 patients have so far relapsed again (six in the CNS). CNS relapse occurred as a next event in four of 17 children who received five IT MTX injections only and in two of 14 children who received additional regular IT MTX. Although children with late marrow relapses may achieve long second remissions, their long-term out-look is poor, and regular IT MTX does not afford adequate CNS prophylaxis. It remains to be seen whether more intensive chemotherapy, including high-dose chemoradiotherapy and bone marrow transplantation, will improve the prognosis in this group of patients

  7. Postpartum smoking relapse--a thematic synthesis of qualitative studies.

    Science.gov (United States)

    Notley, Caitlin; Blyth, Annie; Craig, Jean; Edwards, Alice; Holland, Richard

    2015-11-01

    Many women quit smoking during pregnancy, but relapse after the baby is born. To understand why and identify ways of preventing this, this study reviewed the qualitative literature on women's experience of postpartum smoking relapse. A systematic review of qualitative studies and process evaluations of trials. We undertook a thematic synthesis of published qualitative data. We screened 1336 papers. Twenty-two papers reporting on 16 studies were included, reporting on the views of 1031 postpartum women. Factors affecting relapse and barriers and facilitators to relapse prevention were identified around the key themes of beliefs, social influences, motivation, physiological factors and identity. Women's beliefs about smoking as a means of coping with stress and the need for social support, especially from a partner, emerged as important. Extrinsic motivation to quit during the pregnancy (for the health of the fetus) appeared to be a factor in prompting relapse after the baby was born. During the immediate postpartum period women believed that physiological changes influence cigarette cravings. The stress of caring for a newborn, sleeplessness and adjusting to a new mothering identity were also reported to be important. Among women who quit smoking during pregnancy, those who relapse postpartum talk commonly about no longer needing to protect the baby and the effects of stress. Partner support and a sense of changed identity are cited as factors preventing relapse. © 2015 Society for the Study of Addiction.

  8. Preventing relapse after incentivized choice treatment: A laboratory model.

    Science.gov (United States)

    Bouton, Mark E; Thrailkill, Eric A; Bergeria, Cecilia L; Davis, Danielle R

    2017-08-01

    Two experiments with rats examined relapse of an operant behavior that occurred after the behavior was suppressed by reinforcing (incentivizing) an alternative behavior. In the first phase, a target response (R1) was reinforced. In a treatment phase, R1 was still reinforced, but a new response (R2) was introduced and associated with a larger reinforcer. As in human contingency management treatments, incentivizing R2 this way was effective at suppressing R1. However, when R2's reinforcement was discontinued, there was a robust and immediate relapse to R1. Experiment 1 found that the strength of R1 during relapse testing was not different from that seen in a no treatment control. Experiment 2 found that relapse could nevertheless be reduced by presenting reinforcers not contingent on responding during the test. Either the reinforcer for R1 or the reinforcer for R2 (which were qualitatively different types of food pellets) were effective. The experiments introduce a laboratory method for studying relapse and how to prevent it after contingency management treatments, and suggest at least one treatment that discourages relapse. The incentivized choice paradigm differs from other models of relapse of operant behavior (e.g., resurgence, renewal, reinstatement) in that it does not focus on the return of behaviors that are inhibited by extinction. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Family Income, Parent Education, and Perceived Constraints as Predictors of Observed Program Quality and Parent Rated Program Quality

    Science.gov (United States)

    Torquati, Julia C.; Raikes, Helen H.; Huddleston-Casas, Catherine A.; Bovaird, James A.; Harris, Beatrice A.

    2011-01-01

    Observed child care quality and parent perceptions of child care quality received by children in poor (below Federal Poverty Line, FPL), low-income (between FPL and 200% of FPL), and non-low-income families were examined. Observations were completed in 359 center- and home-based child care programs in four Midwestern states and surveys were…

  10. Clinical efficacy of BG-12 (dimethyl fumarate) in patients with relapsing-remitting multiple sclerosis: subgroup analyses of the CONFIRM study.

    LENUS (Irish Health Repository)

    Hutchinson, Michael

    2013-09-01

    In the phase 3, randomized, placebo-controlled and active reference (glatiramer acetate) comparator CONFIRM study in patients with relapsing-remitting multiple sclerosis, oral BG-12 (dimethyl fumarate) reduced the annualized relapse rate (ARR; primary endpoint), as well as the proportion of patients relapsed, magnetic resonance imaging lesion activity, and confirmed disability progression, compared with placebo. We investigated the clinical efficacy of BG-12 240 mg twice daily (BID) and three times daily (TID) in patient subgroups stratified according to baseline demographic and disease characteristics including gender, age, relapse history, McDonald criteria, treatment history, Expanded Disability Status Scale score, T2 lesion volume, and gadolinium-enhancing lesions. BG-12 treatment demonstrated generally consistent benefits on relapse-related outcomes across patient subgroups, reflecting the positive findings in the overall CONFIRM study population. Treatment with BG-12 BID and TID reduced the ARR and the proportion of patients relapsed at 2 years compared with placebo in all subgroups analyzed. Reductions in ARR with BG-12 BID versus placebo ranged from 34% [rate ratio 0.664 (95% confidence interval 0.422-1.043)] to 53% [0.466 (0.313-0.694)] and from 13% [0.870 (0.551-1.373)] to 67% [0.334 (0.226-0.493)] with BG-12 TID versus placebo. Treatment with glatiramer acetate reduced the ARR and the proportion of patients relapsed at 2 years compared with placebo in most patient subgroups. The results of these analyses indicate that treatment with BG-12 is effective on relapses across a broad range of patients with relapsing-remitting multiple sclerosis with varied demographic and disease characteristics.

  11. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure.

    Science.gov (United States)

    Galiczewski, Janet M; Shurpin, Kathleen M

    2017-06-01

    Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Preventing postpartum smoking relapse: an opportunity for neonatal nurses.

    Science.gov (United States)

    Forest, Sharron

    2009-08-01

    Smoking during pregnancy and exposure to environmental tobacco smoke have harmful and sometimes devastating effects on the health of the newborn. Although interventions for smoking cessation during pregnancy demonstrate effectiveness for increasing smoking abstinence, the majority of women relapse in the postpartum period. However, modifying contributing factors for relapse may improve the success of sustained abstinence. Many parents are eager to quit smoking and willing to participate in smoking cessation interventions. Through a population-based approach to healthcare, neonatal nurses are in an ideal position to prevent relapse and to promote smoking abstinence; they can coordinate and lead efforts for establishing smoking cessation strategies that integrate obstetric, newborn, and pediatric services.

  13. Graves’ Ophthalmopathy Misdiagnosed as Relapsing Conjunctivitis

    Directory of Open Access Journals (Sweden)

    Irini P. Chatziralli

    2010-09-01

    Full Text Available A 59-year-old female patient presented at the outpatients’ Department of Ophthalmology with epiphora, eyelid swelling, and a foreign body feeling in the right eye. The symptoms were present for 4 months, and the patient was treated as suffering from relapsing conjunctivitis. The slit lamp examination revealed keratitis due to exposure, related with the deficient closure of the eyelids. There was a 2 mm difference in the readings with the Hertel exophthalmometry examination between the eyes. Her medical history was clear, and she was referred for computed tomography of the orbits and brain and biochemical examinations (FT3, FT4, and TSH to investigate the presence of an intraorbital mass. FT3 was significantly increased and TSH was accordingly low, indicating the diagnosis of Graves’ disease, which presented without other signs and symptoms apart from ophthalmopathy. Computed tomography scan excluded the diagnosis of an intraorbital mass. Therefore, it is important not to underestimate the ocular manifestations of systemic diseases.

  14. Pemphigus erythematosus relapse associated with atorvastatin intake

    Directory of Open Access Journals (Sweden)

    Lo Schiavo A

    2014-09-01

    Full Text Available Ada Lo Schiavo,1 Rosa Valentina Puca,1 Francesca Romano,1 Roberto Cozzi2 1Department of Dermatology, Second University of Naples, Naples, Italy; 2Department of Dermatology, AORN "A Cardarelli", Naples, Italy Abstract: Statins, also known as 3-hydroxy-3-methylglutaril-CoA reductase inhibitors, are well-tolerated drugs used for prevention of atherosclerosis and cardiovascular events. Although they are generally considered safe, some serious adverse effects, such as myositis, myopathy, and rhabdomyolysis can rarely occur. Furthermore, recent data from long-term follow-up on patients who have been taking statins for a long period of time suggest that prolonged exposure to statins may trigger autoimmune reactions. The exact mechanism of statin-induced autoimmune reactions is unclear. Statins, as proapoptotic agents, release nuclear antigen into the circulation and may induce the production of pathogenic autoantibodies. Herein we report the case of a 70 year-old man who developed a relapse of pemphigus erythematosus, a syndrome with features of both lupus erythematosus and pemphigus, after atorvastatin intake. Keywords: pemphigus erythematosus, autoimmune disease, treatment, pathogenesis, statins

  15. A Motion Videogame for Opioid Relapse Prevention.

    Science.gov (United States)

    Abroms, Lorien C; Leavitt, Leah E; Van Alstyne, Judy M; Schindler-Ruwisch, Jennifer M; Fishman, Marc J; Greenberg, Daniel

    2015-12-01

    This study examined the feasibility and acceptability of a body motion-activated videogame, targeting the prevention of opioid relapse among youth in the context of outpatient treatment. Participants attended four weekly gameplay sessions. Surveys were conducted at baseline and following each week's gameplay and assessed satisfaction with gameplay, craving intensity, and self-efficacy to refuse opioids. Participants expressed a high level of satisfaction with the videogame throughout the 4 weeks and agreed with the statement that they would be more likely to attend treatment sessions if the game was present (mean=4.6; standard deviation [SD]=0.7) and would recommend the videogame to other people in treatment (mean=4.2; SD=0.8). All participants recommended playing the videogame as part of treatment at least weekly, with a third recommending playing daily. Self-reported cravings declined over the 4-week period from baseline (mean=12.7; SD=8.4) to Week 4 (mean=9.8; SD=8.3), although the decline was not significant. Although participants stated that they liked the game, one-third of participants had dropped out of the study by the fourth session of gameplay. Preliminary evidence indicates that a motion videogame for addiction recovery may be feasible and acceptable within the context of outpatient treatment, although additional efforts are needed to keep youth in treatment. Future studies are needed to assess the impact of the game on long-term abstinence, treatment adherence, and engagement.

  16. Effectiveness of Cognitive – Behavioral Therapy on The Decreasing of Relapse of Addiction to Norcotic In The Collegian Students And It s influence on The Increasing of Their Achievement Motivation

    Directory of Open Access Journals (Sweden)

    SK Alavi Langroodi

    2015-05-01

    Results: Results showed that cognitive - behavioral therapy, was effective in reducing the recurrence rate of drug addicted students. Conclusion: With regard to the effective use of effective, cognitive - behavioral therapy in reducing drug relapse and increase the motivation of individuals, Education program aimed at reducing drug relapse and increase the incentive for progress must be made. Keywords: Cognitive – Behavioral Therapy, addiction, achievement motivation.

  17. Irinotecan in patients with relapsed or cisplatin-refractory germ cell cancer: a phase II study of the German Testicular Cancer Study Group

    OpenAIRE

    Kollmannsberger, C; Rick, O; Klaproth, H; Kubin, T; Sayer, H G; Hentrich, M; Welslau, M; Mayer, F; Kuczyk, M; Spott, C; Kanz, L; Bokemeyer, C

    2002-01-01

    Despite generally high cure rates in patients with metastatic germ cell cancer, patients with progressive disease on first-line cisplatin-based chemotherapy or with relapsed disease following high-dose salvage therapy exhibit a very poor prognosis. Irinotecan has shown antitumour activity in human testicular tumour xenografts in nude mice. We have performed a phase II study examining the single agent activity of irinotecan in patients with metastatic relapsed or cisplatin-refractory germ cell...

  18. [Observation of the effects of warming-up and role-playing in psychodrama in terms of mood rating].

    Science.gov (United States)

    Kawai, S

    1993-04-01

    The purpose is to make an appropriate list of terms that describe person's moment-to-moment changes in moods during psychodrama sessions. Seventy nurse students participated in a series of psychodrama sessions, consisting of a session of warming-up and two sessions of role playing. They rated their moods at the beginning of the sessions and after each session, on a five-point scale for each of the 55 terms, which were supposed to cover all kinds of moods during psychodrama sessions. After analyzing variations (using factor analyses) of subjects' ratings, three factors were found to be sufficient for describing their moods, and the terms in the list were eventually reduced to sixteen. Changes of moods analyzed through the ratings of sixteen scales were related significantly with subjects' performances of warming-up and role playing.

  19. The interplay of history of depression and craving in terms of smoking relapse among treatment seeking smokers.

    Science.gov (United States)

    Rodríguez-Cano, Rubén; Paulus, Daniel J; López-Durán, Ana; Martínez-Vispo, Carmela; Fernández Del Río, Elena; Becoña, Elisardo; Zvolensky, Michael J

    2017-01-01

    Although there is an interconnection between history of major depressive disorder and smoking, there has been relatively limited scientific attention oriented on the interplay between history of major depressive disorder and smoking maintenance processes. The current study sought to address whether history of major depressive disorder and post-cessation craving interact in the prediction of relapse among treatment-seeking smokers. Separate models were evaluated as a function of sex. Participants (n = 319, Mage = 41.7, 62.1% female) were treatment-seeking smokers who were abstinent at the end of six weekly 1-hour sessions involving psychosocial treatment for cessation. Participants completed a baseline assessment and reported post-cessation craving. Smoking status was assessed at 1-, 2-, 3-, 6-, and 12-month follow-up after the end of treatment. There was a significant interactive effect evident for females (B = 0.05, OR = 1.05, p = 0.013), but not males. The form of the interaction indicated females with history of major depressive disorder and greater post-treatment craving evinced the highest rate of relapse. Findings suggest that history of major depressive disorder and post-treatment craving are related to increased risk of relapse for female, but not male, smokers. Sex differences play a fundamental role in the explanation of the interaction of history of major depressive disorder and craving post-treatment in smoking relapse. Considering sex differences related to smoking relapse may help to tailor smoking cessation treatments.

  20. Risk factors associated with gastroesophageal reflux disease relapse in primary care patients successfully treated with a proton pump inhibitor.

    Science.gov (United States)

    López-Colombo, A; Pacio-Quiterio, M S; Jesús-Mejenes, L Y; Rodríguez-Aguilar, J E G; López-Guevara, M; Montiel-Jarquín, A J; López-Alvarenga, J C; Morales-Hernández, E R; Ortiz-Juárez, V R; Ávila-Jiménez, L

    There are no studies on the factors associated with gastroesophageal reflux disease (GERD) relapse in primary care patients. To identify the risk factors associated with GERD relapse in primary care patients that responded adequately to short-term treatment with a proton pump inhibitor. A cohort study was conducted that included GERD incident cases. The patients received treatment with omeprazole for 4 weeks. The ReQuest questionnaire and a risk factor questionnaire were applied. The therapeutic success rate and relapse rate were determined at 4 and 12 weeks after treatment suspension. A logistic regression analysis of the possible risk factors for GERD relapse was carried out. Of the 83 patient total, 74 (89.16%) responded to treatment. Symptoms recurred in 36 patients (48.64%) at 4 weeks and in 13 patients (17.57%) at 12 weeks, with an overall relapse rate of 66.21%. The OR multivariate analysis (95% CI) showed the increases in the possibility of GERD relapse for the following factors at 12 weeks after treatment suspension: basic educational level or lower, 24.95 (1.92-323.79); overweight, 1.76 (0.22-13.64); obesity, 0.25 (0.01-3.46); smoking, 0.51 (0.06-3.88); and the consumption of 4-12 cups of coffee per month, 1.00 (0.12-7.84); citrus fruits, 14.76 (1.90-114.57); NSAIDs, 27.77 (1.12-686.11); chocolate, 0.86 (0.18-4.06); ASA 1.63 (0.12-21.63); carbonated beverages, 4.24 (0.32-55.05); spicy food 7-16 times/month, 1.39 (0.17-11.17); and spicy food ≥ 20 times/month, 4.06 (0.47-34.59). The relapse rate after short-term treatment with omeprazole was high. The consumption of citrus fruits and NSAIDs increased the possibility of GERD relapse. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  1. Gemcitabine and docetaxel in relapsed and unresectable high-grade osteosarcoma and spindle cell sarcoma of bone

    OpenAIRE

    Palmerini, E.; Jones, R. L.; Marchesi, E.; Paioli, A.; Cesari, M.; Longhi, A.; Meazza, C.; Coccoli, L.; Fagioli, F.; Asaftei, S.; Grignani, G.; Tamburini, A.; Pollack, S. M.; Picci, P.; Ferrari, S.

    2016-01-01

    Background Few new compounds are available for relapsed osteosarcoma. We retrospectively evaluated the activity of gemcitabine (G) plus docetaxel (D) in patients with relapsed high-grade osteosarcoma and high-grade spindle cell sarcoma of bone (HGS). Methods Patients receiving G 900?mg/m2 d 1, 8; D 75?mg/m2 d 8, every 21?days were eligible. Primary end-point: progression-free survival (PFS) at 4?months; secondary end-point: overall survival (OS) and response rate. Results Fifty-one patients w...

  2. Efficacy of argon plasma coagulation for locoregional relapse after chemoradiotherapy for esophageal cancer

    International Nuclear Information System (INIS)

    Kikuchi, Yoshinori; Domon, Kaoru; Otsuka, Takafumi

    2011-01-01

    Salvage therapy for residual or relapsed esophageal cancer after chemoradiotherapy (CRT) has not yet been established. We retrospectively evaluated relapse-free survival (RFS) after local recurrence following CRT and local control rate in patients who underwent argon plasma coagulation (APC). We reviewed the records of 14 patients who underwent APC after CRT for esophageal cancer at our department between 2001 and 2010 and analyzed overall survival (OS), 5-year survival rate, local control rate after APC and RFS-defined as the period between the end of CRT and the time when an iodine-negative area was found. Median OS and median RFS (mRFS) were 33 months and 6 months, respectively. The 5-year survival rate was 16.2%, and the local control rate after APC was 71.4% (10/14). RFS was significantly longer in the T1 group than in the T2/T3 group (p=0.03); the local control rate after APC did not significantly differ between groups. The high-dose (HD) radiation group had a significantly longer RFS and a tendency toward a higher local control rate after APC than did the standard-dose (SD) radiation group. APC was safe and resulted in a high rate of local control, regardless of T factor. HD radiation was associated with longer RFS and greater efficacy of APC treatment for local recurrence. (author)

  3. Estimation of the variations of ventilation rate and indoor radon concentration using the observed wind velocity and indoor-outdoor temperature difference

    International Nuclear Information System (INIS)

    Nagano, Katsuhiro; Inose, Yuichi; Kojima, Hiroshi

    2006-01-01

    The indoor radon concentration in the building depends on the ventilation rate. Measurement results of indoor-outdoor pressure difference showed the ventilation rate correlated closely with the indoor-outdoor pressure difference. The observation results showed that one of factor of indoor-outdoor pressure difference was the wind velocity. When the wind velocity is small, the ventilation rate is affected by the indoor-outdoor temperature difference and the effect depends on the wind velocity. The temporal variation of indoor radon concentration was predicted by the time depending indoor radon balance model and the ventilation rate estimated from the wind velocity and the indoor-outdoor temperature difference. The temporal variations of predicted radon concentration gave good agreement with the experimental values. The measurement method, indoor radon concentration and ventilation rate, factors of temporal variation of ventilation rate, and prediction of indoor radon concentration are reported. (S.Y.)

  4. Relapse and disease specific survival in 1143 Danish women diagnosed with borderline ovarian tumours (BOT)

    DEFF Research Database (Denmark)

    Schou Karlsen, Nikoline Marie; Karlsen, Mona Aarenstrup; Høgdall, Estrid

    2016-01-01

    .1% in FIGO stages II-IV. Relapse of BOT was detected in 3.7%, hereof 40.5% with malignant transformation. The five-year disease-free survival was 97.6% in FIGO stage I and 87.3% in FIGO stages II-IV. Younger age, laparoscopic surgical approach, fertility sparing surgery, FIGO stages II-IV, bilateral tumour...... presence, serous histology, implants and microinvasion of the tumour were significantly associated with relapse in univariate analyses. The overall five-year survival rate was 92.2% in FIGO stage I and 89.0% in FIGO stages II-IV. Out of 77 deaths in total, only seven women died from BOT. CONCLUSIONS...

  5. Treating Multiply Relapsed or Refractory Hairy Cell Leukemia

    Science.gov (United States)

    In this trial, patients with hairy cell leukemia who have not responded or relapsed after initial chemotherapy will be randomly assigned to receive rituximab combined with either pentostatin or bendamustine.

  6. Novel therapeutic options for relapsed hairy cell leukemia.

    Science.gov (United States)

    Jain, Preetesh; Polliack, Aaron; Ravandi, Farhad

    2015-01-01

    The majority of patients with hairy cell leukemia (HCL) achieve a response to therapy with cladribine or pentostatin with or without rituximab. However, late relapses can occur. Treatment of relapsed HCL can be difficult due to a poor tolerance to chemotherapy, increased risk of infections and decreased responsiveness to chemotherapy. The identification of BRAFV600E mutations and the role of aberrant MEK kinase and Bruton's tyrosine kinase (BTK) pathways in the pathogenesis of HCL have helped to develop novel targeted therapies for these patients. Currently, the most promising therapeutic strategies for relapsed or refractory HCL include recombinant immunoconjugates targeting CD22 (e.g. moxetumomab pasudotox), BRAF inhibitors such as vemurafenib and B cell receptor signaling kinase inhibitors such as ibrutinib. Furthermore, the VH4-34 molecular variant of classic HCL has been identified to be less responsive to chemotherapy. Herein, we review the results of the ongoing clinical trials and potential future therapies for relapsed/refractory HCL.

  7. Relapse of Legionella longbeachae infection in an immunocompromised patient

    NARCIS (Netherlands)

    van't Hullenaar, N. G.; van Ketel, R. J.; Kuijper, E. J.; Bakker, P. J.; Dankert, J.

    1996-01-01

    We describe the first known case of Legionella longbeachae infection in the Netherlands in a patient with myasthenia gravis. Infection with L. longbeachae relapsed after prolonged therapy with erythromycin. No environmental source of L. longbeachae could be traced

  8. Intra and interpersonal determinants for relapse in drug addicts

    Directory of Open Access Journals (Sweden)

    Aline Cristina Zerwes Ferreira

    2016-03-01

    Full Text Available A descriptive qualitative research conducted with 20 drug addicts during treatment at a Center of Psychosocial Attention for Alcohol and other Drugs, aimed to identify intra and interpersonal determinants of relapse perceived by the drug addict. The data were collected through semi-structured interviews, submitted to Content Analysis, and organized into categories following predictive determinants for relapse. The relapse occurred by intrapersonal determinants, as self-efficacy expressed by self-confidence in interrupting the drug consumption; the result expectation by anticipation of pleasurable drug effects; the motivation by the absence of volition to interrupt the consumption; coping with the difficulty to confront daily problems; negative and positive emotional states; and craving. Interpersonal determinants expressed by social support were related to the influence of thirds. The identification of these determinants during treatment to favor relapse prevention and effective rehabilitation.

  9. Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates.

    Science.gov (United States)

    Turok, David K; Jacobson, Janet C; Dermish, Amna I; Simonsen, Sara E; Gurtcheff, Shawn; McFadden, Molly; Murphy, Patricia A

    2014-03-01

    We investigated the 1-year pregnancy rates for emergency contraception (EC) users who selected the copper T380 intrauterine device (IUD) or oral levonorgestrel (LNG) for EC. This prospective study followed women for 1 year after choosing either the copper T380 IUD or oral LNG for EC. The study was powered to detect a 6% difference in pregnancy rates within the year after presenting for EC. Of the 542 women who presented for EC, agreed to participate in the trial and met the inclusion criteria, 215 (40%) chose the copper IUD and 327 (60%) chose oral LNG. In the IUD group, 127 (59%) were nulligravid. IUD insertion failed in 42 women (19%). The 1-year follow-up rate was 443/542 (82%); 64% of IUD users contacted at 1 year still had their IUDs in place. The 1-year cumulative pregnancy rate in women choosing the IUD was 6.5% vs. 12.2% in those choosing oral LNG [hazard ratio (HR) 0.53, 95% confidence interval (CI): 0.29-0.97, p=.041]. By type of EC method actually received, corresponding values were 5.2% for copper IUD users vs. 12.3% for oral LNG users (HR 0.42, 95% CI: 0.20-0.85, p=.017). A multivariable logistic regression model controlling for demographic variables demonstrates that women who chose the IUD for EC had fewer pregnancies in the following year than those who chose oral LNG (HR 0.50, 95% CI: 0.26-0.96, p=.037). One year after presenting for EC, women choosing the copper IUD for EC were half as likely to have a pregnancy compared to those choosing oral LNG. Compared to EC users who choose oral levonorgestrel, those who select the copper IUD have lower rates of pregnancy in the next year. Greater use of the copper IUD for EC may lower rates of unintended pregnancy in high-risk women. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Effect of carbonated hydroxyapatite incorporated advanced platelet rich fibrin intrasulcular injection on the alkaline phosphatase level during orthodontic relapse

    Science.gov (United States)

    Alhasyimi, Ananto Ali; Pudyani, Pinandi Sri; Asmara, Widya; Ana, Ika Dewi

    2018-02-01

    Nowadays, relapse in orthodontic treatment is considered very important because of high incidence of relapse after the treatment. Alkaline phosphatase (ALP) as a biomarker of bone formation will decrease in compression sites during relapse after orthodontic tooth movement. In this situation, manipulating alveolar bone remodeling to increase ALP level is considered one of the new strategies to prevent relapse properly. In the field of tissue engineering, in this study, carbonated hydroxyapatite (CHA) is expected to have the ability to incorporate advanced platelet rich fibrin (aPRF). Next, CHA will retain the aPRF containing various growth factors (GF) until it reaches into a specific targeted area, gradually degraded, and deliver the GF in a controlled manner to prevent relapse. Here, gingival crevicular fluid (GCF) of 45 samples (n=45) were collected and levels of ALP were analyzed using UV-Vis 6300 Spectrophotometer at 405 nm wavelength. We found that there is a significant difference of ALP levels (p<0.05) in GCF between treatments and control groups. ALP level was elevated significantly in CHA and CHA-aPRF groups at days 7 and 14 after debonding compared with the control groups. The peak level of ALP was observed at days 14 after debonding in groups C (0.789 ± 0.039 U/mg). Therefore, it can be concluded that the application of hydrogel CHA with controlled release manner incorporated aPRF enhances bone regeneration by increasing ALP level.

  11. A Unique Case of Relapsing Polychondritis Presenting with Acute Pericarditis

    Directory of Open Access Journals (Sweden)

    John V. Higgins

    2013-01-01

    Full Text Available Relapsing polychondritis (RP is an inflammatory disease of the cartilaginous tissue primarily affecting the cartilaginous structures of the ear, nose, joints, and the respiratory system. Cardiovascular complications of RP are associated with high morbidity and mortality and occur most commonly as valvular disease. Pericarditis is a less common complication, occurring in 4% of patients with RP and has not previously been described at presentation. We describe a case of relapsing polychondritis with acute pericarditis at presentation.

  12. Intestinal Microbiota and Relapse After Hematopoietic-Cell Transplantation.

    Science.gov (United States)

    Peled, Jonathan U; Devlin, Sean M; Staffas, Anna; Lumish, Melissa; Khanin, Raya; Littmann, Eric R; Ling, Lilan; Kosuri, Satyajit; Maloy, Molly; Slingerland, John B; Ahr, Katya F; Porosnicu Rodriguez, Kori A; Shono, Yusuke; Slingerland, Ann E; Docampo, Melissa D; Sung, Anthony D; Weber, Daniela; Alousi, Amin M; Gyurkocza, Boglarka; Ponce, Doris M; Barker, Juliet N; Perales, Miguel-Angel; Giralt, Sergio A; Taur, Ying; Pamer, Eric G; Jenq, Robert R; van den Brink, Marcel R M

    2017-05-20

    Purpose The major causes of mortality after allogeneic hematopoietic-cell transplantation (allo-HCT) are relapse, graft-versus-host disease (GVHD), and infection. We have reported previously that alterations in the intestinal flora are associated with GVHD, bacteremia, and reduced overall survival after allo-HCT. Because intestinal bacteria are potent modulators of systemic immune responses, including antitumor effects, we hypothesized that components of the intestinal flora could be associated with relapse after allo-HCT. Methods The intestinal microbiota of 541 patients admitted for allo-HCT was profiled by means of 16S ribosomal sequencing of prospectively collected stool samples. We examined the relationship between abundance of microbiota species or groups of related species and relapse/progression of disease during 2 years of follow-up time after allo-HCT by using cause-specific proportional hazards in a retrospective discovery-validation cohort study. Results Higher abundance of a bacterial group composed mostly of Eubacterium limosum in the validation set was associated with a decreased risk of relapse/progression of disease (hazard ratio [HR], 0.82 per 10-fold increase in abundance; 95% CI, 0.71 to 0.95; P = .009). When the patients were categorized according to presence or absence of this bacterial group, presence also was associated with less relapse/progression of disease (HR, 0.52; 95% CI, 0.31 to 0.87; P = .01). The 2-year cumulative incidences of relapse/progression among patients with and without this group of bacteria were 19.8% and 33.8%, respectively. These associations remained significant in multivariable models and were strongest among recipients of T-cell-replete allografts. Conclusion We found associations between the abundance of a group of bacteria in the intestinal flora and relapse/progression of disease after allo-HCT. These might serve as potential biomarkers or therapeutic targets to prevent relapse and improve survival after allo-HCT.

  13. Long-term results of pneumatic dilatation for relapsing symptoms of achalasia after Heller myotomy.

    Science.gov (United States)

    Legros, Ludivine; Ropert, Alain; Brochard, Charlène; Bouguen, Guillaume; Pagenault, Maël; Siproudhis, Laurent; Bretagne, Jean-François

    2014-09-01

    The aim of this study was to assess the efficacy and safety of pneumatic dilatation (PD) to treat symptom recurrence after Heller myotomy (HM). Consecutive patients receiving PD for relapsing symptoms following prior HM were included in this retrospective single-center study. Eckardt score ≤3 and/or ∆ Eckardt (difference between Eckardt score before and after dilatation) ≥3 defined the success of initial dilatation. Patients who maintained response longer than 2 months after initial dilatation were defined as short-term responders. Relapsers were offered further on-demand dilatation. Remission was defined as an Eckardt score ≤3 at the study endpoint. Kaplan-Meier survival curves were used to determine relapse rates. Eighteen patients (11 women, seven men) were included from January 2004 to January 2013. Ten patients had type I achalasia, and seven had type III, according to the Chicago classification. Thirty-nine PDs were performed (1.5 [1-2.25] per patient). All patients had short-term responses. The remission rate at the endpoint, after a median follow-up of 33 months, was 78%, but 44% were treated with on-demand PD during the follow-up interval. The proportions of patients without relapse and subsequent PD were 72% at 12 months, 65% at 24 and 36 months, and 49% at 48 months. No factors predictive of long-term response, particularly the type of achalasia, could be identified in this series. There were no perforations. In treating symptom recurrence following HM, PD was safe and effective over the long term when combined with subsequent PD. © 2014 John Wiley & Sons Ltd.

  14. Relapse and disease specific survival in 1143 Danish women diagnosed with borderline ovarian tumours (BOT).

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    Karlsen, Nikoline Marie Schou; Karlsen, Mona Aarenstrup; Høgdall, Estrid; Nedergaard, Lotte; Christensen, Ib Jarle; Høgdall, Claus

    2016-07-01

    The aim of the study was to evaluate the rate of relapse as well as disease-free, overall, and disease-specific survival in women with borderline ovarian tumour (BOT). Furthermore, the study aims to identify the clinical parameters correlated to relapse. National clinical data of women diagnosed with BOT from January 2005 to January 2013 constituted the basis for our study population. The prognostic influence of clinical variables was evaluated using univariate and multivariate analyses. A total of 1143 women were eligible for analysis, with 87.9% in FIGO stage I and 12.1% in FIGO stages II-IV. Relapse of BOT was detected in 3.7%, hereof 40.5% with malignant transformation. The five-year disease-free survival was 97.6% in FIGO stage I and 87.3% in FIGO stages II-IV. Younger age, laparoscopic surgical approach, fertility sparing surgery, FIGO stages II-IV, bilateral tumour presence, serous histology, implants and microinvasion of the tumour were significantly associated with relapse in univariate analyses. The overall five-year survival rate was 92.2% in FIGO stage I and 89.0% in FIGO stages II-IV. Out of 77 deaths in total, only seven women died from BOT. A general favourable prognosis in women with BOT was confirmed in our study. Our findings indicate that systematic, long-term follow-up does not seem necessary in women treated for FIGO stage IA BOT with no residual disease or microinvasion. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Accurately Identifying New QoS Violation Driven by High-Distributed Low-Rate Denial of Service Attacks Based on Multiple Observed Features

    Directory of Open Access Journals (Sweden)

    Jian Kang

    2015-01-01

    Full Text Available We propose using multiple observed features of network traffic to identify new high-distributed low-rate quality of services (QoS violation so that detection accuracy may be further improved. For the multiple observed features, we choose F feature in TCP packet header as a microscopic feature and, P feature and D feature of network traffic as macroscopic features. Based on these features, we establish multistream fused hidden Markov model (MF-HMM to detect stealthy low-rate denial of service (LDoS attacks hidden in legitimate network background traffic. In addition, the threshold value is dynamically adjusted by using Kaufman algorithm. Our experiments show that the additive effect of combining multiple features effectively reduces the false-positive rate. The average detection rate of MF-HMM results in a significant 23.39% and 44.64% improvement over typical power spectrum density (PSD algorithm and nonparametric cumulative sum (CUSUM algorithm.

  16. Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Shirani, Afsaneh; Zhao, Yinshan; Karim, Mohammad Ehsanul; Evans, Charity; Kingwell, Elaine; van der Kop, Mia L; Oger, Joel; Gustafson, Paul; Petkau, John; Tremlett, Helen

    2012-07-18

    Interferon beta is widely prescribed to treat multiple sclerosis (MS); however, its relationship with disability progression has yet to be established. To investigate the association between interferon beta exposure and disability progression in patients with relapsing-remitting MS. Retrospective cohort study based on prospectively collected data (1985-2008) from British Columbia, Canada. Patients with relapsing-remitting MS treated with interferon beta (n = 868) were compared with untreated contemporary (n = 829) and historical (n = 959) cohorts. The main outcome measure was time from interferon beta treatment eligibility (baseline) to a confirmed and sustained score of 6 (requiring a cane to walk 100 m; confirmed at >150 days with no measurable improvement) on the Expanded