Sample records for related clinical states

  1. Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography

    International Nuclear Information System (INIS)

    Hemmingsen, R.; Vorstrup, S.; Clemmesen, L.; Holm, S.; Tfelt-Hansen, P.; Sorensen, A.S.; Hansen, C.; Sommer, W.; Bolwig, T.G.


    The regional cerebral blood flow of 12 patients with severe alcohol withdrawal reactions (delirium tremens or impending delirium tremens) was measured during the acute state before treatment and after recovery. Greater cerebral blood flow was significantly correlated with visual hallucinations and agitation during the acute withdrawal reaction. The results suggest that delirium tremens and related clinical states represent a type of acute brain syndrome mainly characterized by CNS hyperexcitability

  2. Impact of National Clinical Guideline Recommendations for Revascularization of Persistently Occluded Infarct-Related Arteries on Clinical Practice in the United States (United States)

    Deyell, Marc W.; Buller, Christopher E.; Miller, Louis H.; Wang, Tracy Y.; Dai, David; Lamas, Gervasio A.; Srinivas, Vankeepuram S.; Hochman, Judith S.


    Background The Occluded Artery Trial (OAT) was a large, randomized controlled trial published in 2006 that demonstrated no benefit to routine percutaneous coronary intervention (PCI) of persistently totally occluded infarct-related arteries (IRA) identified a minimum of 24 hours (on calendar days 3–28) after myocardial infarction (MI). The purpose of this study was to determine the impact of OAT results and consequent change in guideline recommendations for PCI for treatment of persistently occluded IRAs. Methods We identified all patients enrolled in the CathPCI Registry, from 2005 to 2008, undergoing catheterization more than 24 hours after MI with a totally occluded native coronary artery and no major OAT exclusion criteria. We examined trends in monthly rates of PCI for occlusions after OAT publication and after guideline revisions. Because reporting of diagnostic catheterizations was not mandatory, we examined trends among hospitals in the highest quartile for reporting of diagnostic procedures. Results A total of 28 780 patient visits from 896 hospitals were included. Overall, we found no significant decline in the adjusted monthly rate of PCI of occlusions after publication of OAT (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.989–1.006) or after guideline revisions (OR, 1.007; 95% CI, 0.992–1.022). Among hospitals consistently reporting diagnostic catheterizations, there was no significant decline after OAT publication (OR, 1.018; 95% CI, 0.995–1.042), and there was a trend toward decline after guideline revisions (OR, 0.963; 95% CI, 0.920–1.000). Conclusion These findings suggest that the results of OAT and consequent guideline revisions have not, to date, been fully incorporated into clinical practice in a large cross-section of hospitals in the United States. PMID:21747002

  3. Eye disease related to onchocerciasis: a clinical study in the Aratha-ú, Yanomami Tribe, Roraima State, Brazil. (United States)

    Neto, Guilherme Herzog; Jaegger, Karen; Marchon-Silva, Verônica; Calvão-Brito, Regina Helena Santos; Vieira, João Batista; Banic, Dalma Maria; Maia-Herzog, Marilza


    The prevalence of ocular lesions due to onchocerciasis was evaluated among residents of the Yanomami Tribe, in the northern Amazon, Brazil, an endemic area for onchocerciasis. 83 natives were submitted to an ocular examination including an external examination, biomicroscopy, intraocular pressure measurement, and a fundus examination. Clinical, parasitological and serological tests were carried out simultaneously. The population demonstrated a high prevalence of eosinophilia, skin microfilaria (55%) and onchocercal subcutaneous nodules (35%). A high prevalence of probable onchocerciasis related eye lesions was detected. Punctate keratitis (41%) and microfilaria in the anterior chamber (39%) were found as well as other probable onchocercotic lesions-chorioretinitis (7.2%) and anterior uveitis (6.0%). Other anterior eye lesions (corneal leucomas, conjunctival injection, lid nodules) occurred in 51% of the individuals. The anterior eye lesions were more prevalent than the posterior lesions. We did not find an association of glaucoma with onchocerciasis. The prevalence of these suggestive ocular lesions strongly correlates with the cutaneous nodules and eosinophilia, suggesting that skin nodules may be an indication for an eye examination. The present study provides evidence that significant infection and eye disease due to onchocerciasis persists in certain regions of Northern South America.

  4. Baryoniums and related states

    International Nuclear Information System (INIS)

    Hong-Mo, C.


    A brief introduction is given to current theoretical ideas on baryonium states with particular emphasis on their interpretation as 'colour molecules'. It is argued that baryonium spectroscopy provides a valuable test for colour as a new degree of freedom. (author)

  5. Hand grip endurance test relates to clinical state and prognosis in COPD patients better than 6-minute walk test distance

    Directory of Open Access Journals (Sweden)

    Kovarik M


    Full Text Available Miroslav Kovarik,1,2 Vera Joskova,1,2 Anna Patkova,1,2 Vladimir Koblizek,3 Zdenek Zadak,2 Miloslav Hronek1,2 1Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; 2Department of Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; 3Department of Pulmonary Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: Patients with COPD present peripheral muscle dysfunction and atrophy, expressed as muscle strength and endurance reduction. The goal of this study was direct dynamometric assessment of hand grip endurance and strength in relation to the stage of disease, multidimensional predictors of mortality, and 6-minute walk test (6MWT. To the best of our knowledge, there has been no previous study determining these parameters.Patients and methods: In this observational study, 58 consecutive outpatients with stable COPD and 25 volunteers without respiratory problems were compared. All COPD subjects underwent a comprehensive examination to determine COPD severity, prognostic scales, and 6MWT. Body composition, basic spirometric parameters, and hand grip strength and endurance were determined in all study participants.Results: Patients in the COPD group had a 15% decrease in maximum strength (P=0.012 and a 28% decrease in area under the force/time curve (AUC of the endurance test (P<0.001 compared to the control group. Dynamometric parameters were significantly negatively associated with the stage of disease and values of multivariable prediction indexes, and positively associated with the results of 6MWT. In most cases, closer associations were found with AUC than with 6MWT and in the gender-specific groups.Conclusion: Both hand grip strength and endurance are impaired in COPD patients in comparison with the control group. In particular, AUC could be considered as an attractive option not only to

  6. Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables

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    Ludmylla Teixeira Soares


    Full Text Available BACKGROUND:Vascular traumas are associated with high morbidity rates.OBJECTIVE: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE, from 2011 to 2013.METHOD: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.RESULTS: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%. The principal mechanism of injury was firearm wounding - 110 (41.67% followed by cold weapon wounds - 65 (24.62% and traffic accidents - 42 (15.91%. The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45% and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%. The most common surgeries were ligatures of veins and arteries. There were 163 (61.74% hospital discharges and 33 (12.5% deaths.CONCLUSIONS: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará.

  7. Clinically related anatomy for physicists

    International Nuclear Information System (INIS)

    Wright, A.E.; Boyer, A.L.


    With the advent of CT and MR imaging, delineation of malignancies and the shaping of radiation treatment fields have become much more precise. Treatment planning in more than one transverse plane is more widely practiced as the use of sophisticated computers grow. These developments emphasize the need for the physicist to have a basic knowledge of human anatomy. This course is designed to familiarize the clinical physicist with the gross anatomy and topographic landmarks used by the physician in planning three-dimensional radiation treatment volumes. The significance of the various anatomic structures and their related lymphatics in the spread of disease is discussed. Emphasis is placed on disease entities that pose particular problems due to overlying or nearby healthy structures at risk

  8. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice

    NARCIS (Netherlands)

    Tjaden, Lidwien A.; Grootenhuis, Martha A.; Noordzij, Marlies; Groothoff, Jaap W.


    Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide

  9. Current state of clinical lithotripsy (United States)

    Lingeman, James E.


    Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the treatment of urolithiasis. Because of the clinical success of the original lithotriptor, the Dornier HM3, numerous manufacturers introduced different approaches to lithotripsy based on empiricism rather than an understanding of the fundamental mechanisms of this new technology. Our understanding of shock wave physics and the physiologic effects of shock waves has progressed greatly over the last decade resulting in insights that hopefully will be reflected favorably in future lithotriptor designs and lithotripsy techniques.

  10. Clinical applications of resting state functional connectivity

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    Michael D Fox


    Full Text Available During resting conditions the brain remains functionally and metabolically active. One manifestation of this activity that has become an important research tool is spontaneous fluctuations in the blood oxygen level dependent (BOLD signal of fMRI. The identification of correlation patterns in these spontaneous fluctuations has been termed resting state functional connectivity (fcMRI and has the potential to greatly increase the translation of fMRI into clinical care. In this article we review the advantages of the resting state signal for clinical applications including detailed discussion of signal to noise considerations. We include guidelines for performing resting state research on clinical populations, outline the different areas for clinical application, and identify important barriers to be addressed to facilitate the translation of resting state fcMRI into the clinical realm.

  11. Food security is related to adult type 2 diabetes control over time in a United States safety net primary care clinic population. (United States)

    Shalowitz, M U; Eng, J S; McKinney, C O; Krohn, J; Lapin, B; Wang, C-H; Nodine, E


    Successful Type 2 diabetes management requires adopting a high nutrient-density diet made up of food items that both meet dietary needs and preferences and can be feasibly obtained on a regular basis. However, access to affordable, nutrient-dense foods often is lacking in poorer neighbourhoods. Therefore, low food security should directly impair glucose control, even when patients have full access to and utilize comprehensive medical management. The present study sought to determine whether food security is related longitudinally to glucose control, over-and-above ongoing medication management, among Type 2 diabetes patients receiving comprehensive care at a Midwestern multi-site federally qualified health centre (FQHC). In this longitudinal observational study, we completed a baseline assessment of patients' food security (using the US Household Food Security Module), demographics (via Census items), and diabetes history/management (using a structured clinical encounter form) when patients began receiving diabetes care at the health centre. We then recorded those patients' A1C levels several times during a 24-month follow-up period. Three hundred and ninety-nine patients (56% with low food security) had a baseline A1c measurement; a subsample of 336 (median age=52 years; 56% female; 60% Hispanic, 27% African American, and 9% White) also had at least one follow-up A1c measurement. Patients with lower (vs higher) food security were more likely to be on insulin and have higher A1c levels at baseline. Moreover, the disparity in glucose control by food security status persisted throughout the next 2 years. Although results were based on one multi-site FQHC, potentially limiting their generalizability, they seem to suggest that among Type 2 diabetes patients, low food security directly impairs glucose control-even when patients receive full access to comprehensive medical management-thereby increasing their long-term risks of high morbidity, early mortality, and high

  12. A Review of Clinical Trial Endpoints of Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension and How They Relate to Patient Outcomes in the United States. (United States)

    Divers, Christine; Platt, David; Wang, Edward; Lin, Jay; Lingohr-Smith, Melissa; Mathai, Stephen C


    Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are subgroups of pulmonary hypertension and are considered rare diseases. Understanding how endpoints of clinical trials (and patient registry studies) of patients with PAH and CTEPH are associated with patient outcomes is important in order to address the concerns of patients, health care providers, decision makers, and payers. The purpose of this review was to examine how endpoints used in clinical trials and patient registry studies are associated with outcomes of patients with PAH and CTEPH. A PubMed literature search was conducted to retrieve published studies, including randomized phase III clinical trials and observational studies, from years 2000 to May 2015 that evaluated the associations between change in 6-minute walking distance (6MWD), 6MWD thresholds, change in World Health Organization functional class (WHO-FC), and time to clinical worsening with outcomes of patients with PAH and CTEPH. Based on this review of published literature, a reduction in 6MWD as a criterion for PAH worsening, a deterioration in WHO-FC, and delay in the time to clinical worsening are clinically meaningful trial endpoints and are associated with outcomes of patients with PAH and CTEPH. Utilization and standardization of these endpoints will be useful for comparing interventions of clinical trials and therapies. Hospitalizations are frequent among patients with PAH and CTEPH, and total health care costs are high. From a U.S. payer perspective, clinical worsening is an important composite endpoint in that it includes hospitalization, which can be transformed into a preventative cost value associated with efficacious treatment of patients with PAH and CTEPH. In view of the greater number of medications available to treat PAH, the introduction of the first approved therapy to treat CTEPH, and the increasing use of combination pharmacotherapy, reliable prognostic markers of treatment

  13. Discovering Related Clinical Concepts Using Large Amounts of Clinical Notes. (United States)

    Ganesan, Kavita; Lloyd, Shane; Sarkar, Vikren


    The ability to find highly related clinical concepts is essential for many applications such as for hypothesis generation, query expansion for medical literature search, search results filtering, ICD-10 code filtering and many other applications. While manually constructed medical terminologies such as SNOMED CT can surface certain related concepts, these terminologies are inadequate as they depend on expertise of several subject matter experts making the terminology curation process open to geographic and language bias. In addition, these terminologies also provide no quantifiable evidence on how related the concepts are. In this work, we explore an unsupervised graphical approach to mine related concepts by leveraging the volume within large amounts of clinical notes. Our evaluation shows that we are able to use a data driven approach to discovering highly related concepts for various search terms including medications, symptoms and diseases.

  14. Discovering Related Clinical Concepts Using Large Amounts of Clinical Notes

    Directory of Open Access Journals (Sweden)

    Kavita Ganesan


    Full Text Available The ability to find highly related clinical concepts is essential for many applications such as for hypothesis generation, query expansion for medical literature search, search results filtering, ICD-10 code filtering and many other applications. While manually constructed medical terminologies such as SNOMED CT can surface certain related concepts, these terminologies are inadequate as they depend on expertise of several subject matter experts making the terminology curation process open to geographic and language bias. In addition, these terminologies also provide no quantifiable evidence on how related the concepts are. In this work, we explore an unsupervised graphical approach to mine related concepts by leveraging the volume within large amounts of clinical notes. Our evaluation shows that we are able to use a data driven approach to discovering highly related concepts for various search terms including medications, symptoms and diseases.

  15. Improvement of uncertainty relations for mixed states

    International Nuclear Information System (INIS)

    Park, Yong Moon


    We study a possible improvement of uncertainty relations. The Heisenberg uncertainty relation employs commutator of a pair of conjugate observables to set the limit of quantum measurement of the observables. The Schroedinger uncertainty relation improves the Heisenberg uncertainty relation by adding the correlation in terms of anti-commutator. However both relations are insensitive whether the state used is pure or mixed. We improve the uncertainty relations by introducing additional terms which measure the mixtureness of the state. For the momentum and position operators as conjugate observables and for the thermal state of quantum harmonic oscillator, it turns out that the equalities in the improved uncertainty relations hold

  16. Drug-related disorders and the criminal and clinical background of the prison population of São Paulo State, Brazil.

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    Maíra Mendes dos Santos

    Full Text Available OBJECTIVE: To analyze the association between drug (DAD and alcohol (AAD abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil. METHOD: Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD were combined into a single category. RESULTS: The sample was composed by 1809 interviewed prisoners (1192 men and 617 women. Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17, to be a repeat offender (OR 2.85, and to have committed a property crime (OR 2.18. Prisoners with AAD were repeat offenders (OR 2.18. Among female prisoners, ADAD was associated with repeat offenses (OR 3.39, a criminal record as an adolescent (OR 9.24, a clinical or infectious condition (OR 5.09, another health problem (OR 3.04, and violent crime (OR 2.5. CONCLUSION: The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for

  17. Noonan syndrome and clinically related disorders (United States)

    Tartaglia, Marco; Gelb, Bruce D.; Zenker, Martin


    Noonan syndrome is a relatively common, clinically variable developmental disorder. Cardinal features include postnatally reduced growth, distinctive facial dysmorphism, congenital heart defects and hypertrophic cardiomyopathy, variable cognitive deficit and skeletal, ectodermal and hematologic anomalies. Noonan syndrome is transmitted as an autosomal dominant trait, and is genetically heterogeneous. So far, heterozygous mutations in nine genes (PTPN11, SOS1, KRAS, NRAS, RAF1, BRAF, SHOC2, MEK1 and CBL) have been documented to underlie this disorder or clinically related phenotypes. Based on these recent discoveries, the diagnosis can now be confirmed molecularly in approximately 75% of affected individuals. Affected genes encode for proteins participating in the RAS-mitogen-activated protein kinases (MAPK) signal transduction pathway, which is implicated in several developmental processes controlling morphology determination, organogenesis, synaptic plasticity and growth. Here, we provide an overview of clinical aspects of this disorder and closely related conditions, the molecular mechanisms underlying pathogenesis, and major genotype-phenotype correlations. PMID:21396583

  18. Clinical presentation of neurocysticercosis-related epilepsy. (United States)

    Duque, Kevin R; Burneo, Jorge G


    Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a major risk factor for seizures and epilepsy. Seizure types in NCC vary largely across studies and seizure semiology is poorly understood. We discuss here the studies regarding seizure types and seizure semiology in NCC, and examine the clinical presentation in patients with NCC and drug-resistant epilepsy. We also provide evidence of the role of MRI and EEG in the diagnosis of NCC-related epilepsy. Focal seizures are reported in 60-90% of patients with NCC-related epilepsy, and around 90% of all seizures registered prospectively are focal not evolving to bilateral tonic-clonic seizures. A great number of cases suggest that seizure semiology is topographically related to NCC lesions. Patients with hippocampal sclerosis and NCC have different clinical and neurophysiological characteristics than those with hippocampal sclerosis alone. Different MRI protocols have allowed to better differentiate NCC from other etiologies. Lesions' stages might account on the chances of finding an interictal epileptiform discharge. Studies pursuing the seizure onset in patients with NCC are lacking and they are specially needed to determine both whether the reported events of individual cases are seizures, and whether they are related to the NCC lesion or lesions. This article is part of a Special Issue entitled "Neurocysticercosis and Epilepsy". Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Majorization uncertainty relations for mixed quantum states (United States)

    Puchała, Zbigniew; Rudnicki, Łukasz; Krawiec, Aleksandra; Życzkowski, Karol


    Majorization uncertainty relations are generalized for an arbitrary mixed quantum state ρ of a finite size N. In particular, a lower bound for the sum of two entropies characterizing the probability distributions corresponding to measurements with respect to two arbitrary orthogonal bases is derived in terms of the spectrum of ρ and the entries of a unitary matrix U relating both bases. The results obtained can also be formulated for two measurements performed on a single subsystem of a bipartite system described by a pure state, and consequently expressed as an uncertainty relation for the sum of conditional entropies.

  20. Workshop on Squeezed States and Uncertainty Relations

    International Nuclear Information System (INIS)

    Han, D.; Kim, Y.S.; Zachary, W.W.


    The proceedings from the workshop are presented, and the focus was on the application of squeezed states. There are many who say that the potential for industrial applications is enormous, as the history of the conventional laser suggests. All those who worked so hard to produce squeezed states of light are continuing their efforts to construct more efficient squeezed-state lasers. Quite naturally, they are looking for new experiments using these lasers. The physical basis of squeezed states is the uncertainty relation in Fock space, which is also the basis for the creation and annihilation of particles in quantum field theory. Indeed, squeezed states provide a unique opportunity for field theoreticians to develop a measurement theory for quantum field theory

  1. Inferring the relative resilience of alternative states (United States)

    Angeler, David G.; Allen, Craig R.; Rojo, Carmen; Alvarez-Cobelas, Miguel; Rodrigo, Maria A.; Sanchez-Carrillo, Salvador


    Ecological systems may occur in alternative states that differ in ecological structures, functions and processes. Resilience is the measure of disturbance an ecological system can absorb before changing states. However, how the intrinsic structures and processes of systems that characterize their states affects their resilience remains unclear. We analyzed time series of phytoplankton communities at three sites in a floodplain in central Spain to assess the dominant frequencies or “temporal scales” in community dynamics and compared the patterns between a wet and a dry alternative state. The identified frequencies and cross-scale structures are expected to arise from positive feedbacks that are thought to reinforce processes in alternative states of ecological systems and regulate emergent phenomena such as resilience. Our analyses show a higher species richness and diversity but lower evenness in the dry state. Time series modeling revealed a decrease in the importance of short-term variability in the communities, suggesting that community dynamics slowed down in the dry relative to the wet state. The number of temporal scales at which community dynamics manifested, and the explanatory power of time series models, was lower in the dry state. The higher diversity, reduced number of temporal scales and the lower explanatory power of time series models suggest that species dynamics tended to be more stochastic in the dry state. From a resilience perspective our results highlight a paradox: increasing species richness may not necessarily enhance resilience. The loss of cross-scale structure (i.e. the lower number of temporal scales) in community dynamics across sites suggests that resilience erodes during drought. Phytoplankton communities in the dry state are therefore likely less resilient than in the wet state. Our case study demonstrates the potential of time series modeling to assess attributes that mediate resilience. The approach is useful for assessing

  2. Clinical factors related to schizophrenia relapse. (United States)

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


    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.

  3. Clinical analysis of 503 cases of hyperthyroidism related hepatic damage

    International Nuclear Information System (INIS)

    Zhang Xiaoxia


    The clinical characteristics and the therapeutic method of 503 hyperthyroidism related hepatic damage in the paper was discussed. The incidence of the disease of hyperthyroidism related hepatic damage was 39.7%, the rate increases with the increase in age of the patients and the increase of the course of hyperthy-roidism (P 3 and FT 4 . The state of the illness may be get better with the treatment, and ALT and AST were all resumed; The hyperthyroidism was easy to lead to hepatic damage. Treatment was given priority to controlling of hyperthyroidism and put the protection of liver to the second place: the degree of hepatic damage was closely related to age, the course of disease and the state of illness. A timely diagnoses and proper therapy may be lead to desirable result. (author)

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

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


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

  5. Possession States: Approaches to Clinical Evaluation and Classification

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    S. McCormick


    Full Text Available The fields of anthropology and sociology have produced a large quantity of literature on possession states, physicians however rarely report on such phenomena. As a result clinical description of possession states has suffered, even though these states may be more common and less deviant than supposed. Both ICD-10 and DSM-IV may include specific criteria for possession disorders. The authors briefly review Western notions about possession and kindred states and present guidelines for evaluation and classification.

  6. The clinical popularity of object relations concepts. (United States)

    Friedman, L


    Object relations theory has the effect of supporting the psychoanalyst when he feels that the patient's effort is strongly opposed to his own. The current popularity of object relations theory may be related to the gradual disappearance from Freudian theory of a simple, clear image of an obligatory insistence by the patient that is useful even though it is unreflective. Object relations theory offers the practitioner a way of fortifying himself against blind demand, while newer Freudian theorists cope with the problem by orienting themselves more stringently toward the original paradigm of optional choice.

  7. EDITORIAL: Squeezed states and uncertainty relations (United States)

    Jauregue-Renaud, Rocio; Kim, Young S.; Man'ko, Margarita A.; Moya-Cessa, Hector


    This special issue of Journal of Optics B: Quantum and Semiclassical Optics is composed mainly of extended versions of talks and papers presented at the Eighth International Conference on Squeezed States and Uncertainty Relations held in Puebla, Mexico on 9-13 June 2003. The Conference was hosted by Instituto de Astrofísica, Óptica y Electrónica, and the Universidad Nacional Autónoma de México. This series of meetings began at the University of Maryland, College Park, USA, in March 1991. The second and third workshops were organized by the Lebedev Physical Institute in Moscow, Russia, in 1992 and by the University of Maryland Baltimore County, USA, in 1993, respectively. Afterwards, it was decided that the workshop series should be held every two years. Thus the fourth meeting took place at the University of Shanxi in China and was supported by the International Union of Pure and Applied Physics (IUPAP). The next three meetings in 1997, 1999 and 2001 were held in Lake Balatonfüred, Hungary, in Naples, Italy, and in Boston, USA, respectively. All of them were sponsored by IUPAP. The ninth workshop will take place in Besançon, France, in 2005. The conference has now become one of the major international meetings on quantum optics and the foundations of quantum mechanics, where most of the active research groups throughout the world present their new results. Accordingly this conference has been able to align itself to the current trend in quantum optics and quantum mechanics. The Puebla meeting covered most extensively the following areas: quantum measurements, quantum computing and information theory, trapped atoms and degenerate gases, and the generation and characterization of quantum states of light. The meeting also covered squeeze-like transformations in areas other than quantum optics, such as atomic physics, nuclear physics, statistical physics and relativity, as well as optical devices. There were many new participants at this meeting, particularly

  8. Risk factors, pre-presentation management and clinical state of ...

    African Journals Online (AJOL)


    Aug 23, 2017 ... based on provision of clean water sources, basic hygiene. CC –BY ... clinical state at presentation, management, and outcome were documented. Data was entered ... WHBPF = Washes hands before preparing food. WHBF =.

  9. Clinical and forensic signs related to cocaine abuse. (United States)

    Dinis-Oliveira, Ricardo Jorge; Carvalho, Félix; Duarte, José Alberto; Proença, Jorge Brandão; Santos, Agostinho; Magalhães, Teresa


    Good laboratory practice in toxicological analysis requires pre-analytical steps for collection of detailed information related to the suspected poisoning episodes, including biological and non-biological circumstantial evidences, which should be carefully scrutinized. This procedure provides great help to unveil the suspected cause of poisoning, to select the appropriate and correct samples to be analyzed and can facilitate the decision about the analytical techniques to perform. This implies a good knowledge of the signs related to acute and chronic intoxications by drugs of abuse. In this manuscript we highlight and discuss clinical and forensic imaging related to cocaine abuse, namely the midline destructive lesion, dental health, pseudoscleradermatous triad and crack hands, necrosis and gangrene of extremities and several other skin manifestations, reticular purpura, intracerebral and peripheral hemorrhages, angioneurotic edema, rhabdomyolysis, and crack lung. For this purpose, the state of the art on this topic is discussed, using clinical and forensic cases from our professional database in complement to images and mechanistic data from literature.

  10. Multiparticle states in deformed special relativity

    International Nuclear Information System (INIS)

    Hossenfelder, S.


    We investigate the properties of multiparticle states in deformed special relativity (DSR). Starting from the Lagrangian formalism with an energy dependent metric, the conserved Noether current can be derived which is additive in the usual way. The integrated Noether current had previously been discarded as a conserved quantity, because it was correctly realized that it does no longer obey the DSR transformations. We identify the reason for this mismatch in the fact that DSR depends only on the extensive quantity of total four momentum instead of the energy-momentum densities as would be appropriate for a field theory. We argue that the reason for the failure of DSR to reproduce the standard transformation behavior in the well established limits is due to the missing sensitivity to the volume inside which energy is accumulated. We show that the soccer-ball problem is absent if one formulates DSR instead for the field densities. As a consequence, estimates for predicted effects have to be corrected by many orders of magnitude. Further, we derive that the modified quantum field theory implies a locality bound

  11. [Progress of midfacial fat compartments and related clinical applications]. (United States)

    Wen, Lihong; Wang, Jinhuang; Li, Yang; Liu, Dalie


    To review the research progress of midfacial fat compartments, and to thoroughly understand its current state of the anatomy and the aging morphologic characters of midfacial fat compartments, as well as the current status of clinical applications. The recent literature concerning the midfacial fat compartments and related clinical applications were extensively reviewed and analyzed. Midfacial fat layer has been considered as a fusion and a continuous layer, experiencing a global atrophy when aging. As more anatomical researches have done, recent studies have shown that midfacial fat layer is broadly divided into superficial and deep layers, which are both divided into different fat compartments by fascia, ligaments, or muscles. Midfacial fat compartments tend to atrophy with age, specifically in the deep fat compartments while hypertrophy in the superficial fat compartments. Clinical applications show that fat volumetric restoration with deep medial cheek fat and Ristow's space can restore the appearance of midface effectively. In recent years, the researches of midfacial fat compartments have achieved obvious progress, which will provide new ideas and basis for fat volumetric restoration. Corresponding treatments are selected based on different sites and different layers with different aging changes, reshaping a more youthful midface.

  12. Undergraduate nursing students' experience related to their clinical learning environment and factors affecting to their clinical learning process. (United States)

    Arkan, Burcu; Ordin, Yaprak; Yılmaz, Dilek


    Clinical education is an essential part of nursing education. The purpose of this study was to explore nurse students' experiences related to cinical learning environments, factors effecting to clinical learning process. Descriptive qualitative design was used in this study, and data were collected from 2nd class nursing student (n = 14). The study took the form of in-depth interviews between August-October 2015. The qualitative interviews were analyzed by using simple content analysis. Data were analyzed manually. Experiences nurse students are described five themes. The themes of the study are (1) effecting persons to clinical learning, (2) educational atmosphere, (3) students' personal charactering, (4) the impact of education in school, and (5) students' perceptions related to clinical learning. Participants stated that they experienced many difficulties during clinical learning process. All students importantly stated that nurse teacher is very effecting to clinical learning. This study contributes to the literature by providing data on beginner nursing student' experiences about clinical learning process. The data of this present study show to Turkish nursing student is affecting mostly from persons in clinical learning. The data of this present study will guide nurse teacher when they plan to interventions to be performed to support student during clinical learning process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Relative entropy as a measure of entanglement for Gaussian states

    Institute of Scientific and Technical Information of China (English)

    Lu Huai-Xin; Zhao Bo


    In this paper, we derive an explicit analytic expression of the relative entropy between two general Gaussian states. In the restriction of the set for Gaussian states and with the help of relative entropy formula and Peres-Simon separability criterion, one can conveniently obtain the relative entropy entanglement for Gaussian states. As an example,the relative entanglement for a two-mode squeezed thermal state has been obtained.

  14. The politics of federal-state relations

    International Nuclear Information System (INIS)

    Dravo, A.N.


    States' ability to reject siting of high-level waste repositories has rested on politics, technical judgement and the potential that procedural error could disqualify a project. Prior to enactment of the Nuclear Waste Policy Act, sites were rejected through parochial political action in Congress. The NWPA limited the ability of states to receive parochial assistance, but did not eliminate the potential for Congressional politics to dominate programmatic decisions. Technical and procedural opportunity for affecting siting have, however, increased

  15. 12 CFR 202.11 - Relation to state law. (United States)


    ... other interested party may request that the Board determine whether a state law is inconsistent with the.... (e) Exemption for state-regulated transactions—(1) Applications. A state may apply to the Board for... OPPORTUNITY ACT (REGULATION B) § 202.11 Relation to state law. (a) Inconsistent state laws. Except as...

  16. 12 CFR 213.9 - Relation to state laws. (United States)


    ... interpretative responsibilities for the state consumer leasing law, may apply to the Board for a preemption determination. (b) Exemptions—(1) Application. A state may apply to the Board for an exemption from the... LEASING (REGULATION M) § 213.9 Relation to state laws. (a) Inconsistent state law. A state law that is...


    African Journals Online (AJOL)

    Mrs. I.D


    Dec 25, 2009 ... response from the Nigerian government. ... domestic crises that negatively impacts state stability, the US government ... Harrison C. Ajebon, Department of Political Science, University of Calabar, ..... Sweden. United Kingdom. Switzerland. Asia & far East. Japan ..... case Study of Nigeria, in Ikonnechidi and.

  18. Clinical pharmacology in Russia-historical development and current state. (United States)

    Zagorodnikova Goryachkina, Ksenia; Burbello, Aleksandra; Sychev, Dmitry; Frolov, Maxim; Kukes, Vladimir; Petrov, Vladimir


    Clinical pharmacology in Russia has long history and is currently active, but rather unrecognized internationally. It is governmentally approved as a teaching/scientific specialty since 1983 and as a medical specialty since 1997. Courses of clinical pharmacology are included in the undergraduate curricula in the 5th and/or 6th year of education at all medical schools in the Russian Federation. Postgraduate education includes initial specialization in internal medicine with further residency in clinical pharmacology. Governmental legislation recommends that every healthcare institution has either a department or a single position of clinical pharmacologist. Major routine duties include information about and monitoring of medication use, consultations in difficult clinical situations, pharmacogenetic counseling, therapeutic drug monitoring, pharmacovigilance, and participation in drug and therapeutics (formulary) committees. There are official experts in clinical pharmacology in Russia responsible for coordinating relevant legislative issues. The chief expert clinical pharmacologist represents the discipline directly at the Ministry of Health. Research in clinical pharmacology in Russia is extensive and variable, but only some of it is published internationally. Russia is a participant of international societies of clinical pharmacology and therapeutics and collaboration is actively ongoing. There are still certain problems related to the development of the discipline in Russia-some healthcare institutions do not see the need for clinical pharmacology. However, the number of clinical pharmacologists in Russia is increasing as well as their role in physicians' education, national healthcare, and research.

  19. National Database for Clinical Trials Related to Mental Illness (NDCT) (United States)

    U.S. Department of Health & Human Services — The National Database for Clinical Trials Related to Mental Illness (NDCT) is an extensible informatics platform for relevant data at all levels of biological and...

  20. Generalized uncertainty relations and characteristic invariants for the multimode states

    International Nuclear Information System (INIS)

    Sudarshan, E.C.G.; Chiu, C.B.; Bhamathi, G.


    The close relationship between the zero-point energy, the uncertainty relation, coherent states, squeezed states, and correlated states for one mode is investigated. This group theoretic perspective of the problem enables the parametrization and identification of their multimode generalization. A simple and efficient method of determining the canonical structure of the generalized correlated states is presented. Implication of canonical commutation relations for correlations are not exhausted by the Heisenberg uncertainty relation, not even by the Schroedinger-Robertson uncertainty inequality, but there are relations in the multimode case that are the generalization of the Schroedinger-Robertson relation

  1. Using Relational Reasoning Strategies to Help Improve Clinical Reasoning Practice. (United States)

    Dumas, Denis; Torre, Dario M; Durning, Steven J


    Clinical reasoning-the steps up to and including establishing a diagnosis and/or therapy-is a fundamentally important mental process for physicians. Unfortunately, mounting evidence suggests that errors in clinical reasoning lead to substantial problems for medical professionals and patients alike, including suboptimal care, malpractice claims, and rising health care costs. For this reason, cognitive strategies by which clinical reasoning may be improved-and that many expert clinicians are already using-are highly relevant for all medical professionals, educators, and learners.In this Perspective, the authors introduce one group of cognitive strategies-termed relational reasoning strategies-that have been empirically shown, through limited educational and psychological research, to improve the accuracy of learners' reasoning both within and outside of the medical disciplines. The authors contend that relational reasoning strategies may help clinicians to be metacognitive about their own clinical reasoning; such strategies may also be particularly well suited for explicitly organizing clinical reasoning instruction for learners. Because the particular curricular efforts that may improve the relational reasoning of medical students are not known at this point, the authors describe the nature of previous research on relational reasoning strategies to encourage the future design, implementation, and evaluation of instructional interventions for relational reasoning within the medical education literature. The authors also call for continued research on using relational reasoning strategies and their role in clinical practice and medical education, with the long-term goal of improving diagnostic accuracy.

  2. Squeezed States and Uncertainty Relations. Abstracts

    International Nuclear Information System (INIS)

    Masahito, Hayashi; Reynaud, S.; Jaekel, M.Th.; Fiuraaek, J.; Garcia-Patron, R.; Cerf, N.J.; Hage, B.; Chelkowski, S.; Franzen, A.; Lastzka, N.; Vahlbruch, N.; Danzmann, K.; Schnabel, R.; Hassan, S.S.; Joshi, A.; Jakob, M.; Bergou, J.A.; Kozlovskii, A.V.; Prakash, H.; Kumar, R.


    The purpose of the conference was to bring together people working in the field of quantum optics, with special emphasis on non-classical light sources and related areas, quantum computing, statistical mechanics and mathematical physics. As a novelty, this edition will include the topics of quantum imaging, quantum phase noise and number theory in quantum mechanics. This document gives the program of the conference and gathers the abstracts

  3. The Second International Workshop on Squeezed States and Uncertainty Relations (United States)

    Han, D. (Editor); Kim, Y. S.; Manko, V. I.


    This conference publication contains the proceedings of the Second International Workshop on Squeezed States and Uncertainty Relations held in Moscow, Russia, on 25-29 May 1992. The purpose of this workshop was to study possible applications of squeezed states of light. The Workshop brought together many active researchers in squeezed states of light and those who may find the concept of squeezed states useful in their research, particularly in understanding the uncertainty relations. It was found at this workshop that the squeezed state has a much broader implication than the two-photon coherent states in quantum optics, since the squeeze transformation is one of the most fundamental transformations in physics.

  4. Current clinical research of immunoglobulin G4-related orbital disease

    Directory of Open Access Journals (Sweden)

    Yang Wang


    Full Text Available Immunoglobulin G4-related disease(IgG4-related diseasehas received lots of attention in medical community as a recently recognized fibro-inflammatory condition. It is characterized by infiltration of IgG4-immunopositive plasmacytes and concentration of elevated serum IgG4. IgG4-related disease shows organ enlargement or nodular/hyperplastic lesions in various organs including the pancreas, hepatobiliary tract and orbit, which is called IgG4-related orbital disease. The diagnostic criteria for IgG4-related disease and IgG4-related orbital disease has recently been established, which is based on clinical, imaging and histopathologic features of the orbital lesions. Besides, attention should be drawn to the differentiation from other diseases. The treatment is empirical including corticosteroids, immunosuppressive drugs, radiotherapy, and rituximab. This article reviews clinical progression of IgG4-related orbital disease.

  5. Obtaining patient test results from clinical laboratories: a survey of state law for pharmacists. (United States)

    Witry, Matthew J; Doucette, William R


    To identify states with laws that restrict to whom clinical laboratories may release copies of laboratory test results and to describe how these laws may affect pharmacists' ability to obtain patient laboratory test results. Researchers examined state statutes and administrative codes for all 50 states and the District of Columbia at the University of Iowa Law Library between June and July 2007. Researchers also consulted with lawyers, state Clinical Laboratory Improvement Amendments officers, and law librarians. Laws relating to the study objective were analyzed. 34 jurisdictions do not restrict the release of laboratory test results, while 17 states have laws that restrict to whom clinical laboratories can send copies of test results. In these states, pharmacists will have to use alternative sources, such as physician offices, to obtain test results. Pharmacists must consider state law before requesting copies of laboratory test results from clinical laboratories. This may be an issue that state pharmacy associations can address to increase pharmacist access to important patient information.

  6. Pancreatic cancer clinical trials and accrual in the United States. (United States)

    Hoos, William A; James, Porsha M; Rahib, Lola; Talley, Anitra W; Fleshman, Julie M; Matrisian, Lynn M


    Pancreatic cancer clinical trials open in the United States and their accrual were examined to identify opportunities to accelerate progress in the treatment of pancreatic cancer. Pancreatic cancer-specific clinical trials open in the United States in the years 2011 and 2012 were obtained from the Pancreatic Cancer Action Network database. Accrual information was obtained from trial sponsors. The portfolio of pancreatic cancer clinical trials identified by type (adenocarcinoma or neuroendocrine), phase, disease stage, and treatment approach is reported. More than half of trials for patients with pancreatic ductal adenocarcinoma applied biologic insights to new therapeutic approaches, and 38% focused on optimization of radiation or chemotherapy delivery or regimens. In 2011, pancreatic cancer trials required total enrollment of 11,786 patients. Actual accrual to 93.2% of trials was 1,804 patients, an estimated 4.57% of the patients with pancreatic cancer alive in that year. The greatest need was for patients with resectable cancer. Trials open in 2011 enrolled an average of 15% of their total target accrual. Physician recommendations greatly influenced patients' decision to enroll or not enroll onto a clinical trial. Matching to a clinical trial within a 50-mile radius and identifying trials for recurrent/refractory disease were documented as challenges for patient accrual. Overall trial enrollment indicates that pancreatic cancer trials open in 2011 would require 6.7 years on average to complete accrual. These results suggest that harmonizing patient supply and demand for clinical trials is required to accelerate progress toward improving survival in pancreatic cancer.

  7. Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables


    Garaigordobil, Maite; Bernar?s, Elena; Jaureguizar, Joana; Machimbarrena, Juan M.


    The study had two goals: (1) to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2) to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls). Results revealed: (1) positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and...

  8. Clinical and forensic signs related to opioids abuse. (United States)

    Dinis-Oliveira, Ricardo Jorge; Carvalho, Felix; Moreira, Roxana; Duarte, Jose Alberto; Proenca, Jorge Brandao; Santos, Agostinho; Magalhaes, Teresa


    For a good performance in Clinical and Forensic Toxicology it is important to be aware of the biological and non-biological signs and symptoms related to xenobiotic exposure. This manuscript highlights and analyzes clinical and forensic imaging related to opioids abuse critically. Particularly, respiratory depression, track marks and hemorrhages, skin "popping", practices of phlebotomy, tissue necrosis and ulceration, dermatitis, tongue hyperpigmentation, "coma blisters", intra-arterial administration, candidiasis, wounds associated with anthrax or clostridium contaminated heroin, desomorphine related lesions and characteristic non-biological evidences are some commonly reported findings in opioids abuse, which will be discussed. For this purpose, clinical and forensic cases from our database (National Institute of Legal Medicine and Forensic Sciences, North Branch, Portugal), in addition to literature data, are reviewed.

  9. Changes in sleep polygraphic variables and clinical state in depressed patients during treatment with citalopram

    NARCIS (Netherlands)

    Bemmel, Alex L. van; Hoofdakker, Rutger H. van den; Beersma, Domien G.M.; Bouhuys, Antoinette L.


    Drug-induced improvement of depression may be mediated by changes in sleep physiology. The aim of this study was to relate changes in sleep polygraphic variables to clinical state during treatment with citalopram, a highly specific serotonin uptake inhibitor. Sixteen patients took part. The study

  10. Blocking Avoidance and Escape Responses: Relations With Clinically Relevant Behaviors

    Directory of Open Access Journals (Sweden)

    Juliana Maria Bubna Popovitz

    Full Text Available Abstract: The current study aims to evaluate the possible effects of interrupting problematic clinically relevant behaviors on the percentage of these responses and of clinical improvement-related responses. Two clients were treated with Functional Analytic Psychotherapy (FAP, alternating two conditions (ABAB. On condition A, procedures to the therapist consisted of responding to the clinical improvement responses, and to description of outside of therapeutic setting behaviors, but therapists were advised to ignore problem behaviors emitted in session. During condition B, therapists followed the same procedures, but they were oriented to block (interrupt problematic responses emitted in session. Results suggest increase in the percentage of problem behaviors during condition B. Results are discussed, highlighting the viability of planning the contingent response the therapist emits to clinically relevant behaviors.

  11. Clinical cardiac positron emission tomography: State of the art

    International Nuclear Information System (INIS)

    Gould, K.L.


    Cardiac positron emission tomography (PET) has evolved rapidly from a relatively esoteric research tool into clinical applications providing unique, quantitative information on myocardial perfusion, metabolism, and cell membrane function and having a potentially significant impact on cardiovascular medicine. Although there are many different positron radionuclides for imaging diverse myocardial behavior, three radionuclides have reached accepted clinical utility. Cardiac PET using nitrogen-13-ammonia, rubidium-82, and fluoro-18-deoxyglucose has proved accurate and definitive in multiple university and private-practice sites for diagnosing and assessing severity and location of coronary artery disease in symptomatic or asymptomatic patients, for identifying injured but viable myocardium potentially salvageable by revascularization, and for ruling out clinically significant coronary artery stenosis with a high specificity in patients who might otherwise undergo coronary arteriography to document the absence of significant disease. 89 references

  12. State Confessional Relations: Problem of the Subject Structure

    Directory of Open Access Journals (Sweden)

    Alexandra A. Dorskaya


    Full Text Available In the article various existing definitions of the concept "state and confessional relations" are analyzed, also author's definition is offered. Three levels of the state and confessional relations are revealed: conceptual, legislative and administrative-managerial. In the article it is shown that in Russia a tradition of only two subjects of the state and confessional relations – government bodies and the religious organizations allocation exists. It is revealed that at the present stage many researchers are dissatisfied with such situation. Scientific sources of the problem of the state and church relations within the psychological school of the law, which are addressed to the personality and experiences in the legal sphere are studied and revealed. Special attention is paid to scientific heritage of the M.A. Reysner, who was one of the first to begin study of this problem. In the article the question of the school of three subjects of the state and confessional relations allocation formation, what adds the faithful or faithless personality in addition to two traditional subjects is analyzed. The state and confessional relations are considered in the context of the human rights development. The question of new type of the believer possessing high education level and knowledge formation is considered. In the article it is shown that at the present stage relations of any regulation between the state and religious organizations is based on the basis of international legal standards, domestic legislation and norms of canon law.

  13. 15 CFR Notes Applicable to State... - Notes applicable to State of Understanding related to Medical Equipment: (United States)


    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Notes applicable to State of Understanding related to Medical Equipment: applicable Notes applicable to State of Understanding related to Medical Equipment: Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY,...

  14. State-independent uncertainty relations and entanglement detection (United States)

    Qian, Chen; Li, Jun-Li; Qiao, Cong-Feng


    The uncertainty relation is one of the key ingredients of quantum theory. Despite the great efforts devoted to this subject, most of the variance-based uncertainty relations are state-dependent and suffering from the triviality problem of zero lower bounds. Here we develop a method to get uncertainty relations with state-independent lower bounds. The method works by exploring the eigenvalues of a Hermitian matrix composed by Bloch vectors of incompatible observables and is applicable for both pure and mixed states and for arbitrary number of N-dimensional observables. The uncertainty relation for the incompatible observables can be explained by geometric relations related to the parallel postulate and the inequalities in Horn's conjecture on Hermitian matrix sum. Practical entanglement criteria are also presented based on the derived uncertainty relations.

  15. State-related alterations of gene expression in bipolar disorder

    DEFF Research Database (Denmark)

    Munkholm, Klaus; Vinberg, Maj; Berk, Michael


    Munkholm K, Vinberg M, Berk M, Kessing LV. State-related alterations of gene expression in bipolar disorder: a systematic review. Bipolar Disord 2012: 14: 684-696. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective:  Alterations in gene expression in bipolar disorder...... have been found in numerous studies. It is unclear whether such alterations are related to specific mood states. As a biphasic disorder, mood state-related alterations in gene expression have the potential to point to markers of disease activity, and trait-related alterations might indicate...... vulnerability pathways. This review therefore evaluated the evidence for whether gene expression in bipolar disorder is state or trait related. Methods:  A systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline for reporting systematic reviews, based...

  16. Progress in clinical research and application of resting state functional brain imaging

    International Nuclear Information System (INIS)

    Long Miaomiao; Ni Hongyan


    Resting state functional brain imaging experimental design is free of stimulus task and offers various parametric maps through different data-driven post processing methods with endogenous BOLD signal changes as the source of imaging. Mechanism of resting state brain activities could be extensively studied with improved patient compliance and clinical application compared with task related functional brain imaging. Also resting state functional brain imaging can be used as a method of data acquisition, with implicit neuronal activity as a kind of experimental design, to reveal characteristic brain activities of epileptic patient. Even resting state functional brain imaging data processing method can be used to analyze task related functional MRI data, opening new horizons of task related functional MRI study. (authors)

  17. Normalization of relative and incomplete temporal expressions in clinical narratives. (United States)

    Sun, Weiyi; Rumshisky, Anna; Uzuner, Ozlem


    To improve the normalization of relative and incomplete temporal expressions (RI-TIMEXes) in clinical narratives. We analyzed the RI-TIMEXes in temporally annotated corpora and propose two hypotheses regarding the normalization of RI-TIMEXes in the clinical narrative domain: the anchor point hypothesis and the anchor relation hypothesis. We annotated the RI-TIMEXes in three corpora to study the characteristics of RI-TMEXes in different domains. This informed the design of our RI-TIMEX normalization system for the clinical domain, which consists of an anchor point classifier, an anchor relation classifier, and a rule-based RI-TIMEX text span parser. We experimented with different feature sets and performed an error analysis for each system component. The annotation confirmed the hypotheses that we can simplify the RI-TIMEXes normalization task using two multi-label classifiers. Our system achieves anchor point classification, anchor relation classification, and rule-based parsing accuracy of 74.68%, 87.71%, and 57.2% (82.09% under relaxed matching criteria), respectively, on the held-out test set of the 2012 i2b2 temporal relation challenge. Experiments with feature sets reveal some interesting findings, such as: the verbal tense feature does not inform the anchor relation classification in clinical narratives as much as the tokens near the RI-TIMEX. Error analysis showed that underrepresented anchor point and anchor relation classes are difficult to detect. We formulate the RI-TIMEX normalization problem as a pair of multi-label classification problems. Considering only RI-TIMEX extraction and normalization, the system achieves statistically significant improvement over the RI-TIMEX results of the best systems in the 2012 i2b2 challenge. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  18. Assistance to States on Policies Related to Wind Energy Issues

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Matthew, H; Decesaro, Jennifer; DOE Project Officer - Keith Bennett


    This final report summarizes work carried out under agreement with the US Department of Energy, related to wind energy policy issues. This project has involved a combination of outreach and publications on wind energy, with a specific focus on educating state-level policymakers. Education of state policymakers is vitally important because state policy (in the form of incentives or regulation) is a crucial part of the success of wind energy. State policymakers wield a significant influence over all of these policies. They are also in need of high quality, non-biased educational resources which this project provided. This project provided outreach to legislatures, in the form of meetings designed specifically for state legislators and legislative staff, responses to information requests on wind energy, and publications. The publications addressed: renewable energy portfolio standards, wind energy transmission, wind energy siting, case studies of wind energy policy, avian issues, economic development, and other related issues. These publications were distributed to legislative energy committee members, and chairs, legislative staff, legislative libraries, and other related state officials. The effect of this effort has been to provide an extensive resource of information about wind information for state policymakers in a form that is useful to them. This non-partisan information has been used as state policymakers attempt to develop their own policy proposals related to wind energy in the states.

  19. A lower bound on the relative error of mixed-state cloning and related operations

    International Nuclear Information System (INIS)

    Rastegin, A E


    We extend the concept of the relative error to mixed-state cloning and related physical operations, in which the ancilla contains some information a priori about the input state. The lower bound on the relative error is obtained. It is shown that this result provides further support for a stronger no-cloning theorem

  20. Classifying medical relations in clinical text via convolutional neural networks. (United States)

    He, Bin; Guan, Yi; Dai, Rui


    Deep learning research on relation classification has achieved solid performance in the general domain. This study proposes a convolutional neural network (CNN) architecture with a multi-pooling operation for medical relation classification on clinical records and explores a loss function with a category-level constraint matrix. Experiments using the 2010 i2b2/VA relation corpus demonstrate these models, which do not depend on any external features, outperform previous single-model methods and our best model is competitive with the existing ensemble-based method. Copyright © 2018. Published by Elsevier B.V.

  1. Improved Sensitivity Relations in State Constrained Optimal Control

    International Nuclear Information System (INIS)

    Bettiol, Piernicola; Frankowska, Hélène; Vinter, Richard B.


    Sensitivity relations in optimal control provide an interpretation of the costate trajectory and the Hamiltonian, evaluated along an optimal trajectory, in terms of gradients of the value function. While sensitivity relations are a straightforward consequence of standard transversality conditions for state constraint free optimal control problems formulated in terms of control-dependent differential equations with smooth data, their verification for problems with either pathwise state constraints, nonsmooth data, or for problems where the dynamic constraint takes the form of a differential inclusion, requires careful analysis. In this paper we establish validity of both ‘full’ and ‘partial’ sensitivity relations for an adjoint state of the maximum principle, for optimal control problems with pathwise state constraints, where the underlying control system is described by a differential inclusion. The partial sensitivity relation interprets the costate in terms of partial Clarke subgradients of the value function with respect to the state variable, while the full sensitivity relation interprets the couple, comprising the costate and Hamiltonian, as the Clarke subgradient of the value function with respect to both time and state variables. These relations are distinct because, for nonsmooth data, the partial Clarke subdifferential does not coincide with the projection of the (full) Clarke subdifferential on the relevant coordinate space. We show for the first time (even for problems without state constraints) that a costate trajectory can be chosen to satisfy the partial and full sensitivity relations simultaneously. The partial sensitivity relation in this paper is new for state constraint problems, while the full sensitivity relation improves on earlier results in the literature (for optimal control problems formulated in terms of Lipschitz continuous multifunctions), because a less restrictive inward pointing hypothesis is invoked in the proof, and because

  2. [Feedback in relation to training of practical clinical skills

    DEFF Research Database (Denmark)

    Hansen, C.S.; Ringsted, Charlotte Vibeke


    Feedback has been identified as an essential component of motor learning. However, feedback principles derived from motor learning theories cannot uncritically be applied to clinical skills training because this knowledge is based primarily on the study of very simple motor skills. Research...... into feedback in relation to clinical skills training is currently limited. Theories on motor learning can serve as the basis for designing research in this domain, especially the importance of including retention tests when measuring permanent learning outcomes Udgivelsesdato: 2008/10/27...

  3. Relating quality of life to Glasgow outcome scale health states. (United States)

    Kosty, Jennifer; Macyszyn, Luke; Lai, Kevin; McCroskery, James; Park, Hae-Ran; Stein, Sherman C


    There has recently been a call for the adoption of comparative effectiveness research (CER) and related research approaches for studying traumatic brain injury (TBI). These methods allow researchers to compare the effectiveness of different therapies in producing patient-oriented outcomes of interest. Heretofore, the only measures by which to compare such therapies have been mortality and rate of poor outcome. Better comparisons can be made if parametric, preference-based quality-of-life (QOL) values are available for intermediate outcomes, such as those described by the Glasgow Outcome Scale Extended (GOSE). Our objective was therefore to determine QOL for the health states described by the GOSE. We interviewed community members at least 18 years of age using the standard gamble method to assess QOL for descriptions of GOSE scores of 2-7 derived from the structured interview. Linear regression analysis was also performed to assess the effect of age, gender, and years of education on QOL. One hundred and one participants between the ages of 18 and 83 were interviewed (mean age 40 ± 19 years), including 55 men and 46 women. Functional impairment and QOL showed a strong inverse relationship, as assessed by both linear regression and the Spearman rank order coefficient. No consistent effect or age, gender, or years of education was seen. As expected, QOL decreased with functional outcome as described by the GOSE. The results of this study will provide the groundwork for future groups seeking to apply CER methods to clinical studies of TBI.

  4. Internet addiction: Prevalence and relation with mental states in adolescents. (United States)

    Kawabe, Kentaro; Horiuchi, Fumie; Ochi, Marina; Oka, Yasunori; Ueno, Shu-Ichi


    Internet addiction disrupts the daily lives of adolescents. We investigated the prevalence of Internet addiction in junior high school students, elucidated the relation between Internet addiction and mental states, and determined the factors associated with Internet addiction in adolescents. Junior high school students (aged 12-15 years) were assessed using Young's Internet Addiction Test (IAT), the Japanese version of the General Health Questionnaire (GHQ), and a questionnaire on access to electronic devices. Based on total IAT scores, 2.0% (male, 2.1%; female, 1.9%) and 21.7% (male, 19.8%; female, 23.6%) of the total 853 participants (response rate, 97.6%) were classified as addicted and possibly addicted, respectively. Total GHQ scores were significantly higher in the addicted (12.9 ± 7.4) and possibly addicted groups (8.8 ± 6.0) than in the non-addicted group (4.3 ± 4.6; P addicted group than in the non-addicted group. Further, accessibility to smartphones was significantly associated with Internet addiction. Students in the addicted and possibly addicted groups were considered 'problematic' Internet users. Use of smartphones warrants special attention, being among the top factors contributing to Internet addiction. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

  5. Visual steady state in relation to age and cognitive function. (United States)

    Horwitz, Anna; Dyhr Thomsen, Mia; Wiegand, Iris; Horwitz, Henrik; Klemp, Marc; Nikolic, Miki; Rask, Lene; Lauritzen, Martin; Benedek, Krisztina


    Neocortical gamma activity is crucial for sensory perception and cognition. This study examines the value of using non-task stimulation-induced EEG oscillations to predict cognitive status in a birth cohort of healthy Danish males (Metropolit) with varying cognitive ability. In particular, we examine the steady-state VEP power response (SSVEP-PR) in the alpha (8Hz) and gamma (36Hz) bands in 54 males (avg. age: 62.0 years) and compare these with 10 young healthy participants (avg. age 27.6 years). Furthermore, we correlate the individual alpha-to-gamma difference in relative visual-area power (ΔRV) with cognitive scores for the older adults. We find that ΔRV decrease with age by just over one standard deviation when comparing young with old participants (pintelligence is significantly negatively correlated with ΔRV in the older adult cohort, even when processing speed, global cognition, executive function, memory, and education (pincrease in ΔRV of one standard deviation is associated with a reduction in intelligence of 48% of a standard deviation (p<0.01). Finally, we conclude that the difference in cerebral rhythmic activity between the alpha and gamma bands is associated with age and cognitive status, and that ΔRV therefore provide a non-subjective clinical tool with which to examine cognitive status in old age.

  6. Visual steady state in relation to age and cognitive function.

    Directory of Open Access Journals (Sweden)

    Anna Horwitz

    Full Text Available Neocortical gamma activity is crucial for sensory perception and cognition. This study examines the value of using non-task stimulation-induced EEG oscillations to predict cognitive status in a birth cohort of healthy Danish males (Metropolit with varying cognitive ability. In particular, we examine the steady-state VEP power response (SSVEP-PR in the alpha (8Hz and gamma (36Hz bands in 54 males (avg. age: 62.0 years and compare these with 10 young healthy participants (avg. age 27.6 years. Furthermore, we correlate the individual alpha-to-gamma difference in relative visual-area power (ΔRV with cognitive scores for the older adults. We find that ΔRV decrease with age by just over one standard deviation when comparing young with old participants (p<0.01. Furthermore, intelligence is significantly negatively correlated with ΔRV in the older adult cohort, even when processing speed, global cognition, executive function, memory, and education (p<0.05. In our preferred specification, an increase in ΔRV of one standard deviation is associated with a reduction in intelligence of 48% of a standard deviation (p<0.01. Finally, we conclude that the difference in cerebral rhythmic activity between the alpha and gamma bands is associated with age and cognitive status, and that ΔRV therefore provide a non-subjective clinical tool with which to examine cognitive status in old age.

  7. Q2 anti Q2 states with relatively narrow widths

    International Nuclear Information System (INIS)

    Ono, Seiji.


    Using the mass formulas which correctly predict the mass of mesons and baryons the mass of diquark states is computed. From this mass spectrum the existance of the observed narrow baryonia and wide baryonia can be naturally understood. Other relatively narrow Q 2 anti Q 2 states are predicted to exist. (orig.) [de

  8. Dysthymic disorder: clinical characteristics in relation to age at onset. (United States)

    Barzega, G; Maina, G; Venturello, S; Bogetto, F


    The variability in the clinical presentation of dysthymia has given rise to a rich debate in literature, and various hypotheses have been proposed. One is that the clinical presentation differs in relation to age at onset. The aim of the study was to evaluate differences in socio-demographic and clinical characteristics in a sample of patients with dysthymia (DSM-IV), in relation to age at onset. 84 consecutive outpatients with a diagnosis of dysthymia (DSM-IV) were studied. All subjects were evaluated by a semistructured clinical interview and the following rating scales: HAM-A, HAM-D, MADRS, Paykel's Interview for Recent Life Events. 23.8% of the sample had early-onset (dysthymia. Patients with early-onset disorder were significantly younger at the observation, more frequently female and single. They had a significantly longer duration of illness and in a significantly higher percentage had already received a specialist treatment before admission in the present trial. No differences in the frequency of symptoms were observed. A significantly higher percentage of patients with late-onset disease reported at least one stressful event in the year preceding the onset of dysthymia. A positive history of major depression was significantly more common among the early-onset group; social phobia, panic disorder and conversive disorder were also more frequent in this group. The late-onset patients frequently presented generalized anxiety disorder, substance abuse and somatization disorder. The study is retrospective and enrolls a limited number of cases. The present study agrees with other reports on the differences in clinical presentation of dysthymia according to age at onset. Although they are not actually related to age at onset, some interesting findings emerged in the symptomatological characterization of the disorder, referring to the diagnostic criteria proposed in DSM-IV.

  9. Bound entangled states violate a nonsymmetric local uncertainty relation

    International Nuclear Information System (INIS)

    Hofmann, Holger F.


    As a consequence of having a positive partial transpose, bound entangled states lack many of the properties otherwise associated with entanglement. It is therefore interesting to identify properties that distinguish bound entangled states from separable states. In this paper, it is shown that some bound entangled states violate a nonsymmetric class of local uncertainty relations [H. F. Hofmann and S. Takeuchi, Phys. Rev. A 68, 032103 (2003)]. This result indicates that the asymmetry of nonclassical correlations may be a characteristic feature of bound entanglement

  10. Fostering new relational experience: clinical process in couple psychotherapy. (United States)

    Marmarosh, Cheri L


    One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight. These clinical processes will be presented with empirical support. Experts from a session will be used to highlight how these processes influence the couple and promote increased intimacy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  11. Work-related stressors experienced by part-time clinical affiliate nursing faculty in baccalaureate education. (United States)

    Whalen, Kathleen S


    This descriptive and multivariate correlational study identifies work-related situations that were perceived as stressful in a sample of part-time clinical affiliate nursing faculty (n = 91) from a western state who teach in baccalaureate programs. The most stressful conditions include being physically and emotionally drained; working outside regular hours; dealing with the number of role expectations; and receiving inadequate monetary compensation. Subjects reported other specific stressful situations related to their work with clinical agencies, universities, and students. The researcher also examined the relationships between selected background factors (number of years of clinical teaching experience, clinical teacher education, and holding a second job), role stress, and job satisfaction. Even though this sample had a high job satisfaction rating, the variable, role stress, was shown to significantly predict job satisfaction. Lastly, implications for nurse educators in baccalaureate programs are explored.

  12. Correlates of Abortion Related Maternal Mortality at the Lagos State ...

    African Journals Online (AJOL)

    This study was carried out to highlight the probable correlates of mortality among patients managed for abortion related complications at the Lagos State University Teaching Hospital, Ikeja. All patients managed for abortion related complications between 1st January 2000 and 31st December 2003 were studied. Certain ...

  13. The Off-Campus Clinical Program of the College of Optometry, Ferris State College. (United States)

    Paramore, James E.


    The clinical education program at Ferris State College, College of Optometry, and the various clinics affiliated with the college are described. To ensure quality, all individuals with the responsibility of teaching the students are faculty of Ferris State. (MLW)

  14. Comparisons of hypertension-related costs from multinational clinical studies. (United States)

    Mullins, C Daniel; Sikirica, Mirko; Seneviratne, Viran; Ahn, Jeonghoon; Akhras, Kasem S


    This study identifies and compares the individual cost components of hospital and ambulatory services that manage the care of hypertensive patients in eight countries: the US, the UK, France, Spain, Germany, Italy, Canada and Australia. Hypertension-related costs are classified according to four major cardiovascular events: (i) acute myocardial infarction; (ii) congestive heart failure; (iii) stroke; and (iv) renal failure, which was subdivided into renal failure treated by dialysis and renal failure treated by kidney transplantation. To make cross-country costs comparisons, we used the DRG codes used in the US and DRG-like codes from each country. US cost information was obtained from hypertension data available from the literature and health economics researchers. For costs in other countries, we consulted with national health economics experts in each country, used analyses by the Research Triangle Institute, and performed Medline and international literature searches. When available, we obtained information from the countries' public and private nationally representative data sources. For cross-country currency adjustments, all currencies were converted using the Purchasing Power Parities from the Organisation for Economic Cooperation and Development, and then converted into inflation-adjusted year 2000 US dollars. There exists considerable variation in hypertension-related costs from multinational clinical studies. This study documents that costs are generally higher in the US than in other countries; however, this is not always true. In particular, costs of treating heart failure in France and the costs of renal failure without transplantation in Germany and the UK are relatively high. While analysing multinational hypertensive cost data, this study also addresses the impact of cross-country cost variations on cost analyses. During the last decade, drug-development researchers have drawn extensively upon multinational trials to resolve enrollment problems and

  15. Clinical features of IgG4-related rhinosinusitis. (United States)

    Hanaoka, Machiko; Kammisawa, Terumi; Koizumi, Satomi; Kuruma, Sawako; Chiba, Kazuro; Kikuyama, Masataka; Shirakura, Satoshi; Sugimoto, Taro; Hishima, Tsunekazu


    IgG4-related disease is a systemic disease that affects various organs of the body. Aim of this study is to elucidate the clinical characteristics of IgG4-related rhinosinusitis. Clinical features, laboratory findings, radiological and endoscopic findings, associated disease, treatment and prognosis were retrospectively examined in 10 patients with IgG4-related rhinosinusitis. The age was 59.1±11.3 years old and male-to-female ratio was 1:1. The chief nasal complaints were hyposmia (n=4), nasal obstruction (n=3), and nothing (n=3). Serum IgG4 levels were elevated in all patients and the value was 740.4±472.4mg/dl. Other IgG4-related diseases were associated in all 10 patients, including IgG4-related sialadenitis (n=6), IgG4-related dacryoadenitis (n=5), and autoimmune pancreatitis (n=5). Imaging findings on CT/MRI were obstruction of the way of elimination (n=10), thickening of the sinus mucous membrane (n=10), and fluid in the sinus (n=6). All of the cases had bilateral findings. Nasal endoscopic findings were chiefly deviated nasal septum (n=5), polyps (n=4), edema of the mucous membrane (n=3). Histologically, abundant infiltration of IgG4 positive plasma cell and lymphocyte and an elevated IgG4+/IgG+ cell ration was detected in all 8 patients and 5 patients, respectively. Endoscopic sinus surgery was performed in 8 patients. Eight patients were treated with steroid therapy for other associated IgG4-related diseases. Symptoms improved in all 6 patients after an initial treatment (endoscopic surgery (n=5) and steroids (n=1)), but one patient suffered relapse. IgG4-related rhinosinusitis is a distinct entity of IgG4-related disease, and is associated in patients with multiple IgG4-related diseases. Copyright © 2017 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.

  16. United States - Japanese nuclear relations: implications for the pacific region

    International Nuclear Information System (INIS)

    Suttmeier, R.P.


    The initiation of a new approach to non-proliferation policy by the United States in 1977 was the most upsetting development in the history of US-Japanese nuclear relations. The policy has seemingly altered Japanese views of its own nuclear future very little, yet it has altered the tone of the nuclear relationship with the United States. Recent Japanese nuclear power developments, both technical and administrative, are outlined and the prospects for the future of the United States-Japanese nuclear relationship and for Pacific regional cooperation assessed. Issues of importance in the relationship include reprocessing - enrichment, plutonium management, spent fuel and waste management and uranium supplies

  17. Cauchy inequality and uncertainty relations for mixed states

    International Nuclear Information System (INIS)

    Shirokov, M.I.


    Cauchy inequality (CI) relates scalar products of two vectors and their norms. I point out other similar inequalities (SI). Starting with CI Schroedinger derived his uncertainty relation (UR). By using SI other various UR can be obtained. It is shown that they follow from the Schroedinger UR. Two generalizations of CI are obtained for mixed states described by density matrices. Using them two generalizations of UR for mixed states are derived. Both differ from the UR generalization known from the literature. The discussion of these generalizations is given

  18. Public Relations in the State Institutions from Galati

    Directory of Open Access Journals (Sweden)

    Daniela Aurelia Tanase Popa


    Full Text Available The paper aims at identifying and analyzing specific public relations activities in various state institutions from Galati in order to shape a PR typological profile in this geographic area. From the methodological point of view, the paper is based on in-depth interview technique for data collection and content analysis as a method of interpretation. The purpose of this qualitative study is to investigate the professional activity of the specialist in public relations in state institutions in Galati and achieving it was made possible through a structured interview guide on three indicators: professional environment, typological profile, professional responsibility.

  19. Exploring resting-state EEG brain oscillatory activity in relation to cognitive functioning in multiple sclerosis. (United States)

    Keune, Philipp M; Hansen, Sascha; Weber, Emily; Zapf, Franziska; Habich, Juliane; Muenssinger, Jana; Wolf, Sebastian; Schönenberg, Michael; Oschmann, Patrick


    Neurophysiologic monitoring parameters related to cognition in Multiple Sclerosis (MS) are sparse. Previous work reported an association between magnetoencephalographic (MEG) alpha-1 activity and information processing speed. While this remains to be replicated by more available electroencephalographic (EEG) methods, also other established EEG markers, e.g. the slow-wave/fast-wave ratio (theta/beta ratio), remain to be explored in this context. Performance on standard tests addressing information processing speed and attention (Symbol-Digit Modalities Test, SDMT; Test of Attention Performance, TAP) was examined in relation to resting-state EEG alpha-1 and alpha-2 activity and the theta/beta ratio in 25MS patients. Increased global alpha-1 and alpha-2 activity and an increased frontal theta/beta ratio (pronounced slow-wave relative to fast-wave activity) were associated with lower SDMT processing speed. In an exploratory analysis, clinically impaired attention was associated with a significantly increased frontal theta/beta ratio whereas alpha power did not show sensitivity to clinical impairment. EEG global alpha power and the frontal theta/beta ratio were both associated with attention. The theta/beta ratio involved potential clinical sensitivity. Resting-state EEG recordings can be obtained during the routine clinical process. The examined resting-state measures may represent feasible monitoring parameters in MS. This notion should be explored in future intervention studies. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  20. Causal relations among events and states in dynamic geographical phenomena (United States)

    Huang, Zhaoqiang; Feng, Xuezhi; Xuan, Wenling; Chen, Xiuwan


    There is only a static state of the real world to be recorded in conventional geographical information systems. However, there is not only static information but also dynamic information in geographical phenomena. So that how to record the dynamic information and reveal the relations among dynamic information is an important issue in a spatio-temporal information system. From an ontological perspective, we can initially divide the spatio-temporal entities in the world into continuants and occurrents. Continuant entities endure through some extended (although possibly very short) interval of time (e.g., houses, roads, cities, and real-estate). Occurrent entities happen and are then gone (e.g., a house repair job, road construction project, urban expansion, real-estate transition). From an information system perspective, continuants and occurrents that have a unique identity in the system are referred to as objects and events, respectively. And the change is represented implicitly by static snapshots in current spatial temporal information systems. In the previous models, the objects can be considered as the fundamental components of the system, and the change is modeled by considering time-varying attributes of these objects. In the spatio-temporal database, the temporal information that is either interval or instant is involved and the underlying data structures and indexes for temporal are considerable investigated. However, there is the absence of explicit ways of considering events, which affect the attributes of objects or the state. So the research issue of this paper focuses on how to model events in conceptual models of dynamic geographical phenomena and how to represent the causal relations among events and the objects or states. Firstly, the paper reviews the conceptual modeling in a temporal GIS by researchers. Secondly, this paper discusses the spatio-temporal entities: objects and events. Thirdly, this paper investigates the causal relations amongst

  1. Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

    Directory of Open Access Journals (Sweden)

    Maite Garaigordobil


    Full Text Available The study had two goals: (1 to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2 to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls. Results revealed: (1 positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and childhood stress; and (2 negative correlations between depression and personal adaptation, global self-concept, social skills, and resilience (sense of competence and affiliation. Linear regression analysis including the global dimensions revealed 4 predictors of childhood depression that explained 50.6% of the variance: high clinical maladjustment, low global self-concept, high level of stress, and poor social skills. However, upon introducing the sub-dimensions, 9 predictor variables emerged that explained 56.4% of the variance: many internalizing problems, low family self-concept, high anxiety, low responsibility, low personal self-assessment, high social stress, few aggressive behaviors toward peers, many health/psychosomatic problems, and external locus of control. The discussion addresses the importance of implementing prevention programs for childhood depression at early ages.

  2. Systemic relational therapy and the case from the clinical practice

    Directory of Open Access Journals (Sweden)

    Tatjana Rožič


    Full Text Available In the present article are represented the principal guidelines of the systemic relational model of psychotherapy and an example of clinical practice where the pacient was incluced in this kind of therapy. In the essence of systemic relational model there is a person which is captured in the repetition of old patterns in spite of its painfulness and hardness. Captured and helpless in old patterns, the person not only repeats but also recreates them, because they promise safety, belonging and connectedness. From the review of the therapy it is evident that behind the pacient's concrete problems stands her family system to which she is loyal in the way that only deepens her distress. By the increasing the responsability for herself, for her feelings and her acts, it increases the pacient's funcionality, too.

  3. A cross-cultural comparison of clinical supervision in South Korea and the United States. (United States)

    Son, Eunjung; Ellis, Michael V


    We investigated similarities and differences in clinical supervision in two cultures: South Korea and the United States The study had two parts: (1) a test of the cross-cultural equivalence of four supervision measures; and (2) a test of two competing models of cultural differences in the relations among supervisory style, role difficulties, supervisory working alliance, and satisfaction with supervision. Participants were 191 South Korean and 187 U.S. supervisees currently engaged in clinical supervision. The U.S. measures demonstrated sufficient measurement equivalence for use in South Korea. Cultural differences moderated the relations among supervisory styles, role difficulties, supervisory working alliance, and supervision satisfaction. Specifically, the relations among these variables were significantly stronger for U.S. than for South Korean supervisees. Implications for theory, research, and practice were discussed.

  4. Enhancing state-community relations through the ward development ...

    African Journals Online (AJOL)

    The primary responsibility of the government is to develop communities under its jurisdiction through community development projects. The development of the rural areas creates conditions conducive for community living, enhances the legitimacy of government and promotes state-community relations. But the political ...

  5. Higher Education Relations: Iranian and the United States Experience. (United States)

    Fereshteh, M. Hussein

    This review examined the views of 35 higher education professionals in order to explore the history of higher education relations between Iran and the United States particularly before and after the revolution in Iran. The study used interviews with participants, correspondence, and published material from journals, monographs, and newspapers. All…

  6. Relative controllability of nonlinear systems with delays in state and ...

    African Journals Online (AJOL)

    In this work, sufficient conditions are developed for the relative controllability of perturbed nonlinear systems with time varying multiple delays in control with the perturbation function having implicit derivative with delays depending on both state and control variable, using Darbo's fixed points theorem. Journal of the Nigerian ...

  7. Fifth International Conference on Squeezed States and Uncertainty Relations (United States)

    Han, D. (Editor); Janszky, J. (Editor); Kim, Y. S. (Editor); Man'ko, V. I. (Editor)


    The Fifth International Conference on Squeezed States and Uncertainty Relations was held at Balatonfured, Hungary, on 27-31 May 1997. This series was initiated in 1991 at the College Park Campus of the University of Maryland as the Workshop on Squeezed States and Uncertainty Relations. The scientific purpose of this series was to discuss squeezed states of light, but in recent years the scope is becoming broad enough to include studies of uncertainty relations and squeeze transformations in all branches of physics including quantum optics and foundations of quantum mechanics. Quantum optics will continue playing the pivotal role in the future, but the future meetings will include all branches of physics where squeeze transformations are basic. As the meeting attracted more participants and started covering more diversified subjects, the fourth meeting was called an international conference. The Fourth International Conference on Squeezed States and Uncertainty Relations was held in 1995 was hosted by Shanxi University in Taiyuan, China. The fifth meeting of this series, which was held at Balatonfured, Hungary, was also supported by the IUPAP. In 1999, the Sixth International Conference will be hosted by the University of Naples in 1999. The meeting will take place in Ravello near Naples.

  8. Surveillance of work-related asthma in new york state. (United States)

    Tice, Cori J; Cummings, Karen R; Gelberg, Kitty H


    The objective of this paper is to determine the percent of adults with asthma attributable to work and describe characteristics of the work-related asthma population in New York State. Sociodemographic and control characteristics of those with and without work-related asthma are compared. Data from three population-based surveys and one case-based surveillance system were analyzed. Work-relatedness of asthma was determined by self-report for the population-based surveys and by physician report for the case-based system. Self-reported sociodemographic and control characteristics were analyzed for the population-based surveys by work-relatedness. The percent of work-relatedness among adults with current asthma in New York State ranged from 10.6% to 44.5%. Significantly more adults with work-related asthma had poorly controlled asthma than those without work-related asthma. More adults with work-related asthma also tended to be employed in the manufacturing, educational services, and public administration industries than the general population. The most frequently reported exposure was dust. Adults with work-related asthma have decreased control and adverse socioeconomic impacts compared to those with asthma that is not work-related. Increased recognition and physician reporting is necessary to further prevent the impact of work-related exposures.

  9. Recursion relations for the overlap of a Morse continuum state with a Lanczos basis state

    International Nuclear Information System (INIS)

    Lutrus, C.K.; Suck Salk, S.H.


    In the resonant reactive scattering theory of Mundel, Berman, and Domcke [Phys. Rev. A 32, 181 (1985)], the overlap of a Morse continuum state and a Lanczos basis state appears in the expression of transition amplitude. In their study, recursion relations for Green's functions in the Lanczos basis were used for computational efficiency. In this paper we derive new recursion relations specifically for the evaluation of overlap between the Morse continuum wave and Lanczos basis state that appears in the transition amplitude of resonant scattering. They are found to be simple to use with great accuracy

  10. Variational description of continuum states in terms of integral relations

    International Nuclear Information System (INIS)

    Kievsky, A.; Viviani, M.; Barletta, Paolo; Romero-Redondo, C.; Garrido, E.


    Two integral relations derived from the Kohn variational principle (KVP) are used for describing scattering states. In usual applications the KVP requires the explicit form of the asymptotic behavior of the scattering wave function. This is not the case when the integral relations are applied since, due to their short-range nature, the only condition for the scattering wave function Ψ is that it be the solution of (H-E)Ψ=0 in the internal region. Several examples are analyzed for the computation of phase shifts from bound-state-type wave functions or, in the case of the scattering of charged particles, it is possible to obtain phase shifts using free asymptotic conditions. As a final example we discuss the use of the integral relations in the case of the hyperspherical adiabatic method.

  11. Sense of Coherence and Personality Traits Related to Depressive State

    Directory of Open Access Journals (Sweden)

    Yoko Kikuchi


    Full Text Available Aims. The current study aims to examine the influence of job stress, SOC, and personality traits on depressive state. Methods. A self-reported survey was conducted among 347 female nurses in a general hospital. Job stress was measured using the Japanese version of the Brief-Job Stress Questionnaire scale. Depressive state was assessed by the K6 scale. We used 13-item SOC scale. Personality traits were assessed by the Japanese version of Ten-Item Personality Inventory. Multiple liner regression analyses were conducted to examine predictors that significantly affect depressive state. Results. Job and life satisfaction and SOC negatively related to the depressive state (β=-0.76,  P<0.01;  β=-0.18,  P<0.001, resp. while neuroticism was positively correlated (β=0.49,  P<0.001. Also, intrinsic rewards tended to negatively relate (β=-0.80,  P<0.1. Conclusions. From a practical perspective, the possible influence of SOC and neurotic personality on depressive state should be considered for health care professionals.

  12. The relation between quality of clinical trials and acupuncture efficacy

    Directory of Open Access Journals (Sweden)

    David Gonçalves Nordon


    Full Text Available Introduction: Clinical trials of acupuncture not always have concordant results, mostly due to their great heterogeneity. Two indexes have been developed to analyze the quality of acupuncture trials. This study hypothesizes that, the more adequate the intervention and the control techniques, the more efficacious the acupuncture. Methods: Both indexes were applied to 27 randomized clinical trials comparing acupuncture to placebo. Results were compared by using the Mann-Whitney test. Results: Studies favorable to acupuncture had a intervention score’s median of 11.5; for the unfavorable ones, it was 7, p: 0.0017. Articles with and without statistically significant differences, though, had the same median for their scores in the control index: 6. Discussion: There is a positive relation between a better score for acupuncture technique and a statistically significant difference between acupuncture and interventional control. However, due to the little heterogeneity in the degree of physiological effect from each article, the control index had no statistical significance. Conclusion: This study established that, among acupuncture RCT controlled by placebo or sham of moderate physiological effect, the adequacy of the technique is more important than the adequacy of control in establishing a statistically significant difference between acupuncture and interventional control.

  13. Fibrin related antigens: assay development, clinical and kinetic studies

    Energy Technology Data Exchange (ETDEWEB)

    Kruskal, J B


    This thesis describes an assay which is able to measure and to determine the proportions of fibrin- and fibrinogen-related antigens (FRA) present in clinical samples. No assay exists at present which is capable of distinguishing between fibrin and fibrinogen degradation products concurrently and in a clinical setting. The assay may be used as a tool with which to gain further insight to pathophysiology of disorders characterized by activation of the coagulation and fibrinolytic pathways. This study provides and analysis of the FRA profiles in patients with disorders characterised by possible enhanced fibrinolytic activity. Studies have been undertaken on patients with acute and chronic liver diseases, on patients with the various syndromes of coronary artery disease and on patients with insulin-dependent diabetes mellitus with and without evidence of microvascular disease. Certain observations made it evident that further studies were required in order to explain previously undocumented fibrinolytic abnormalities in certain patient groups. Data obtained from patients with liver disease provided information compatible with the activation of their fibrinolytic pathways. The initial scope of this study was then extended to further investigate the deranged haemostatic mechanisms in patients with severe liver diseases. Kinetic studies were performed which required the development of specific technology to be able to measure certain previously undertermined parameters. Mathematical models describing the rates of fibrin formation and lysis were developed for human studies. Fibrin-derived D-dimer was radiolabelled and its validity as and intravenous tracer and maker of fibrin degradation established.

  14. Vomiting and migraine-related clinical parameters in pediatric migraine. (United States)

    Eidlitz-Markus, Tal; Haimi-Cohen, Yishai; Zeharia, Avraham


    To investigate the characteristics of vomiting in pediatric migraineurs and the relationship of vomiting with other migraine-related parameters. The cohort included children and adolescents with migraine attending a headache clinic of a tertiary pediatric medical center from 2010 to 2016. Patients were identified by a retrospective database search. Data were collected from medical files. The presence of vomiting was associated with background and headache-related parameters. The study group included 453 patients, 210 boys (46.4%) and 243 girls (53.6%), of mean age 11.3 ± 3.7 years. Vomiting was reported by 161 patients (35.5%). On comparison of patients with and without vomiting, vomiting was found to be significantly associated with male gender (54% vs 42.1%, P migraine onset (8.0 ± 3. years vs 9.6 ± 3.7 years, P migraine (67% vs 58.7%, P migraine (24.1% vs 10.1%, P migraine in both parents (9.3% vs 3.1%, P = .007), and migraine in either parent (57.5% vs 45.5%, P = .02). The higher rate of vomiting in the younger patients and the patients with awakening pain may be explained by a common underlying pathogenetic mechanism of vomiting and migraine involving autonomic nerve dysfunction/immaturity. The association of vomiting with parental migraine points to a genetic component of vomiting and migraine. It should be noted that some of the findings may simply reflect referral patterns in the tertiary clinic. © 2017 American Headache Society.

  15. Evaluation of a clinic-based cholinesterase test kit for the Washington State Cholinesterase Monitoring Program. (United States)

    Hofmann, Jonathan N; Carden, Angela; Fenske, Richard A; Ruark, Harold E; Keifer, Matthew C


    The Washington State Cholinesterase Monitoring Program for pesticide handlers requires blood draws at local clinics, with samples tested at a central laboratory. At present, workers with inhibited cholinesterase activity may be re-exposed before they can be removed from work. In this study we explored the option of on-site testing at local clinics using the EQM Test-mate Kittrade mark, a portable cholinesterase test kit. Test kit cholinesterase activity measurements were performed on 50 blood samples by our research staff, and compared to measurements on the same samples by the Washington State Public Health Laboratory. Another set of samples was also analyzed with the test kit by medical staff at an eastern Washington clinic. Triplicate measurements with the test kit had a 3.3% average coefficient of variation (CV) for plasma cholinesterase (PChE), and a 3.5% average CV for erythrocyte cholinesterase (AChE) measurements. The kit's PChE measurements were similar to PHL measurements (average ratio of 0.98) when performed in the laboratory, but had a tendency to underestimate activity when used in the clinic setting (average ratio of 0.87). The kit systematically overestimated AChE activity by 42-48% relative to the PHL measurements, regardless of where the samples were analyzed. This easy-to-use test kit appeared to be a viable method for clinic-based PChE measurements, but was less consistent for AChE measurements performed in the clinic. Absolute measurements with the kit need to be evaluated carefully relative to standardized methods. (c) 2008 Wiley-Liss, Inc.

  16. Fourth International Conference on Squeezed States and Uncertainty Relations (United States)

    Han, D. (Editor); Peng, Kunchi (Editor); Kim, Y. S. (Editor); Manko, V. I. (Editor)


    The fourth International Conference on Squeezed States and Uncertainty Relations was held at Shanxi University, Taiyuan, Shanxi, China, on June 5 - 9, 1995. This conference was jointly organized by Shanxi University, the University of Maryland (U.S.A.), and the Lebedev Physical Institute (Russia). The first meeting of this series was called the Workshop on Squeezed States and Uncertainty Relations, and was held in 1991 at College Park, Maryland. The second and third meetings in this series were hosted in 1992 by the Lebedev Institute in Moscow, and in 1993 by the University of Maryland Baltimore County, respectively. The scientific purpose of this series was initially to discuss squeezed states of light, but in recent years, the scope is becoming broad enough to include studies of uncertainty relations and squeeze transformations in all branches of physics, including, of course, quantum optics and foundations of quantum mechanics. Quantum optics will continue playing the pivotal role in the future, but the future meetings will include all branches of physics where squeeze transformations are basic transformation. This transition took place at the fourth meeting of this series held at Shanxi University in 1995. The fifth meeting in this series will be held in Budapest (Hungary) in 1997, and the principal organizer will be Jozsef Janszky of the Laboratory of Crystal Physics, P.O. Box 132, H-1052. Budapest, Hungary.

  17. Clinical profile of patients with nascent alcohol related seizures

    Directory of Open Access Journals (Sweden)

    P Sandeep


    Full Text Available Aim: The aim of this study is to characterize the clinical profile of patients with alcohol related seizures (ARS and to identify the prevalence of idiopathic generalized epilepsy (IGE in the same. Materials and Methods: 100 consecutive male patients presenting to a tertiary care center in South India with new onset ARS were analyzed with alcohol use disorders identification test (AUDIT score. All underwent 19 channel digital scalp electroencephalography (EEG and at least computed tomography (CT scan. Results: A total of 27 patients (27% who had cortical atrophy on CT had a mean duration of alcohol intake of 23.62 years compared with 14.55 years in patients with no cortical atrophy (P < 0.001. Twenty-two patients (22% had clustering in the current episode of whom 18 had cortical atrophy. Nearly, 88% patients had generalized tonic clonic seizures while 12% who had partial seizures underwent magnetic resonance imaging (MRI, which identified frontal focal cortical dysplasia in one. Mean lifetime duration of alcohol intake in patients presenting with seizures within 6 hours (6H-gp of intake of alcohol was significantly lower (P = 0.029. One patient in the 6H-gp with no withdrawal symptoms had EEG evidence for IGE and had a lower AUDIT score compared with the rest. Conclusion: CT evidence of cortical atrophy is related to the duration of alcohol intake and portends an increased risk for clustering. Partial seizures can be a presenting feature of ARS and those patients may benefit from MRI to identify underlying symptomatic localization related epilepsy (8.3% of partial seizures. IGE is more likely in patients presenting with ARS within first 6 hours especially if they do not have alcohol withdrawal symptoms and scalp EEG is helpful to identify this small subgroup (~1% who may require long-term anti-epileptic medication.

  18. Age-related distance esotropia: Clinical features and therapeutic outcomes. (United States)

    Gómez de Liaño Sánchez, P; Olavarri González, G; Merino Sanz, P; Escribano Villafruela, J C


    To describe the clinical characteristics and surgical outcomes of a group of patients with age-related distance esotropia (ARDE). A retrospective study was conducted on a consecutive case series of 16 adult patients diagnosed with ARDE between 2008 and 2015. The clinical features evaluated included mean age and gender, primary position deviations at distance and near, measured in prism dioptres (pd), treatment offered in each case, and post-surgical deviations. Ductions and versions were full, with no evidence of lateral rectus paresis. None of these patients had any obvious underlying neurological disorder, such as, high myopia or thyroid disease. A good result is considered to be the disappearance of diplopia in all positions of gaze. A total of 16 patients (11 females [68.8%]) were identified. The mean age at diagnosis was 78.19±6.77 years. The mean initial esodeviation was 2.25±3.08 pd at near (-4 to +8 pd) and 9.5±4.18 pd at distance (2 to 18 pd). Treatment was not necessary in 5 cases because the symptoms were intermittent or well-tolerated. Of the 11 patients with symptoms, one was corrected with an external base therapeutic prism. Botulinum toxin was administered in another patient, without satisfactory results. Unilateral medial rectus muscle recession was performed on one patient, and unilateral lateral rectus plication on 7 patients, indicating prisms before surgery. One patient refused surgery despite continuous diplopia in far vision. After a mean follow-up of 16.5 months, all operated patients were asymptomatic. Not all patients with ARDE require treatment, as the tolerance to diplopia varies from one subject to another. Both medial rectus weakening and lateral rectus strengthening provides excellent results. Crown Copyright © 2016. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Systematic review of clinical practice guidelines related to multiple sclerosis.

    Directory of Open Access Journals (Sweden)

    Jia Guo

    Full Text Available BACKGROUND: High quality clinical practice guidelines (CPGs can provide clinicians with explicit recommendations on how to manage health conditions and bridge the gap between research and clinical practice. Unfortunately, the quality of CPGs for multiple sclerosis (MS has not been evaluated. OBJECTIVE: To evaluate the methodological quality of CPGs on MS using the AGREE II instrument. METHODS: According to the inclusion and exclusion criteria, we searched four databases and two websites related to CPGs, including the Cochrane library, PubMed, EMBASE, DynaMed, the National Guideline Clearinghouse (NGC, and Chinese Biomedical Literature database (CBM. The searches were performed on September 20th 2013. All CPGs on MS were evaluated by the AGREE II instrument. The software used for analysis was SPSS 17.0. RESULTS: A total of 27 CPGs on MS met inclusion criteria. The overall agreement among reviews was good or substantial (ICC was above 0.70. The mean scores for each of all six domains were presented as follows: scope and purpose (mean ± SD: 59.05 ± 16.13, stakeholder involvement (mean ± SD: 29.53 ± 17.67, rigor of development (mean ± SD: 31.52 ± 21.50, clarity of presentation (mean ± SD: 60.39 ± 13.73, applicability (mean ± SD: 27.08 ± 17.66, editorial independence (mean ± SD: 28.70 ± 22.03. CONCLUSIONS: The methodological quality of CPGs for MS was acceptable for scope, purpose and clarity of presentation. The developers of CPGs need to pay more attention to editorial independence, applicability, rigor of development and stakeholder involvement during the development process. The AGREE II instrument should be adopted by guideline developers.

  20. Segment convolutional neural networks (Seg-CNNs) for classifying relations in clinical notes. (United States)

    Luo, Yuan; Cheng, Yu; Uzuner, Özlem; Szolovits, Peter; Starren, Justin


    We propose Segment Convolutional Neural Networks (Seg-CNNs) for classifying relations from clinical notes. Seg-CNNs use only word-embedding features without manual feature engineering. Unlike typical CNN models, relations between 2 concepts are identified by simultaneously learning separate representations for text segments in a sentence: preceding, concept1, middle, concept2, and succeeding. We evaluate Seg-CNN on the i2b2/VA relation classification challenge dataset. We show that Seg-CNN achieves a state-of-the-art micro-average F-measure of 0.742 for overall evaluation, 0.686 for classifying medical problem-treatment relations, 0.820 for medical problem-test relations, and 0.702 for medical problem-medical problem relations. We demonstrate the benefits of learning segment-level representations. We show that medical domain word embeddings help improve relation classification. Seg-CNNs can be trained quickly for the i2b2/VA dataset on a graphics processing unit (GPU) platform. These results support the use of CNNs computed over segments of text for classifying medical relations, as they show state-of-the-art performance while requiring no manual feature engineering. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  1. State of malaria diagnostic testing at clinical laboratories in the United States, 2010: a nationwide survey

    Directory of Open Access Journals (Sweden)

    Abanyie Francisca A


    Full Text Available Abstract Background The diagnosis of malaria can be difficult in non-endemic areas, such as the United States, and delays in diagnosis and errors in treatment occur too often. Methods A nationwide survey of laboratories in the United States and its nine dependent territories was conducted in 2010 to determine factors that may contribute to shortcomings in the diagnosis of malaria. This survey explored the availability of malaria diagnostic tests, techniques used, and reporting practices. Results The survey was completed by 201 participants. Ninety percent reported that their laboratories had at least one type of malaria diagnostic test available on-site. Nearly all of the respondents' laboratories performed thick and thin smears on-site; approximately 50% had access to molecular testing; and only 17% had access to rapid diagnostic tests on-site. Seventy-three percent reported fewer than five confirmed cases of malaria in their laboratory during the 12-month period preceding the survey. Twenty-eight percent stated that results of species identification took more than 24 hours to report. Only five of 149 respondents that performed testing 24 hours a day, 7 days a week complied with all of the Clinical and Laboratory Standards Institute (CLSI guidelines for analysis and reporting of results. Conclusion Although malaria diagnostic testing services were available to a majority of U.S. laboratories surveyed, very few were in complete compliance with all of the CLSI guidelines for analysis and reporting of results, and most respondents reported very few cases of malaria annually. Laboratories' difficulty in adhering to the rigorous CLSI guidelines and their personnel's lack of practice and proficiency may account for delays and errors in diagnosis. It is recommended that laboratories that infrequently process samples for malaria seek opportunities for practice and proficiency training annually and take advantage of available resources to assist in

  2. Unequal Bargaining? Australia's Aviation Trade Relations with the United States (United States)

    Solomon, Russell


    International aviation trade bargaining is distinguished by its use of a formal process of bilateral bargaining based on the reciprocal exchange of rights by states. Australia-United States aviation trade relations are currently without rancour, but this has not always been the case and in the late 1980s and early 1990s, their formal bilateral aviation negotiations were a forum for a bitter conflict between two competing international aviation policies. In seeking to explain the bilateral aviation outcomes between Australia and the United States and how Australia has sought to improve upon these, analytical frameworks derived from international political economy were considered, along with the bilateral bargaining process itself. The paper adopts a modified neorealist model and concludes that to understand how Australia has sought to improve upon these aviation outcomes, neorealist assumptions that relative power capabilities determine outcomes must be qualified by reference to the formal bilateral bargaining process. In particular, Australia's use of this process and its application of certain bargaining tactics within that process remain critical to understanding bilateral outcomes.

  3. Approximate thermodynamic state relations in partially ionized gas mixtures

    International Nuclear Information System (INIS)

    Ramshaw, John D.


    Thermodynamic state relations for mixtures of partially ionized nonideal gases are often approximated by artificially partitioning the mixture into compartments or subvolumes occupied by the pure partially ionized constituent gases, and requiring these subvolumes to be in temperature and pressure equilibrium. This intuitively reasonable procedure is easily shown to reproduce the correct thermal and caloric state equations for a mixture of neutral (nonionized) ideal gases. The purpose of this paper is to point out that (a) this procedure leads to incorrect state equations for a mixture of partially ionized ideal gases, whereas (b) the alternative procedure of requiring that the subvolumes all have the same temperature and free electron density reproduces the correct thermal and caloric state equations for such a mixture. These results readily generalize to the case of partially degenerate and/or relativistic electrons, to a common approximation used to represent pressure ionization effects, and to two-temperature plasmas. This suggests that equating the subvolume electron number densities or chemical potentials instead of pressures is likely to provide a more accurate approximation in nonideal plasma mixtures

  4. Maximum Correntropy Unscented Kalman Filter for Spacecraft Relative State Estimation

    Directory of Open Access Journals (Sweden)

    Xi Liu


    Full Text Available A new algorithm called maximum correntropy unscented Kalman filter (MCUKF is proposed and applied to relative state estimation in space communication networks. As is well known, the unscented Kalman filter (UKF provides an efficient tool to solve the non-linear state estimate problem. However, the UKF usually plays well in Gaussian noises. Its performance may deteriorate substantially in the presence of non-Gaussian noises, especially when the measurements are disturbed by some heavy-tailed impulsive noises. By making use of the maximum correntropy criterion (MCC, the proposed algorithm can enhance the robustness of UKF against impulsive noises. In the MCUKF, the unscented transformation (UT is applied to obtain a predicted state estimation and covariance matrix, and a nonlinear regression method with the MCC cost is then used to reformulate the measurement information. Finally, the UT is adopted to the measurement equation to obtain the filter state and covariance matrix. Illustrative examples demonstrate the superior performance of the new algorithm.

  5. Aspergillus fumigatus-Related Species in Clinical Practice. (United States)

    Lamoth, Frédéric


    Aspergillus fumigatus is the main etiologic agent of invasive aspergillosis (IA). Other Aspergillus species belonging to the section Fumigati (A. fumigatus complex) may occasionally be the cause of IA. These strains are often misidentified, as they cannot be distinguished from A. fumigatus by conventional morphological analysis and sequencing methods. This lack of recognition may have important consequences as these A. fumigatus-related species often display some level of intrinsic resistance to azoles and other antifungal drugs. A. lentulus, A. udagawae, A. viridinutans, and A. thermomutatus (Neosartorya pseudofischeri) have been associated with refractory cases of IA. Microbiologists should be able to suspect the presence of these cryptic species behind a putative A. fumigatus isolate on the basis of some simple characteristics, such as defect in sporulation and/or unusual antifungal susceptibility profile. However, definitive species identification requires specific sequencing analyses of the beta-tubulin or calmodulin genes, which are not available in most laboratories. Multiplex PCR assays or matrix-assisted laser desorption ionization - time-of-flight mass spectrometry (MALDI-TOF MS) gave promising results for rapid and accurate distinction between A. fumigatus and other Aspergillus spp. of the section Fumigati in clinical practice. Improved diagnostic procedures and antifungal susceptibility testing may be helpful for the early detection and management of these particular IA cases.

  6. Aspergillus fumigatus-Related Species in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Frederic eLamoth


    Full Text Available Aspergillus fumigatus is the main etiologic agent of invasive aspergillosis (IA. Other Aspergillus species belonging to the section Fumigati (A. fumigatus complex may occasionally be the cause of IA. These strains are often misidentified, as they cannot be distinguished from A. fumigatus by conventional morphological analysis and sequencing methods. This lack of recognition may have important consequences as these A. fumigatus-related species often display some level of intrinsic resistance to azoles and other antifungal drugs. A. lentulus, A. udagawae, A. viridinutans and A. thermomutatus (Neosartorya pseudofischeri have been associated with refractory cases of IA. Microbiologists should be able to suspect the presence of these cryptic species behind a putative A. fumigatus isolate on the basis of some simple characteristics, such as defect in sporulation and/or unusual antifungal susceptibility profile. However, definitive species identification requires specific sequencing analyses of the beta-tubulin or calmodulin genes, which are not available in most laboratories. Multiplex PCR assays or matrix-assisted laser desorption ionization – time-of-flight mass spectrometry (MALDI-TOF MS gave promising results for rapid and accurate distinction between A. fumigatus and other Aspergillus spp. of the section Fumigati in clinical practice. Improved diagnostic procedures and antifungal susceptibility testing may be helpful for the early detection and management of these particular IA cases.

  7. Obesity-related glomerulopathy: pathogenesis, pathologic, clinical characteristics and treatment. (United States)

    Xu, Tianhua; Sheng, Zitong; Yao, Li


    In light of the rapid increase in the number of obesity incidences worldwide, obesity has become an independent risk factor for chronic kidney disease. Obesity-related glomerulopathy (ORG) is characterized by glomerulomegaly in the presence or absence of focal and segmental glomerulosclerosis lesions. IgM and complement 3 (C3) nonspecifically deposit in lesions without immune-complex-type deposits during ORG immunofluorescence. ORG-associated glomerulomegaly and focal and segmental glomerulosclerosis can superimpose on other renal pathologies. The mechanisms under ORG are complex, especially hemodynamic changes, inflammation, oxidative stress, apoptosis, and reduced functioning nephrons. These mechanisms synergize with obesity to induce end-stage renal disease. A slow increase of subnephrotic proteinuria ( < 3.5 g/d) is the most common clinical manifestation of ORG. Several treatment methods for ORG have been developed. Of these methods, renin-angiotensin-aldosterone system blockade and weight loss are proven effective. Targeting mitochondria may offer a novel strategy for ORG therapy. Nevertheless, more research is needed to further understand ORG.

  8. Stationary Distribution and Thermodynamic Relation in Nonequilibrium Steady States

    KAUST Repository

    Komatsu, Teruhisa S.; Nakagawa, Naoko; Sasa, Shin-ichi; Tasaki, Hal; Ito, Nobuyasu


    We describe our recent attempts toward statistical mechanics and thermodynamics for nonequilibrium steady states (NESS) realized, e.g., in a heat conducting system. Our first result is a simple expression of the probability distribution (of microscopic states) of a NESS. Our second result is a natural extension of the thermodynamic Clausius relation and a definition of an accompanying entropy in NESS. This entropy coincides with the normalization constant appearing in the above mentioned microscopic expression of NESS, and has an expression similar to the Shannon entropy (with a further symmetrization). The NESS entropy proposed here is a clearly defined measurable quantity even in a system with a large degrees of freedom. We numerically measure the NESS entropy in hardsphere fluid systems with a heat current, by observing energy exchange between the system and the heat baths when the temperatures of the baths are changed according to specified protocols.

  9. Sixth International Conference on Squeezed States and Uncertainty Relations (United States)

    Han, D. (Editor); Kim, Y. S. (Editor); Solimento, S. (Editor)


    These proceedings contain contributions from about 200 participants to the 6th International Conference on Squeezed States and Uncertainty Relations (ICSSUR'99) held in Naples May 24-29, 1999, and organized jointly by the University of Naples "Federico II," the University of Maryland at College Park, and the Lebedev Institute, Moscow. This was the sixth of a series of very successful meetings started in 1990 at the College Park Campus of the University of Maryland. The other meetings in the series were held in Moscow (1992), Baltimore (1993), Taiyuan P.R.C. (1995) and Balatonfuered, Hungary (1997). The present one was held at the campus Monte Sant'Angelo of the University "Federico II" of Naples. The meeting sought to provide a forum for updating and reviewing a wide range of quantum optics disciplines, including device developments and applications, and related areas of quantum measurements and quantum noise. Over the years, the ICSSUR Conference evolved from a meeting on quantum measurement sector of quantum optics, to a wide range of quantum optics themes, including multifacet aspects of generation, measurement, and applications of nonclassical light (squeezed and Schrodinger cat radiation fields, etc.), and encompassing several related areas, ranging from quantum measurement to quantum noise. ICSSUR'99 brought together about 250 people active in the field of quantum optics, with special emphasis on nonclassical light sources and related areas. The Conference was organized in 8 Sections: Squeezed states and uncertainty relations; Harmonic oscillators and squeeze transformations; Methods of quantum interference and correlations; Quantum measurements; Generation and characterisation of non-classical light; Quantum noise; Quantum communication and information; and Quantum-like systems.

  10. Removable denture-related oral mucosal lesions: descriptive clinical study

    Directory of Open Access Journals (Sweden)

    Gökçen Akçiçek


    Full Text Available Objective: The aim of this study was to investigate whether there was a relationship between removable denture-related oral mucosal lesions and denture type, and demographic characteristics. Materials and Method: The age, sex, denture type, systemic condition and medication use, presence of denture-related oral mucosal lesions (DROML, their locations and patients’ awareness of above mentioned lesions were recorded for 199 patients. Pearson chi-square test was used to analyse the relationship between the DROML and denture type, and demographic characteristics of the patients. Results: Among the patients included to the study, 122 (61.3% were female and 77 (38.7% were male. Ninety-six patients (48.2% exhibited DROML, whereas 103 patients (51.8% had no DROML. No relationship was detected between DROML and age, and sex (p>0.05. The most commonly detected DROML was denture stomatitis (34.7%. Denture stomatitis was significantly more frequently seen in partial denture wearers (p<0.05, while epulis fissuratum and flabby ridge were statistically more frequent in complete denture wearers (p<0.001. Traumatic ulcer was more frequently found in mandibular complete denture wearers (p<0.05, while epulis fissuratum and flabby ridge were significantly more common in maxillary complete denture wearers (p<0.001. Among the patients with DROML, 57.3% stated that they were unaware of these lesions. Conclusion: In this study sample, the rate of DROML was high in patients wearing removable dentures (48.2%, and more than half of the patients with DROML were not aware of these lesions. Upon these findings, it is considered that removable denture wearers should follow the denture usage instructions and should be informed about the importance of periodic controls.

  11. Visual steady state in relation to age and cognitive function

    DEFF Research Database (Denmark)

    Horwitz, Anna; Dyhr Thomsen, Mia; Wiegand, Iris


    Neocortical gamma activity is crucial for sensory perception and cognition. This study examines the value of using non-task stimulation-induced EEG oscillations to predict cognitive status in a birth cohort of healthy Danish males (Metropolit) with varying cognitive ability. In particular, we...... examine the steady-state VEP power response (SSVEP-PR) in the alpha (8Hz) and gamma (36Hz) bands in 54 males (avg. age: 62.0 years) and compare these with 10 young healthy participants (avg. age 27.6 years). Furthermore, we correlate the individual alpha-to-gamma difference in relative visual-area power...

  12. A Disease-Associated Microbial and Metabolomics State in Relatives of Pediatric Inflammatory Bowel Disease Patients. (United States)

    Jacobs, Jonathan P; Goudarzi, Maryam; Singh, Namita; Tong, Maomeng; McHardy, Ian H; Ruegger, Paul; Asadourian, Miro; Moon, Bo-Hyun; Ayson, Allyson; Borneman, James; McGovern, Dermot P B; Fornace, Albert J; Braun, Jonathan; Dubinsky, Marla


    Microbes may increase susceptibility to inflammatory bowel disease (IBD) by producing bioactive metabolites that affect immune activity and epithelial function. We undertook a family based study to identify microbial and metabolic features of IBD that may represent a predisease risk state when found in healthy first-degree relatives. Twenty-one families with pediatric IBD were recruited, comprising 26 Crohn's disease patients in clinical remission, 10 ulcerative colitis patients in clinical remission, and 54 healthy siblings/parents. Fecal samples were collected for 16S ribosomal RNA gene sequencing, untargeted liquid chromatography-mass spectrometry metabolomics, and calprotectin measurement. Individuals were grouped into microbial and metabolomics states using Dirichlet multinomial models. Multivariate models were used to identify microbes and metabolites associated with these states. Individuals were classified into 2 microbial community types. One was associated with IBD but irrespective of disease status, had lower microbial diversity, and characteristic shifts in microbial composition including increased Enterobacteriaceae, consistent with dysbiosis. This microbial community type was associated similarly with IBD and reduced microbial diversity in an independent pediatric cohort. Individuals also clustered bioinformatically into 2 subsets with shared fecal metabolomics signatures. One metabotype was associated with IBD and was characterized by increased bile acids, taurine, and tryptophan. The IBD-associated microbial and metabolomics states were highly correlated, suggesting that they represented an integrated ecosystem. Healthy relatives with the IBD-associated microbial community type had an increased incidence of elevated fecal calprotectin. Healthy first-degree relatives can have dysbiosis associated with an altered intestinal metabolome that may signify a predisease microbial susceptibility state or subclinical inflammation. Longitudinal prospective


    Directory of Open Access Journals (Sweden)

    O. O. Basieva


    Full Text Available Aim of study: complex pancreas study in rheumatoid arthritis (RA. Material and methods: 120 RA pts were examined clinically Pancreas US-and biochemical study (level of a-amylase and lipase of blood serum by kinetic-calorimetric method was performed in this grouh. Results: 50.8% of pts demonstrated increase of pancreas echo, in 23.3%- widened Wirsung s duct, in 45%- single small focal indurations, more often in the body and cauda pancreatis. Decrease of lipolitic and amylolytic pancreas activity is characteristic for RA, especially in systemic process and long-term disease. Clinical and functional disturbances are connected with morphological changes.

  14. Clinical Characteristics and Current Treatment of Age-Related Macular Degeneration (United States)

    Yonekawa, Yoshihiro; Kim, Ivana K.


    Age-related macular degeneration (AMD) is a multifactorial degeneration of photoreceptors and retinal pigment epithelium. The societal impact is significant, with more than 2 million individuals in the United States alone affected by advanced stages of AMD. Recent progress in our understanding of this complex disease and parallel developments in therapeutics and imaging have translated into new management paradigms in recent years. However, there are many unanswered questions, and diagnostic and prognostic precision and treatment outcomes can still be improved. In this article, we discuss the clinical features of AMD, provide correlations with modern imaging and histopathology, and present an overview of treatment strategies. PMID:25280900

  15. Haematology outreach clinics in the Free State and Northern Cape

    African Journals Online (AJOL)

    They repeatedly have to travel hundreds of kilometres, at ... To limit travel, we often monitor patients between their clinic visits with the help of their general practitioners. However, this is not optimal for all conditions and we were looking for alternatives. At the .... Approximately 10% of the patients had medical insurance.

  16. Regulations in the United States for cell transplantation clinical trials in neurological diseases

    Institute of Scientific and Technical Information of China (English)

    He Zhu; Yuanqing Tan; Qi Gu; Weifang Han; Zhongwen Li; Jason S Meyer; Baoyang Hu


    Objective: This study aimed to use a systematic approach to evaluate the current utilization, safety, and effectiveness of cell therapies for neurological diseases in human. And review the present regulations, considering United States (US) as a representative country, for cell transplantation in neurological disease and discuss the challenges facing the field of neurology in the coming decades. Methods:A detailed search was performed in systematic literature reviews of cellular‐based therapies in neurological diseases, using PubMed, web of science, and clinical trials. Regulations of cell therapy products used for clinical trials were searched from the Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Results: Seven most common types of cell therapies for neurological diseases have been reported to be relatively safe with varying degrees of neurological recovery. And a series of regulations in US for cellular therapy was summarized including preclinical evaluations, sourcing material, stem cell manufacturing and characterization, cell therapy product, and clinical trials. Conclusions:Stem cell‐based therapy holds great promise for a cure of such diseases and will value a growing population of patients. However, regulatory permitting activity of the US in the sphere of stem cells, technologies of regenerative medicine and substitutive cell therapy are selective, theoretical and does not fit the existing norm and rules. Compiled well‐defined regulations to guide the application of stem cell products for clinical trials should be formulated.

  17. Education in the workplace for the physician: clinical management states as an organizing framework. (United States)

    Greenes, R A


    Medical educators are interested in approaches to making selected relevant knowledge available in the context of problem-based care. This is of value both during the process of care and as a means of organizing information for offline self-study. Four trends in health information technology are relevant to achieving the goal and can be expected to play a growing role in the future. First, health care enterprises are developing approaches for access to information resources related to the care of a patient, including clinical data and images but also communication tools, referral and other logistic tools, decision support, and educational materials. Second, information for patients and methods for patient-doctor interaction and decision making are becoming available. Third, computer-based methods for representation of practice guidelines are being developed to support applications that can incorporate their logic. Finally, considering patients as being in particular "clinical management states" (or CMSs) for specific problems, approaches are being developed to use guidelines as a kind of "predictive" framework to enable development of interfaces for problem-based clinical encounters. The guidelines for a CMS can be used to identify the kinds of resources specifically needed for clinical encounters of that type. As the above trends converge to produce problem-specific environments, professional specialty organizations and continuing medical education course designers will need to focus energies on organizing and updating medical knowledge to make it available in CMS-specific contexts.

  18. Influence of human papillomavirus on the clinical presentation of oropharyngeal carcinoma in the United States. (United States)

    Stenmark, Matthew H; Shumway, Dean; Guo, Cui; Vainshtein, Jeffrey; Mierzwa, Michelle; Jagsi, Reshma; Griggs, Jennifer J; Banerjee, Mousumi


    Much of what is known about the significance of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is derived from single-institution retrospective studies, post hoc analyses of tissue specimens from clinical trials, and tissue bank studies with a small sample size. The objective of this study is to investigate the impact of HPV on the frequency and clinical presentation of oropharyngeal carcinoma in a large, national sample with information from patients who underwent HPV testing. Retrospective, cross-sectional study. We identified a comprehensive national sample of 8,359 patients with oropharyngeal carcinoma and known HPV status diagnosed between 2010 and 2011 within the National Cancer Database. Multivariable logistic regression was used to assess correlates of patient and tumor characteristics on HPV status. Among patients with oropharyngeal carcinoma, the frequency of HPV-related squamous cell carcinoma in the United States was 65.4%. HPV-related oropharyngeal carcinoma was associated with younger age, male sex, and white race (P presentation (P clinical profile, supporting efforts to re-evaluate the staging and treatment paradigm for HPV-associated oropharyngeal cancer. 4. Laryngoscope, 127:2270-2278, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Cognitive development, clinical knowledge, and clinical experience related to diagnostic ability. (United States)

    Aquilino, M L


    To examine the relationship among cognitive development, clinical knowledge, and clinical experience in nursing students. A survey of junior and senior baccalaureate nursing students from three Midwestern colleges (N = 55). Students' diagnostic ability increased as they gained clinical experience and clinical knowledge. However, students failed to identify many nursing diagnoses and demonstrated only moderate levels of cognitive development. Nurse educators and nursing students need to change their approaches to teaching and learning to enhance students' diagnostic ability and cognitive development.

  20. Haematology outreach clinics in the Free State and Northern Cape

    African Journals Online (AJOL)

    patients' domicile, how they were referred, types of diagnoses and ... The intention was to offer a more accessible and affordable service to more patients in the Free State and Northern Cape, in accordance with provincial policy.' The Departments of ... The cost would have been higher if consultants had had to stay over.

  1. Aerobic-Strength Exercise Improves Metabolism and Clinical State in Parkinson’s Disease Patients

    Directory of Open Access Journals (Sweden)

    Patrik Krumpolec


    Full Text Available Regular exercise ameliorates motor symptoms in Parkinson’s disease (PD. Here, we aimed to provide evidence that exercise brings additional benefits to the whole-body metabolism and skeletal muscle molecular and functional characteristics, which might help to explain exercise-induced improvements in the clinical state. 3-months supervised endurance/strength training was performed in early/mid-stage PD patients and age/gender-matched individuals (n = 11/11. The effects of exercise on resting energy expenditure (REE, glucose metabolism, adiposity, and muscle energy metabolism (31P-MRS were evaluated and compared to non-exercising PD patients. Two muscle biopsies were taken to determine intervention-induced changes in fiber type, mitochondrial content, and expression of genes related to muscle energy metabolism, as well as proliferative and regenerative capacity. Exercise improved the clinical disability score (MDS-UPDRS, bradykinesia, balance, walking speed, REE, and glucose metabolism and increased muscle expression of energy sensors (AMPK. However, the exercise-induced increase in muscle mass/strength, mitochondrial content, type II fiber size, and postexercise phosphocreatine (PCr recovery (31P-MRS were found only in controls. Nevertheless, MDS-UPDRS was associated with muscle AMPK and mechano-growth factor (MGF expression. Improvements in fasting glycemia were positively associated with muscle function and the expression of Sirt1 and Cox7a1, and the parameters of fitness/strength were positively associated with the expression of MyHC2, MyHC7, and MGF. Moreover, reduced bradykinesia was associated with better muscle metabolism (maximal oxidative capacity and postexercise PCr recovery; 31P-MRS. Exercise training improved the clinical state in early/mid-stage Parkinson’s disease patients, including motor functions and whole-body metabolism. Although the adaptive response to exercise in PD was different from that of controls, exercise

  2. Public relations in the State Office for Nuclear Safety

    International Nuclear Information System (INIS)

    Prochazkova, Radka


    The State Office for Nuclear Safety (SONS) is a government agency. The Office is headed by a chairperson who is appointed by the Czech Government. The Office has got its own budget and reports directly to the Czech Government. SONS was established in 1993 and continued activities of the former Czechoslovak Commission for Atomic Energy. SONS main activity is the central administration and supervision of the peaceful utilization of nuclear power and ionizing radiation and in the field of radiation protection. SONS is regulated mainly by the Atomic Act. A separate department of Public Relations was established last year in SONS especially due to the enactment of the statutory obligation of government agencies to render information. Basic P.R. communication means in the field of external communication include: Information Center; Internet; Press Releases; Publications - publishing regularly or for topical events; Seminars; Meetings; Press conferences; Editorial articles; Answering questions

  3. Thermodynamic behavior of glassy state of structurally related compounds. (United States)

    Kaushal, Aditya Mohan; Bansal, Arvind Kumar


    Thermodynamic properties of amorphous pharmaceutical forms are responsible for enhanced solubility as well as poor physical stability. The present study was designed to investigate the differences in thermodynamic parameters arising out of disparate molecular structures and associations for four structurally related pharmaceutical compounds--celecoxib, valdecoxib, rofecoxib, and etoricoxib. Conventional and modulated temperature differential scanning calorimetry were employed to study glass forming ability and thermodynamic behavior of the glassy state of model compounds. Glass transition temperature of four glassy compounds was in a close range of 327.6-331.8 K, however, other thermodynamic parameters varied considerably. Kauzmann temperature, strength parameter and fragility parameter showed rofecoxib glass to be most fragile of the four compounds. Glass forming ability of the compounds fared similar in the critical cooling rate experiments, suggesting that different factors were determining the glass forming ability and subsequent behavior of the compounds in glassy state. A comprehensive understanding of such thermodynamic facets of amorphous form would help in rationalizing the approaches towards development of stable glassy pharmaceuticals.

  4. [Possible relation between clinical guidelines and legal standard of medicine]. (United States)

    Furukawa, Toshiharu; Kitagawa, Yuko


    Legal standard of medicine is not equal across the all kinds of medical institutions. Each medical institution is required its respective standard of medicine in which its doctors are expected to have studied medical informations, which have been spread among medical institutions with similar characteristics. Therefore, in principle, clinical guidelines for the treatment of a disease formed by public committees do not directly become the medical standards of respective disease treatment. However, doctors would be legally required to practice medicine with reference to the clinical guidelines because medical informations, mediated by internet or many kinds of media, have been spread very fast to all medical institutions these days. Moreover, doctors would be required to inform their patients of non-standardized new treatments, even if such treatments are not listed in clinical guidelines in case patients have special concern about new treat-

  5. Research in the United States relative to geochemistry and health (United States)

    Petrie, W.L.; Cannon, H.L.


    Increasing concern regarding the effects of the geochemical environment on health in the United States has fostered research studies in a number of universities and government agencies. The necessity to evaluate the effects of natural and man-made elemental excesses in the environment on health requires the establishment of requirements and tolerance limits for the various elements in water and crops. Maps of the geographic distribution of these elements in rocks, surficial materials and ground and surface waters are also essential for comparison with the occurrence of disease. Funding support for research projects that relate to various parameters of these problems emanates largely from a few federal agencies, and much of the work is conducted at government, university and private facilities. An example of the latter is the National Academy of Sciences-National Research Council, which has several components that are addressing a variety of comparative studies of the geochemical environment related to health; studies involve specific trace elements (like selenium and magnesium), diseases (like cancer, urolithiasis and cardiovascular disease), other health factors (like aging and nutrition) and links with timely major problems (like the health effects of greatly increasing the use of coal). ?? 1979.

  6. Leadership Is Positively Related to Athletic Training Students' Clinical Behaviors (United States)

    Kutz, Matthew R.


    Context: Leadership development by health professionals positively affects patient outcomes. Objective: To 1) determine if there is any relationship between demonstrated leadership behaviors and clinical behaviors among entry-level AT students (ATS); 2) to explore if the level of leadership behavior changes between ATS level; and 3) to determine…

  7. The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State. (United States)

    Schoonover, Heather

    The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

  8. Relations between Behavioral Inhibition, Big Five Personality Factors, and Anxiety Disorder Symptoms in Non-Clinical and Clinically Anxious Children (United States)

    Vreeke, Leonie J.; Muris, Peter


    This study examined the relations between behavioral inhibition, Big Five personality traits, and anxiety disorder symptoms in non-clinical children (n = 147) and clinically anxious children (n = 45) aged 6-13 years. Parents completed the Behavioral Inhibition Questionnaire-Short Form, the Big Five Questionnaire for Children, and the Screen for…

  9. Relations between behavioral inhibition, big five personality factors, and anxiety disorder symptoms in non-clinical and clinically anxious children

    NARCIS (Netherlands)

    L.J. Vreeke (Leonie); P.E.H.M. Muris (Peter)


    textabstractThis study examined the relations between behavioral inhibition, Big Five personality traits, and anxiety disorder symptoms in non-clinical children (n = 147) and clinically anxious children (n = 45) aged 6-13 years. Parents completed the Behavioral Inhibition Questionnaire-Short Form,

  10. Spontaneous pneumomediastinum on CT : related condition and its clinical significance

    International Nuclear Information System (INIS)

    Kim, Sung Hyun; Im, Jung Gi; Seo, Joon Beom; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung


    The purpose of this paper is to tabulate underlying disease and to assess the clinical significance of CT-diagnosed spontaneous pneumomediastinum. We retrospectively reviewed CT scans and medical records of 11 consecutive patients with spontaneous pneumomediastinum, and analyzed their clinical history and course, and in five cases, pulmonary function. CT scans of 126 patients with idiopathic pulmonary fibrosis (IPE) collected while the 11 consecutive patients were being treated were analyzed for the prevalence of pneumomediastinum. We analyzed CT findings with respect to the amount and distribution of air in the mediastinum, and the presence of absence of air outside the mediastinum. Spontaneous pneumomediastinum might be associated with idiopathic pulmonary fibrosis and might be a poor prognostic factor in patients with IPE or BOOP. (author). 18 refs., 2 figs

  11. Spontaneous pneumomediastinum on CT : related condition and its clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Hyun; Im, Jung Gi; Seo, Joon Beom; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung [Seoul National Univ. (Korea, Republic of). Coll. of Medicine


    The purpose of this paper is to tabulate underlying disease and to assess the clinical significance of CT-diagnosed spontaneous pneumomediastinum. We retrospectively reviewed CT scans and medical records of 11 consecutive patients with spontaneous pneumomediastinum, and analyzed their clinical history and course, and in five cases, pulmonary function. CT scans of 126 patients with idiopathic pulmonary fibrosis (IPE) collected while the 11 consecutive patients were being treated were analyzed for the prevalence of pneumomediastinum. We analyzed CT findings with respect to the amount and distribution of air in the mediastinum, and the presence of absence of air outside the mediastinum. Spontaneous pneumomediastinum might be associated with idiopathic pulmonary fibrosis and might be a poor prognostic factor in patients with IPE or BOOP. (author). 18 refs., 2 figs.

  12. ABO blood groups and malaria related clinical outcome. (United States)

    Deepa; Alwar, Vanamala A; Rameshkumar, Karuna; Ross, Cecil


    The study was undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. From October 2007 to September 2008, malaria positive patients' samples were evaluated in this study. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cell counter. After determining the blood groups, malarial species and the severity of clinical course were correlated. A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodium falciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results of the blood groups showed 22 - 'A' group, 42 - 'B' group, 35 - 'O' group and 1 was 'AB' group. When the clinical courses between different groups were compared using the following parameters for severe infection--a parasitic load of >10/1000 RBCs, severe anemia with hemoglobin 101°F and other organ involvement, it was observed that 'O' group had an advantage over other the groups. The difference in rosetting ability between red blood cells of different 'ABO' blood groups with a diminished rosetting potential in blood group 'O' red blood cells was due to the differential host susceptibility. 'O' group had an advantage over the other three blood groups. Based on literature and the results of this study, the diminished rosetting potential in blood group 'O' red blood cells is suggested as the basis for the differential host susceptibility.

  13. State, Foreign Operations, and Related Programs: FY2008 Appropriations

    National Research Council Canada - National Science Library

    Veillette, Connie; Epstein, Susan B


    ... an unprecedented level compared with the past 40 years. Emergency supplementals enacted since the September 11, 2001, terrorist attacks to assist the front-line states in the war on terrorism, fund Afghanistan and Iraq reconstruction, and upgrade State...

  14. Clinical identification of the simple sleep-related movement disorders. (United States)

    Walters, Arthur S


    Simple sleep-related movement disorders must be distinguished from daytime movement disorders that persist during sleep, sleep-related epilepsy, and parasomnias, which are generally characterized by activity that appears to be simultaneously complex, goal-directed, and purposeful but is outside the conscious awareness of the patient and, therefore, inappropriate. Once it is determined that the patient has a simple sleep-related movement disorder, the part of the body affected by the movement and the age of the patient give clues as to which sleep-related movement disorder is present. In some cases, all-night polysomnography with accompanying video may be necessary to make the diagnosis. Hypnic jerks (ie, sleep starts), bruxism, rhythmic movement disorder (ie, head banging/body rocking), and nocturnal leg cramps are discussed in addition to less well-appreciated disorders such as benign sleep myoclonus of infancy, excessive fragmentary myoclonus, and hypnagogic foot tremor/alternating leg muscle activation.

  15. Clinical reappraisal and state of the art of nephropexy. (United States)

    Mogorovich, Andrea; Selli, Cesare; De Maria, Maurizio; Manassero, Francesca; Durante, Jacopo; Urbani, Lucio


    The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.

  16. Vegetative and minimally conscious state(s) survey: attitudes of clinical neuropsychologists and speech and language therapists. (United States)

    Wilson, F Colin; Harpur, Jocelyn; McConnell, Nigel


    To gauge the understanding and opinions of clinical neuropsychologists and speech and language therapists (SLT) in relation to vegetative (VS) and minimally conscious (MCS) patients relative to available practice guidelines. Semi-structured questionnaires were sent to all UK Practitioner Full Members of the BPS Division of Neuropsychology (307) and SLT managers (371) in March to April 2002 examining post qualification clinical practice, professional-family involvement and views on neuro-rehabilitation access. Difference(s) in clinical practice among clinical neuropsychologists and SLTs were observed. Some 27% returned questionnaires (n=184). Despite significant working experience, most respondents poorly defined both VS and MCS. Among clinical neuropsychologists and speech and language therapists not working with these patients, less positive attitudes regarding the value of neuro-rehabilitation were endorsed. Despite the development of SMART training for VS, there is a dearth of specific training in MCS assessment and management. The need to improve professional understanding among these staff groups is highlighted.

  17. Clinical, molecular, and pharmacological aspects of FMR1 related disorders. (United States)

    Pugin, A; Faundes, V; Santa María, L; Curotto, B; Aliaga, S; Salas, I; Soto, P; Bravo, P; Peña, M I; Alliende, M A


    Fragile X syndrome, the most common inherited cause of intellectual disability, is associated with a broad spectrum of disorders across different generations of a single family. This study reviews the clinical manifestations of fragile X-associated disorders as well as the spectrum of mutations of the fragile X mental retardation 1 gene (FMR1) and the neurobiology of the fragile X mental retardation protein (FMRP), and also provides an overview of the potential therapeutic targets and genetic counselling. This disorder is caused by expansion of the CGG repeat (>200 repeats) in the 5 prime untranslated region of FMR1, resulting in a deficit or absence of FMRP. FMRP is an RNA-binding protein that regulates the translation of several genes that are important in synaptic plasticity and dendritic maturation. It is believed that CGG repeat expansions in the premutation range (55 to 200 repeats) elicit an increase in mRNA levels of FMR1, which may cause neuronal toxicity. These changes manifest clinically as developmental problems such as autism and learning disabilities as well as neurodegenerative diseases including fragile X-associated tremor/ataxia syndrome (FXTAS). Advances in identifying the molecular basis of fragile X syndrome may help us understand the causes of neuropsychiatric disorders, and they will probably contribute to development of new and specific treatments. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. What domains of clinical function should be assessed after sport-related concussion? A systematic review. (United States)

    Feddermann-Demont, Nina; Echemendia, Ruben J; Schneider, Kathryn J; Solomon, Gary S; Hayden, K Alix; Turner, Michael; Dvořák, Jiří; Straumann, Dominik; Tarnutzer, Alexander A


    Sport-related concussion (SRC) is a clinical diagnosis made after a sport-related head trauma. Inconsistency exists regarding appropriate methods for assessing SRC, which focus largely on symptom-scores, neurocognitive functioning and postural stability. Systematic literature review. MEDLINE, EMBASE, PsycINFO, Cochrane-DSR, Cochrane CRCT, CINAHL, SPORTDiscus (accessed July 9, 2016). Original (prospective) studies reporting on postinjury assessment in a clinical setting and evaluation of diagnostic tools within 2 weeks after an SRC. Forty-six studies covering 3284 athletes were included out of 2170 articles. Only the prospective studies were considered for final analysis (n=33; 2416 athletes). Concussion diagnosis was typically made on the sideline by an (certified) athletic trainer (55.0%), mainly on the basis of results from a symptom-based questionnaire. Clinical domains affected included cognitive, vestibular and headache/migraine. Headache, fatigue, difficulty concentrating and dizziness were the symptoms most frequently reported. Neurocognitive testing was used in 30/33 studies (90.9%), whereas balance was assessed in 9/33 studies (27.3%). The overall quality of the studies was considered low. The absence of an objective, gold standard criterion makes the accurate diagnosis of SRC challenging. Current approaches tend to emphasise cognition, symptom assessment and postural stability with less of a focus on other domains of functioning. We propose that the clinical assessment of SRC should be symptom based and interdisciplinary. Whenever possible, the SRC assessment should incorporate neurological, vestibular, ocular motor, visual, neurocognitive, psychological and cervical aspects. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Development of Obesity and Related Diseases in African Refugees After Resettlement to United States. (United States)

    Rhodes, Corinne M; Chang, Yuchiao; Percac-Lima, Sanja


    Despite increases in obesity and related diseases in developing nations, initial refugee clinical visits do not address these issues. We explored the development of obesity and related diseases in a longitudinal prospective cohort of African refugees resettling in northeastern US. Using state Department of Health data, refugees were linked to a health system. Body mass index, diabetes, hypertension, and hyperlipidemia status were extracted from charts. US regional controls from NAMCS/NHAMCS data were matched by age, sex, race, and visit year. African refugee BMI increased after resettlement at 1 (1.7 ± 2.9, p resettlement to prevent development of obesity and related disease in this vulnerable population.

  20. Clinical Signs, Staphylococcus and Atopic Eczema-Related Seromarkers

    Directory of Open Access Journals (Sweden)

    Kam Lun Hon


    Full Text Available Childhood eczema or atopic dermatitis (AD is a distressing disease associated with pruritus, sleep disturbance, impaired quality of life and Staphylococcus aureus isolation. The pathophysiology of AD is complex and various seromarkers of immunity are involved. We investigated if anti-staphylococcal enterotoxin IgE (anti-SE, selected seromarkers of T regulatory (Treg, T helper (Th and antigen-presenting cells (APC are associated with clinical signs of disease severity and quality of life. Disease severity was assessed with the Scoring Atopic Dermatitis (SCORAD index, and quality of life with the Children’s Dermatology Life Quality Index (CDLQI in AD patients ≤18 years old. Concentrations of anti-staphylococcus enterotoxin A and B immunoglobulin E (anti-SEA and anti-SEB, selected Treg/Th/APC chemokines, skin hydration and transepidermal water loss (TEWL were measured in these patients. Forty patients with AD [median (interquartile range age of 13.1 (7.9 years were recruited. Backward stepwise linear regression (controlling for age, personal allergic rhinitis and asthma, and other blood markers showed the serum anti-SEB level was positively associated with S. aureus and S. epidermidis isolations, objective SCORAD, clinical signs and CDLQI. TNF-α (a Th1 cytokine was positively associated with objective SCORAD (B = 4.935, p = 0.010, TGF-β (a Treg cytokine negatively with disease extent (B = −0.015, p = 0.001, IL-18 (an APC cytokine positively with disease extent (B = 0.438, p = 0.001 and with TEWL (B = 0.040, p = 0.010, and IL-23 (an APC cytokine negatively with disease extent (B = −2.812, p = 0.006 and positively with pruritus (B = 0.387, p = 0.007. Conclusions: Blood levels of anti-SEB, Th1, Treg and APC cytokines are correlated with various clinical signs of AD. AD is a systemic immunologic disease involving Staphylococcus aureus, cellular, humoral, cytokine and chemokine pathophysiology.

  1. The trials, tribulations, and relative success of the ongoing clinical merger of two large academic hospital systems. (United States)

    Cohen, J R; Dowling, M; Gallagher, J S


    The North Shore Health System and the Long Island Jewish Medical Center merged in 1997 and now form the third largest not-for-profit academic health care system in the United States. The authors analyze the specific factors responsible for the relative success of the clinical merger, review their merger's initial failures and how they crafted a more pragmatic and appropriate set of guiding principles to continue the merger, and discuss the future of their institution's clinical integration strategy. In 2000, clinical integration of the 19 clinical departments at the two merged institutions was surveyed across five broad areas: conferences, residency programs, common faculty and support staff, finances, and research. Extents of clinical integration ranged from 20% to 72%. Six departments had more than 50% clinical integration, and overall clinical integration was 42%. Not surprisingly, clinical integration had occurred most frequently with conferences (50%) and least with finances (25%). The single-chairperson model for department leadership has been most successful in achieving significant clinical integration of the formerly separate departments. The relative success of the clinical merger has been guided by the principle that no clinical service should be integrated simply for the sake of merging, but rather that integration should be encouraged where and when it makes sense to achieve specific program goals. In addition, the merger would not have proceeded without constant communication among the leadership and staff, flexibility in building leadership models, patience in having events progress over a time course that developed trust among the senior leaders, and the presence of a senior executive structure whose authority to make decisions is accepted. The most important factor for achieving a reasonable level of clinical integration is the ability of the clinical leaders to collaborate and lead the change process.

  2. How to ascertain drug related deaths during clinical trials ? (United States)

    Lele, R D


    Recent guidelines by the Drug Controller General of India require extra care by Investigators & Sponsors of Clinical Trials in India. The author, an eminent member & Chairman of various Independent Ethics Committees in Mumbai, proposes various concrete solutions for adherence to these guidelines. Insurance cover to the subjects, use of Internet databanks for drug interactions, active involvement by the pharmacologists in Ethics Committee, review of data from animal studies, being amongst them. In case of death due to trial, autopsies, or at least verbal autopsies, are essential in the interest of Science and Law. More importantly Anticipation and prevention of ADEs can be done by exclusion of subjects from trials by using newer technologies like cDNA in microarrays to determine several polygenic quantitative trait loci (QTLs) and tests for Single Nucleotide Polymorphisms (SNPs). Drug manufacturers must provide prototypes of Affymetrix chips to clinicians and bear the cost in their own enlightened self-interest.

  3. [Forensic psychiatry. Its relations to clinical psychiatry and criminology]. (United States)

    Kröber, H-L


    A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.

  4. Perceived family-related stressors and clinical manifestations of ...

    African Journals Online (AJOL)

    These symptoms vary in individuals, usually multiple and affect different body parts. Studies have shown that stress relating to health, work and financial ... but association with pattern and extent of PSM has not been widely studied in Nigeria. ... disorder- patient health questionnaire somatoform, anxiety and depression ...

  5. Clinical implications of brain atrophy by computed tomography in patients with age-related dementia

    International Nuclear Information System (INIS)

    Imai, Yukimitsu; Honma, Akira; Ashida, Hiroshi; Hasegawa, Kazuo


    The purpose of the present study is to clarify the clinical significance of brain atrophy by computed tomography in age-related dementia. Eighty elderly patients with clinical diagnosis of presenile or senile dementia whose mental states were assessed clinically and by several psychometric test were studied by computed tomography. Patients with suspected cerebrovascular disorders and normal pressure hydrocephalus were excluded. Three tomographic sections through anterior and posterior horns and cella media of lateral ventricles and cortex with intracranial space of 60 - 80 cm 2 were evaluated. CSF spaces (%) were measured as an index of brain atrophy. The measurement of CSF spaces (%) was carried out by the computerized planimetric method to avoid visual definition of ventricular borders. In this study, CSF spaces comprised ventricular and subarachnoid spaces. Hasegawa's dementia scale, Bender-Gestalt test and Kohs' block design test were employed for the cognitive assessment of the subjects. In two sections through lateral ventricles, significant correlations were obtained between CSF spaces (%) and scores of Hasegawa's dementia scale and Kohs' block design test. Scores of Bender-Gestalt test did not correlate with CSF spaces (%) in these two sections. In the section through cortex, no correlation were found between CSF spaces (%) and scores of any psychometric test. Also, no positive correlations were obtained between age and CSF spaces (%) in the three sections. (author)

  6. A Study of Power Relations in Doctor-Patient Interactions in Selected Hospitals in Lagos State, Nigeria (United States)

    Adam, Qasim


    This paper explores power relations in clinical interactions in Nigeria. It seeks to investigate the use of power between doctors and patients during consultations on patient-centred approach to medicine in selected public and private hospitals in Lagos State, Nigeria. The objective is to establish how doctors' projection of power, using the…

  7. Heat-related illness in Washington State agriculture and forestry sectors. (United States)

    Spector, June T; Krenz, Jennifer; Rauser, Edmund; Bonauto, David K


    We sought to describe heat-related illness (HRI) in agriculture and forestry workers in Washington State. Demographic and clinical Washington State Fund workers' compensation agriculture and forestry HRI claims data (1995-2009) and Washington Agriculture Heat Rule citations (2009-2012) were accessed and described. Maximum daily temperature (Tmax) and Heat Index (HImax) were estimated by claim date and location using AgWeatherNet's weather station network. There were 84 Washington State Fund agriculture and forestry HRI claims and 60 Heat Rule citations during the study period. HRI claims and citations were most common in crop production and support subsectors. The mean Tmax (HImax) was 95°F (99°F) for outdoor HRI claims. Potential HRI risk factors and HRI-related injuries were documented for some claims. Agriculture and forestry HRI cases are characterized by potential work-related, environmental, and personal risk factors. Further work is needed to elucidate the relationship between heat exposure and occupational injuries. © 2014 Wiley Periodicals, Inc.

  8. Cytogenetic, clinical, and cytologic characteristics of radiotherapy-related leukemias

    International Nuclear Information System (INIS)

    Philip, P.; Pedersen-Bjergaard, J.


    From 1978 to 1985, we observed eight cases of acute nonlymphocytic leukemia or preleukemia, three cases of acute lymphoblastic leukemia, and three cases of chronic myeloid leukemia in patients previously treated exclusively with radiotherapy for other tumor types. The latent period from administration of radiotherapy to development of leukemia varied between 12 and 243 months. Clonal chromosome aberrations reported previously as characteristic of acute nonlymphocytic leukemia following therapy with alkylating agents were observed in three of the eight patients with acute nonlymphocytic leukemia (5q- and -7) and in two of the three patients with acute lymphoblastic leukemia (-7 and 12p-). All three patients with radiotherapy-related chronic myeloid leukemia presented a t(9;22)(q34;q11). The results suggest that cytogenetic characteristics may reflect the etiology in radiation-induced acute leukemias, whereas radiation-related chronic myeloid leukemia does not seem to differ chromosomally from de novo cases of the disease


    Directory of Open Access Journals (Sweden)

    Vladimir Ivanovich Vasilyev


    Full Text Available IgG4-related diseases are a new nosological entity that encompasses a few previously known diseases. IgG4-related systemic disease is diagnosed if two or more affected organs are detected. This group of diseases has two similar signs: serological (elevated serum IgG4 subclass concentrations and histological (organ and tissue infiltration from plasmo-cytes secreting IgG4, and eosinophils, and the development of fibrosclerosis and phlebitis obliterans. The paper describes two cases. In one case, a multisystemic disease was observed virtually at its onset whereas in the other this lesion was diagnosed several years after the natural course of the disease.

  10. Reporting and evaluation of HIV-related clinical endpoints in two multicenter international clinical trials

    DEFF Research Database (Denmark)

    Lifson, A; Rhame, F; Bellosa, W


    adjudication between reviewers before diagnostic certainty was assigned. CONCLUSION: Important requirements for HIV trials using clinical endpoints include objective definitions of "confirmed" and "probable," a formal reporting process with adequate information and supporting source documentation, evaluation......PURPOSE: The processes for reporting and review of progression of HIV disease clinical endpoints are described for two large phase III international clinical trials. METHOD: SILCAAT and ESPRIT are multicenter randomized HIV trials evaluating the impact of interleukin-2 on disease progression...... and death in HIV-infected patients receiving antiretroviral therapy. We report definitions used for HIV progression of disease endpoints, procedures for site reporting of such events, processes for independent review of reported events by an Endpoint Review Committee (ERC), and the procedure...

  11. Constantine and Christianity: The formation of church/state relations ...

    African Journals Online (AJOL)

    This paper discusses the effects of the events and legislation of that period on both church and state. It will attempt to explain how as a result of Constantine's policies, the Christian Church and the Roman State each gained control of, and influence over the other. This in turn resulted in a mutual dependency which allowed ...

  12. Global ship accidents and ocean swell-related sea states (United States)

    Zhang, Zhiwei; Li, Xiao-Ming


    With the increased frequency of shipping activities, navigation safety has become a major concern, especially when economic losses, human casualties and environmental issues are considered. As a contributing factor, the sea state plays a significant role in shipping safety. However, the types of dangerous sea states that trigger serious shipping accidents are not well understood. To address this issue, we analyzed the sea state characteristics during ship accidents that occurred in poor weather or heavy seas based on a 10-year ship accident dataset. Sea state parameters of a numerical wave model, i.e., significant wave height, mean wave period and mean wave direction, were analyzed for the selected ship accident cases. The results indicated that complex sea states with the co-occurrence of wind sea and swell conditions represent threats to sailing vessels, especially when these conditions include similar wave periods and oblique wave directions.

  13. Global ship accidents and ocean swell-related sea states

    Directory of Open Access Journals (Sweden)

    Z. Zhang


    Full Text Available With the increased frequency of shipping activities, navigation safety has become a major concern, especially when economic losses, human casualties and environmental issues are considered. As a contributing factor, the sea state plays a significant role in shipping safety. However, the types of dangerous sea states that trigger serious shipping accidents are not well understood. To address this issue, we analyzed the sea state characteristics during ship accidents that occurred in poor weather or heavy seas based on a 10-year ship accident dataset. Sea state parameters of a numerical wave model, i.e., significant wave height, mean wave period and mean wave direction, were analyzed for the selected ship accident cases. The results indicated that complex sea states with the co-occurrence of wind sea and swell conditions represent threats to sailing vessels, especially when these conditions include similar wave periods and oblique wave directions.

  14. CDKL5-Related Disorders: From Clinical Description to Molecular Genetics. (United States)

    Bahi-Buisson, N; Bienvenu, T


    Mutations in the cyclin-dependent kinase-like 5 gene (CDKL5) have been described in girls with Rett-like features and early-onset epileptic encephalopathy including infantile spasms. To date, with more than 80 reported cases, the phenotype of CDKL5-related encephalopathy is better defined. The main features consist of early-onset seizures starting before 5 months of age, severe mental retardation with absent speech and Rett-like features such as hand stereotypies and deceleration of head growth. On the other hand, neuro-vegetative signs and developmental regression are rare in CDKL5 mutation patients. The CDKL5 gene encodes a serine threonine kinase protein which is characterized by a catalytic domain and a long C-terminal extension involved in the regulation of the catalytic activity of CDKL5 and in the sub-nuclear localization of the protein. To our knowledge, more than 70 different point mutations have been described including missense mutations within the catalytic domain, nonsense mutations causing the premature termination of the protein distributed in the entire open reading frame, splice variants, and frameshift mutations. Additionally, CDKL5 mutations have recently been described in 7 males with a more severe epileptic encephalopathy and a worse outcome compared to female patients. Finally, about 23 male and female patients have been identified with gross rearrangements encompassing all or part of the CDKL5 gene, with a phenotype reminiscent of CDKL5-related encephalopathy combined with dysmorphic features. Even if recent data clearly indicate that CDKL5 plays an important role in brain function, the protein remains largely uncharacterized. Phenotype-genotype correlation is additionally hampered by the relatively small number of patients described.

  15. State-Level Estimates of Cancer-Related Absenteeism Costs (United States)

    Tangka, Florence K.; Trogdon, Justin G.; Nwaise, Isaac; Ekwueme, Donatus U.; Guy, Gery P.; Orenstein, Diane


    Background Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. Methods In analyses of data from the 2004–2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. Results We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. Conclusions The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population. PMID:23969498

  16. Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts

    NARCIS (Netherlands)

    Zaal, R.J.; Jansen, M.; Duisenberg-van Essenberg, M.; C.C., Tijssen; Roukema, J.A.; van den Bemt, P.M.


    Background Both clinical pharmacists and computerized physician order entry systems with clinical decision support (CPOE/CDSS) can reduce drug-related problems (DRPs). However, the contribution of a clinical pharmacist in addition to CPOE/CDSS has not been established in a prospective study.

  17. Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts

    NARCIS (Netherlands)

    R.J. Zaal (Rianne); M.M.P.M. Jansen (Mark M. P.); M. Duisenberg-Van Essenberg (Marjolijn); C.C. Tijssen (Cees); J.A. Roukema; P.M.L.A. van den Bemt (Patricia)


    textabstractBackground Both clinical pharmacists and computerized physician order entry systems with clinical decision support (CPOE/CDSS) can reduce drug-related problems (DRPs). However, the contribution of a clinical pharmacist in addition to CPOE/CDSS has not been established in a prospective

  18. A Relation Between Topological Quantum Field Theory and the Kodama State


    Oda, Ichiro


    We study a relation between topological quantum field theory and the Kodama (Chern-Simons) state. It is shown that the Kodama (Chern-Simons) state describes a topological state with unbroken diffeomorphism invariance in Yang-Mills theory and Einstein's general relativity in four dimensions. We give a clear explanation of "why" such a topological state exists.

  19. Review of clinical practice guidelines for the management of LDL-related risk. (United States)

    Morris, Pamela B; Ballantyne, Christie M; Birtcher, Kim K; Dunn, Steven P; Urbina, Elaine M


    Managing risk related to low-density lipoprotein (LDL) is vital in therapy for patients at risk for atherosclerotic cardiovascular disease (ASCVD) events given its important etiologic role in atherogenesis. Despite decades of research showing reduction of ASCVD risk with multiple approaches to lowering of LDL cholesterol, there continue to be significant gaps in care with inadequate numbers of patients receiving standard of care lipid-lowering therapy. Confusion regarding implementation of the multiple published clinical practice guidelines has been identified as one contributor to suboptimal management of LDL-related risk. This review summarizes the current guidelines for reduction of LDL-related cardiovascular risk provided by a number of major professional societies, which have broad applicability to diverse populations worldwide. Statements have varied in the process and methodology of development of recommendations, the grading system for level and strength of evidence, the inclusion or exclusion of expert opinion, the suggested ASCVD risk assessment tool, the lipoproteins recommended for risk assessment, and the lipoprotein targets of therapy. The similarities and differences among important guidelines in the United States and internationally are discussed, with recommendations for future strategies to improve consistency in approaches to LDL-related ASCVD risk and to reduce gaps in implementation of evidence-based therapies. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Related Rules and Programs that Help States Attain PM Standards (United States)

    EPA’s national and regional rules to reduce emissions of pollutants that form particle pollution will help state and local governments meet the PM NAAQS. A number of voluntary programs also are helping areas reduce fine PM pollution.

  1. 29 CFR 1403.5 - Relations with State and local mediation agencies. (United States)


    ... 29 Labor 4 2010-07-01 2010-07-01 false Relations with State and local mediation agencies. 1403.5 Section 1403.5 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE FUNCTIONS AND DUTIES § 1403.5 Relations with State and local mediation agencies. (a) If under State or local...

  2. State of the Art of International Public Relations Education. (United States)

    Wakefield, Gay; And Others

    To examine aspects of the political/economic/social/cultural environments (PESCE) affecting international public relations and their significance to the future of public relations practitioners, this paper reviews the 1980s literature regarding the current and projected trends in international public relations practice and their implications for…

  3. Health Related Quality of Life in Children with Autism Spectrum Disorders: The Clinical and Demographic Related Factors in Turkey (United States)

    Kose, Sezen; Erermis, Serpil; Ozturk, Onder; Ozbaran, Burcu; Demiral, Nagehan; Bildik, Tezan; Aydin, Cahide


    We aimed to investigate the Health Related Quality of Life and related clinical variables (HRQoL) of children with Autism Spectrum Disorders (ASD). We included 102 children with ASD (46 with autism, 38 with pervasive developmental disorder not otherwise specified (PDD-NOS) and 18 with Asperger's syndrome (AS)) and 39 typically developing children…

  4. Filtering overpopulated isoscalar tensor states with mass relations

    International Nuclear Information System (INIS)

    Burakovsky, Leonid; Page, Philip R.


    Schwinger-type mass formulas are used to analyze glueball-meson mixing for isoscalar tensor mesons. In one solution, the f J (2220) is the physical glueball, and in the other the glueball is distributed over various states, with f 2 (1810) having the largest glueball component. Neither the f 2 (1565) nor the f J (1710) are among the physical states without assuming significant coupling to decay channels. The decay f 2 (1525)→ππ is consistent with experiment, and f J (2220) is neither narrow nor decays flavor democratically. (c) 2000 The American Physical Society

  5. Clinical review: Current state and future perspectives in the diagnosis of diabetes insipidus: a clinical review. (United States)

    Fenske, Wiebke; Allolio, Bruno


    The differential diagnosis of diabetes insipidus (DI) is often challenging but essential, because treatment may vary substantially. This article analyzes the database and performance of currently used differential diagnostic tests for DI and discusses future perspectives for diagnostic improvement. A review of electronic and print data comprising original and review articles retrieved from the PubMed or Cochrane Library database up to January 2012 was conducted. The search term "polyuria polydipsia syndrome" was cross-referenced with underlying forms of disease and associated clinical, diagnostic, and therapeutic MeSH terms. In addition, references from review articles and textbook chapters were screened for papers containing original data. Search results were narrowed to articles containing primary data with a description of criteria for the differential diagnosis of DI. Fifteen articles on differential diagnosis of DI were identified, mainly consisting of small series of patients, and mostly covering only part of the differential diagnostic spectrum of DI. Test protocols differed, and prospective validation of diagnostic criteria was consistently missing. Inconsistent data were reported on the diagnostic superiority of direct plasma arginine vasopressin determination over the indirect water deprivation test. Both test methods revealed limitations, especially in the differentiation of disorders with a milder phenotype. The available data demonstrate limitations of current biochemical tests for the differential diagnosis of DI, potentially leading to incorrect diagnosis and treatment. The newly available assay for copeptin, the C terminus of the vasopressin precursor, holds promise for a higher diagnostic specificity and simplification of the differential diagnostic protocol in DI.

  6. Israel: Background and Relations with the United States

    National Research Council Canada - National Science Library

    Migdalovitz, Carol


    ... its neighbors. Armed conflict has marked every decade of Israel's existence. Despite its unstable regional environment, Israel has developed a vibrant parliamentary democracy, albeit with relatively fragile governments...

  7. Israel: Background and Relations with the United States

    National Research Council Canada - National Science Library

    Migdalovitz, Carol


    ... its neighbors. Armed conflict has marked every decade of Israel's existence. Despite its unstable regional environment, Israel has developed a vibrant parliamentary democracy, albeit with relatively fragile governments...

  8. Israel: Background and Relations with the United States

    National Research Council Canada - National Science Library

    Migdalovitz, Carol


    ... its neighbors. Armed conflict has marked every decade of Israel's existence. Despite its unstable regional environment, Israel has developed a vibrant parliamentary democracy, albeit with relatively fragile governments...

  9. 24 CFR 3500.13 - Relation to State laws. (United States)


    .... (1) The Secretary may not determine that a State law or regulation is inconsistent with any provision... affiliated business arrangements are inconsistent with RESPA or this part, the Secretary may not construe... that are inconsistent with RESPA or this part are preempted to the extent of the inconsistency. However...

  10. Incidence of ricket clinical symptoms and relation between clinical and laboratory findings in infants

    Directory of Open Access Journals (Sweden)

    Čukalović M.


    Full Text Available Rickets presents osteomalacia which is developed due to negative balance of calcium and / or phosphorus during growth and development. Therefore it appears only in children. The most common reason of insufficient mineralization is deficiency of vitamin D, which is necessary for inclusion of calcium in cartilage and bones. As result, proliferation of cartilage and bone tissue appears, creating calluses on typical places. Bones become soft and curve, resulting in deformities. Our present study included 86 infants, in whom, besides other diseases, clinical and laboratory signs of rickets were identified. In our study, rickets is most common (82.5% in infants older than 6 months. By clinical picture, craniotabes is present in 46.5% of cases, Harisson groove in 26.7%, rachitic bracelets in 17.4%, rachitic rosary in 17.4% and carpopedal spasms in 2.3% of cases. Leading biochemical signs of vitamin D deficient rickets is hypophosphatemia (in 87.3% of cases, normal calcemia (in 75.6% of cases and increased values of alkaline phosphatase (in 93% of cases. It has been shown that rickets in infant age may later affect higher incidence of juvenile diabetes, infection of lower respiratory tract, osteoporosis, and so on.

  11. Evaluating sub-clinical cognitive dysfunction and event-related potentials (P300) in clinically isolated syndrome. (United States)

    Kocer, Belgin; Unal, Tugba; Nazliel, Bijen; Biyikli, Zeynep; Yesilbudak, Zulal; Karakas, Sirel; Irkec, Ceyla


    This study investigated the presence of sub-clinical cognitive dysfunction in patients with clinically isolated syndrome (CIS) and the abnormalities of cognitive event-related potentials (ERPs). Subclinical cognitive dysfunction was assessed in 20 patients with CIS and in 20 healthy controls. Patients had impairments in verbal learning and long-term memory, evaluating attention, executive function and visuospatial skills, in decreasing order of frequency. SDLT and SIT were the most, and COWAT and BNT were the least affected tests. The N200 and P200 latencies were prolonged, and N100, N200 and P200 amplitudes were reduced in the patients relative to the controls, from the Fz, Cz and Pz electrode positions (p<0.05). Detailed cognitive testing is valuable in determining subclinical cognitive dysfunction in CIS patients. ERP abnormalities as well as abnormalities in detailed cognitivetesting in patients with CIS are helpful in the diagnosis of sub-clinical cognitive dysfunction.

  12. Present and Future of the United States-Bolivia Relations (United States)


    Bolivariana para las Americas (Spanish for Bolivarian Alternative for the Americas) ALC Acuerdo de Libre Comercio (Spanish for Free Trade Agreement) ATPA...Challenge Account) DEA Drug Enforcement Agency FELCN Fuerza Especial de Lucha Contra el Narcotráfico (Spanish for Special Force to Combat Drug...Organizacion de Estados Americanos (Spanish for Organization of American States) PNUD United Nations Program for Development) TCP Tratado de Comercio de

  13. Israel: Background and Relations with the United States (United States)


    provided a grant of 15% of an investment of up to $3.5 billion or $525 million to secure the deal. In May 2006, prominent U.S. investor Warren Buffet ...emergence of a geographically contiguous Palestinian state. On April 14, 2004, however, President Bush noted the need to take into account changed...between military needs and taking into account humanitarian considerations needs to be found.”114 P.L. 111-117, the Consolidated Appropriations Act

  14. Third International Workshop on Squeezed States and Uncertainty Relations (United States)

    Han, D. (Editor); Kim, Y. S. (Editor); Rubin, Morton H. (Editor); Shih, Yan-Hua (Editor); Zachary, Woodford W. (Editor)


    The purpose of these workshops is to bring together an international selection of scientists to discuss the latest developments in Squeezed States in various branches of physics, and in the understanding of the foundations of quantum mechanics. At the third workshop, special attention was given to the influence that quantum optics is having on our understanding of quantum measurement theory. The fourth meeting in this series will be held in the People's Republic of China.

  15. Clinical Engeneering Experience at the Hospital of the State University of Londrina


    Ernesto Fernando Ferreyra Ramírez


    This paper describes the four-year experience of implementation of Clinical Engineering services at the Hospital of the State University of Londrina (HURNP/UEL). It was performed by the Electrical Engineering Department (DEEL), through a project involving lecturers and students from the Electrical and Civil Engineering Courses of the same university. The main objectives were the formation of human resources in the Clinical Engineering area and a positive contribution to the healthcare service...

  16. Clinical and evoked pain, personality traits, and emotional states: can familial confounding explain the associations? (United States)

    Strachan, Eric; Poeschla, Brian; Dansie, Elizabeth; Succop, Annemarie; Chopko, Laura; Afari, Niloofar


    Pain is a complex phenomenon influenced by context and person-specific factors. Affective dimensions of pain involve both enduring personality traits and fleeting emotional states. We examined how personality traits and emotional states are linked with clinical and evoked pain in a twin sample. 99 female twin pairs were evaluated for clinical and evoked pain using the McGill Pain Questionnaire (MPQ) and dolorimetry, and completed the 120-item International Personality Item Pool (IPIP), the Positive and Negative Affect Scale (PANAS), and ratings of stress and mood. Using a co-twin control design we examined a) the relationship of personality traits and emotional states with clinical and evoked pain and b) whether genetics and common environment (i.e. familial factors) may account for the associations. Neuroticism was associated with the sensory component of the MPQ; this relationship was not confounded by familial factors. None of the emotional state measures was associated with the MPQ. PANAS negative affect was associated with lower evoked pressure pain threshold and tolerance; these associations were confounded by familial factors. There were no associations between IPIP traits and evoked pain. A relationship exists between neuroticism and clinical pain that is not confounded by familial factors. There is no similar relationship between negative emotional states and clinical pain. In contrast, the relationship between negative emotional states and evoked pain is strong while the relationship with enduring personality traits is weak. The relationship between negative emotional states and evoked pain appears to be non-causal and due to familial factors. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Clinical Engeneering Experience at the Hospital of the State University of Londrina

    Directory of Open Access Journals (Sweden)

    Ernesto Fernando Ferreyra Ramírez


    Full Text Available This paper describes the four-year experience of implementation of Clinical Engineering services at the Hospital of the State University of Londrina (HURNP/UEL. It was performed by the Electrical Engineering Department (DEEL, through a project involving lecturers and students from the Electrical and Civil Engineering Courses of the same university. The main objectives were the formation of human resources in the Clinical Engineering area and a positive contribution to the healthcare services offered by the HURNP for the community in the surroundings of Londrina – Paraná State – Brazil.

  18. Systematization of clinical trials related to treatment of metabolic syndrome, 1980-2015. (United States)

    Cardona Velásquez, Santiago; Guzmán Vivares, Laura; Cardona-Arias, Jaiberth Antonio


    Despite the clinical, epidemiological, and economic significance of metabolic syndrome, the profile of clinical trials on this disease is unknown. To characterize the clinical trials related to treatment of metabolic syndrome during the 1980-2015 period. Systematic review of the literature using an ex ante search protocol which followed the phases of the guide Preferred Reporting Items for Systematic Reviews and Meta-Analyses in four multidisciplinary databases with seven search strategies. Reproducibility and methodological quality of the studies were assessed. One hundred and six trials were included, most from the United States, Italy, and Spain, of which 63.2% evaluated interventions effective for several components of the syndrome such as diet (40.6%) or physical activity (22.6%). Other studies assessed drugs for a single factor such as hypertension (7.5%), hypertriglyceridemia (11.3%), or hyperglycemia (9.4%). Placebo was used as control in 54.7% of trials, and outcome measures included triglycerides (52.8%), HDL (48.1%), glucose (29.2%), BMI (33.0%), blood pressure (27.4%), waist circumference (26.4%), glycated hemoglobin (11.3%), and hip circumference (7.5%). It was shown that studies ob efficacy of treatment for metabolic syndrome are scarce and have mainly been conducted in the last five years and in high-income countries. Trials on interventions that affect three or more factors and assess several outcome measures are few, and lifestyle interventions (diet and physical activity) are highlighted as most important to impact on this multifactorial syndrome. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. State and local policies related to sexual orientation in the United States. (United States)

    Cramer, Ryan; Hexem, Sarah; LaPollo, Archana; Cuffe, Kendra M; Chesson, Harrell W; Leichliter, Jami S


    Poorer health suffered by lesbian, gay, and bisexual (LGB) populations may be associated with public policies. We collected the laws that in 2013 prohibited discrimination based on sexual orientation from 50 United States (US) states, the District of Columbia (Washington, DC or DC), and the 30 most populous US metropolitan areas. To facilitate future research, we coded certain aspects of these laws to create a dataset. We generated descriptive statistics by jurisdiction type and tested for regional differences in state law using Chi-square tests. Sixteen (31.4 per cent) states prohibited discrimination by all employers based on sexual orientation, 25 states (49.0 per cent) in public employment, 18 states (35.3 per cent) in government contracting, and 21 states (41.2 per cent) in private employment. Twenty-one states prohibited discrimination (41.2 per cent) in housing practices (selling and renting), and 17 (33.3 per cent) in public accommodations. Local (county/city) laws prohibiting discrimination were less common. State laws differed significantly by US census region - West, Midwest, Northeast, and South. Future analyses of these data could examine the impact of these laws on various outcomes, including health among LGB populations.

  20. Constructive interference in steady-state/FIESTA-C clinical applications in neuroimaging

    International Nuclear Information System (INIS)

    Kulkami, Makarand


    Full text: High spatial resolution is one of the major problems in neuroimaging, par ticularly in cranial and spinal nerve imaging. Constructive interference in steady-state/fast imaging employing steady-state acquisition with phase cycling is a robust sequence in imaging the cranial and spinal nerve patholo gies. This pictorial review is a concise article about the applications of this sequence in neuroimaging with clinical examples.

  1. Coherent states and related quantizations for unbounded motions

    International Nuclear Information System (INIS)

    Bagrov, V G; Gazeau, J-P; Gitman, D M; Levin, A D


    We discuss the construction of coherent states (CS) for systems with continuous spectra. First, we propose to adopt the Malkin–Manko approach, developed for systems with discrete spectra, to the case under consideration. Following this approach, we consider two examples, a free particle and a particle in a linear potential. Second, we generalize the approach of action-angle CS to systems with continuous spectra. In the first approach we start with a well-defined quantum formulation (canonical quantization) of a physical system and the construction of CS follows from such a quantization. In the second approach, the quantization procedure is inherent to the CS construction itself. (paper)

  2. Mass Taxation and State-Society Relations in East Africa


    Fjeldstad, Odd-Helge; Therkildsen, Ole


    Poll (‘head'''') tax has been the most common form of direct mass taxation in many sub-Saharan African countries since colonial times. Until very recently it was a dominant source of revenue for local governments. It has been a source of tension and conflict between state authorities and rural people from the colonial period until today, and a major catalyst for many rural rebellions. By tracing the history of poll taxes in Tanzania and Uganda, the chapter examines how these taxes have impact...

  3. Tornado-related fatalities--five states, Southeastern United States, April 25-28, 2011. (United States)


    During April 25-28, 2011, a massive storm system generated 351 tornadoes (including 15 registering 4 or 5 on the Enhanced Fujita [EF] scale*), killing 338 persons in Alabama, Arkansas, Georgia, Mississippi, and Tennessee. This was the third-deadliest tornado event in the United States, surpassing an April 1974 event that resulted in 315 fatalities. This event also was historic because of the record number of fatalities that occurred despite modern advances in tornado forecasting, advanced warning times, and media coverage. Risk factors for death and injury from tornadoes are sheltering in mobile homes, proximity to an EF-4 or EF-5 tornado, being an older adult (aged ≥65 years), lack of accessibility to safe rooms (e.g., basements or reinforced shelters), and a night-time tornado impact. To describe the fatalities by demographic characteristics, type of shelter used, cause of death, and tornado severity and location, CDC reviewed data from the American Red Cross (Red Cross), death certificates, and the National Weather Service (NWS). This report summarizes the results of that review. Among the 338 decedents, median age was 55.0 years (range: 4 days-97 years); approximately one third were older adults. On tornado impact, 46.7% of decedents were in single-family homes, and 26.6% were in mobile homes. The leading cause of death was traumatic injury, including 21.9% with head injuries. Half of the deadly tornadoes were rated EF-4 or EF-5 and were responsible for 89.5% of the deaths. To prevent tornado-related deaths, health messaging should encourage the public (especially older adults and residents of mobile/manufactured homes) to pre-identify an accessible safe room, prepare the room with personal protection items (e.g., blankets and helmets), and monitor local weather.

  4. [A Street Clinic in a state capital in Northeast Brazil from the perspective of homeless people]. (United States)

    Ferreira, Cíntia Priscila da Silva; Rozendo, Célia Alves; Melo, Givânya Bezerra de


    The objective of this study was to evaluate the Street Clinic strategy in Maceió, Alagoas State, Brazil, from the perspective of its users. This was a qualitative study in coverage areas of the Street Clinic in Maceió. Research subjects were 18 homeless individuals assisted by the clinic (10 men and 8 women), ranging from 20 to 40 years of age. Data were collected from September 2014 to February 2015 using a semi-structured interview. Content analysis was applied to the data and identified two categories: the first, the Street Clinic as such, revealed the strategy's critical points, challenges, and potentialities; the second showed the Street Clinic as social support, affect, and hope for change for the homeless. The strategy was rated positively by users, providing social support on health problems and other daily issues.

  5. Health-related quality of life in patients with dual diagnosis: clinical correlates

    Directory of Open Access Journals (Sweden)

    Benaiges Irina


    Full Text Available Abstract Background Although the studies published so far have found an affectation in the Health Related Quality of Life (HRQOL in both psychiatric and substance use dependence disorders, very few studies have applied HRQOL as an assessment measure in patients suffering both comorbid conditions, or Dual Diagnosis. The aim of the current study was to assess HRQOL in a group of patients with Dual Diagnosis compared to two other non-comorbid groups and to determine what clinical factors are related to HRQOL. Methods Cross-sectional assessment of three experimental groups was made through the Short Form – 36 Item Health Survey (SF-36. The sample consisted of a group with Dual Diagnosis (DD; N = 35, one with Severe Mental Illness alone (SMI; N = 35 and another one with Substance Use Dependence alone (SUD; N = 35. The sample was composed only by males. To assess the clinical correlates of SF-36 HRQOL, lineal regression analyses were carried out. Results The DD group showed lower scores in most of the subscales, and in the mental health domain. The group with SUD showed in general a better state in the HRQOL while the group with SMI held an intermediate position with respect to the other two groups. Daily medication, suicidal attempts and daily number of coffees were significantly associated to HRQOL, especially in the DD group. Conclusions The DD group showed lower self-reported mental health quality of life. Assessment of HRQOL in dual patients allows to identify specific needs in this population, and may help to establish therapeutic goals to improve interventions.

  6. CNTRO: A Semantic Web Ontology for Temporal Relation Inferencing in Clinical Narratives. (United States)

    Tao, Cui; Wei, Wei-Qi; Solbrig, Harold R; Savova, Guergana; Chute, Christopher G


    Using Semantic-Web specifications to represent temporal information in clinical narratives is an important step for temporal reasoning and answering time-oriented queries. Existing temporal models are either not compatible with the powerful reasoning tools developed for the Semantic Web, or designed only for structured clinical data and therefore are not ready to be applied on natural-language-based clinical narrative reports directly. We have developed a Semantic-Web ontology which is called Clinical Narrative Temporal Relation ontology. Using this ontology, temporal information in clinical narratives can be represented as RDF (Resource Description Framework) triples. More temporal information and relations can then be inferred by Semantic-Web based reasoning tools. Experimental results show that this ontology can represent temporal information in real clinical narratives successfully.

  7. Development of a taxonomy of practice-related stressors experienced by veterinarians in the United States (United States)

    Vande Griek, Olivia H.; Clark, Malissa A.; Witte, Tracy K.; Nett, Randall J.; Moeller, Amanda N.; Stabler, Margaret E.


    OBJECTIVE To develop a comprehensive taxonomy of practice-related stressors experienced by US veterinarians. DESIGN Cross-sectional survey. SAMPLE A subset of 1,422 US veterinarians who provided written (vs selected) responses to a question in a previous survey regarding practice-related stressors. PROCEDURES Using grounded theory analysis, 3 researchers inductively analyzed written survey responses concerning respondents’ main practice-related stressors. In 5 iterations, responses were individually coded and categorized, and a final list of practice-related stressor categories and subcategories was iteratively and collaboratively developed until theoretical and analytic saturation of the data was achieved. RESULTS A taxonomy of 15 categories of broad practice-related stressors and 40 subcategories of more specific practice-related stressors was developed. The most common practice-related stressor categories included financial insecurity (n = 289 [20.3%]), client issues (254 [17.9%]), coworker or interpersonal issues (181 [12.7%]), and work-life balance (166 [11.7%]). The most common subcategories were clients unwilling to pay (118 [8.3%]), low income (98 [6.9%]), cost of maintaining practice (56 [3.9%]), and government or state board policies (48 [3.4%]). CONCLUSIONS AND CLINICAL RELEVANCE This study provided a comprehensive list of the types of practice-related stressors experienced by US veterinarians, building a foundation for future research into relationships between job stress and mental health in this population. Frequency data on the various stressors provided an initial understanding of factors that might be contributing to high stress rates among US veterinarians. PMID:29319445

  8. Development of a taxonomy of practice-related stressors experienced by veterinarians in the United States. (United States)

    Vande Griek, Olivia H; Clark, Malissa A; Witte, Tracy K; Nett, Randall J; Moeller, Amanda N; Stabler, Margaret E


    OBJECTIVE To develop a comprehensive taxonomy of practice-related stressors experienced by US veterinarians. DESIGN Cross-sectional survey. SAMPLE A subset of 1,422 US veterinarians who provided written (vs selected) responses to a question in a previous survey regarding practice-related stressors. PROCEDURES Using grounded theory analysis, 3 researchers inductively analyzed written survey responses concerning respondents' main practice-related stressors. In 5 iterations, responses were individually coded and categorized, and a final list of practice-related stressor categories and subcategories was iteratively and collaboratively developed until theoretical and analytic saturation of the data was achieved. RESULTS A taxonomy of 15 categories of broad practice-related stressors and 40 subcategories of more specific practice-related stressors was developed. The most common practice-related stressor categories included financial insecurity (n = 289 [20.3%]), client issues (254 [17.9%]), coworker or interpersonal issues (181 [12.7%]), and work-life balance (166 [11.7%]). The most common subcategories were clients unwilling to pay (118 [8.3%]), low income (98 [6.9%]), cost of maintaining practice (56 [3.9%]), and government or state board policies (48 [3.4%]). CONCLUSIONS AND CLINICAL RELEVANCE This study provided a comprehensive list of the types of practice-related stressors experienced by US veterinarians, building a foundation for future research into relationships between job stress and mental health in this population. Frequency data on the various stressors provided an initial understanding of factors that might be contributing to high stress rates among US veterinarians.

  9. An Inventory of Crop Wild Relatives of the United States

    NARCIS (Netherlands)

    Khoury, C.K.; Greene, S.; Wiersema, J.; Maxted, N.; Jarvis, A.; Struik, P.C.


    The use of crop wild relatives (CWRs) in breeding is likely to continue to intensify as utilization techniques improve and crop adaptation to climate change becomes more pressing. Signifi cant gaps remain in the conservation of these genetic resources. As a fi rst step toward a national strategy for

  10. State space modeling of time-varying contemporaneous and lagged relations in connectivity maps. (United States)

    Molenaar, Peter C M; Beltz, Adriene M; Gates, Kathleen M; Wilson, Stephen J


    Most connectivity mapping techniques for neuroimaging data assume stationarity (i.e., network parameters are constant across time), but this assumption does not always hold true. The authors provide a description of a new approach for simultaneously detecting time-varying (or dynamic) contemporaneous and lagged relations in brain connectivity maps. Specifically, they use a novel raw data likelihood estimation technique (involving a second-order extended Kalman filter/smoother embedded in a nonlinear optimizer) to determine the variances of the random walks associated with state space model parameters and their autoregressive components. The authors illustrate their approach with simulated and blood oxygen level-dependent functional magnetic resonance imaging data from 30 daily cigarette smokers performing a verbal working memory task, focusing on seven regions of interest (ROIs). Twelve participants had dynamic directed functional connectivity maps: Eleven had one or more time-varying contemporaneous ROI state loadings, and one had a time-varying autoregressive parameter. Compared to smokers without dynamic maps, smokers with dynamic maps performed the task with greater accuracy. Thus, accurate detection of dynamic brain processes is meaningfully related to behavior in a clinical sample. Published by Elsevier Inc.

  11. Geochemical surveys in the United States in relation to health

    Energy Technology Data Exchange (ETDEWEB)

    Tourtelot, H A


    Geochemical surveys in relation to health may be classified as having one, two or three dimensions. One-dimensional surveys examine relations between concentrations of elements such as Pb in soils and other media and burdens of the same elements in humans, at a given time. The spatial distributions of element concentrations are not investigated. The primary objective of two-dimensional surveys is to map the distributions of element concentrations, commonly according to stratified random sampling designs based on either conceptual landscape units or artificial sampling strata, but systematic sampling intervals have also been used. Political units have defined sample areas that coincide with the units used to accumulate epidemiological data. Element concentrations affected by point sources have also been mapped. Background values, location of natural or technological anomalies and the geographic scale of variation for several elements often are determined. Three-dimensional surveys result when two-dimensional surveys are repeated to detect environmental changes.

  12. Psychometric Properties of the Penn State Worry Questionnaire for Children in a Large Clinical Sample (United States)

    Pestle, Sarah L.; Chorpita, Bruce F.; Schiffman, Jason


    The Penn State Worry Questionnaire for Children (PSWQ-C; Chorpita, Tracey, Brown, Collica, & Barlow, 1997) is a 14-item self-report measure of worry in children and adolescents. Although the PSWQ-C has demonstrated favorable psychometric properties in small clinical and large community samples, this study represents the first psychometric…

  13. Increased levels of circulating CD34+ cells in neovascular age-related macular degeneration: relation with clinical and OCT features. (United States)

    Kara, Caner; Özdal, Pınar Ç; Beyazyıldız, Emrullah; Özcan, Nurgül E; Teke, Mehmet Y; Vural, Gülden; Öztürk, Faruk


    To investigate the levels of circulating CD34+ stem cells in patients with neovascular type age-related macular degeneration (AMD) and its relation with clinical and optical coherence tomography (OCT) findings. The study consisted of 55 patients: 28 patients (18 male and 10 female) with neovascular type AMD as a study group and 27 patients (12 male and 15 female) scheduled for cataract surgery as a control group. The level of CD34+ stem cells was measured by flow cytometry. Demographic and clinical data were recorded. The mean ages of patients in the study and control groups were 71 ± 8 and 68 ± 6 years, respectively. There was no statistically significant difference in terms of age, sex, or systemic disease association between study and control groups. However, smoking status was significantly higher in the study group (67.9% vs 37.0%; p = 0.02). Stem cell levels were significantly higher in the study group (1.5 ± 0.9 vs 0.5 ± 0.3; p<0.001), but there was no relation between stem cell levels and clinical and OCT findings. Increased circulating CD34+ stem cell levels were observed in patients with choroidal neovascular membrane associated with AMD, but no significant relation was found between cell levels and clinical and OCT findings.

  14. Golf-related injuries treated in United States emergency departments. (United States)

    Walsh, Brittany A; Chounthirath, Thiphalak; Friedenberg, Laura; Smith, Gary A


    This study investigates unintentional non-fatal golf-related injuries in the US using a nationally representative database. This study analyzed golf-related injuries treated in US hospital emergency departments from 1990 through 2011 using the National Electronic Injury Surveillance System database. Injury rates were calculated using golf participation data. During 1990 through 2011, an estimated 663,471 (95% CI: 496,370-830,573) individuals ≥7years old were treated in US emergency departments for golf-related injuries, averaging 30,158 annually or 12.3 individuals per 10,000 golf participants. Patients 18-54years old accounted for 42.2% of injuries, but injury rates per 10,000 golf participants were highest among individuals 7-17years old (22.1) and ≥55years old (21.8) compared with 18-54years old (7.6). Patients ≥55years old had a hospital admission rate that was 5.01 (95% CI: 4.12-6.09) times higher than that of younger patients. Injured by a golf club (23.4%) or struck by a golf ball (16.0%) were the most common specified mechanisms of injury. The head/neck was the most frequently injured body region (36.2%), and sprain/strain (30.6%) was the most common type of injury. Most patients were treated and released (93.7%) and 5.9% required hospitalization. Although golf is a source of injury among all age groups, the frequency and rate of injury were higher at the two ends of the age spectrum. Given the higher injury and hospital admission rates of patients ≥55years, this age group merits the special attention of additional research and injury prevention efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Stability and related properties of vacua and ground states

    International Nuclear Information System (INIS)

    Wreszinski, Walter F.; Jaekel, Christian D.


    We consider the formal non-relativistic limit (nrl) of the :φ 4 : s+1 relativistic quantum field theory (rqft), where s is the space dimension. Following the work of R. Jackiw [R. Jackiw, in: A. Ali, P. Hoodbhoy (Eds.), Beg Memorial Volume, World Scientific, Singapore, 1991], we show that, for s = 2 and a given value of the ultraviolet cutoff κ, there are two ways to perform the nrl: (i) fixing the renormalized mass m 2 equal to the bare mass m 0 2 ; (ii) keeping the renormalized mass fixed and different from the bare mass m 0 2 . In the (infinite-volume) two-particle sector the scattering amplitude tends to zero as κ → ∞ in case (i) and, in case (ii), there is a bound state, indicating that the interaction potential is attractive. As a consequence, stability of matter fails for our boson system. We discuss why both alternatives do not reproduce the low-energy behaviour of the full rqft. The singular nature of the nrl is also nicely illustrated for s = 1 by a rigorous stability/instability result of a different nature

  16. Mixed-state bipolar I and II depression: time to remission and clinical characteristics. (United States)

    Shim, In Hee; Woo, Young Sup; Jun, Tae-Youn; Bahk, Won-Myong


    We compared the time to achieve remission and the clinical characteristics of patients with bipolar depressive mixed state and those with bipolar depressive non-mixed state. The subjects (N=131) were inpatients diagnosed between 2006 and 2012 with bipolar I or II disorder, depression and were classified into the following three groups: "pure depressive state" (PD, n=70), "sub-threshold mixed state" (SMX, n=38), and "depressive mixed state" (DMX, n=23). Diagnosis of a DMX was in accordance with Benazzi's definition: three or more manic symptoms in a depressive episode. The subjects' charts were retrospectively reviewed to ascertain the time to achieve remission from the index episode and to identify other factors, such as demographic and clinical characteristics, specific manic symptoms, and pharmacological treatment, that may have contributed to remission. The time to achieve remission was significantly longer in the DMX (p=0.022) and SMX (p=0.035) groups than in the PD group. Adjustment for covariates using a Cox proportional hazards model did not change these results. Clinically, subjects with a DMX were more likely to have manic symptoms in the index episode, especially inflated self-esteem and psychomotor agitation than those in the PD. We investigated only inpatients and therefore could not comment on outpatients. These findings showed that sub-syndromal manic symptoms in bipolar depression had different clinical characteristics and a more severe illness course, including a longer time to achieve remission, than did a pure depressive state. © 2013 Elsevier B.V. All rights reserved.

  17. A Comparative Analysis of Internal Communication and Public Relations Audits. State of the Art. (United States)

    Dozier, David M.; Hellweg, Susan A.

    A review of current literature regarding the state of the art in the conduct of internal communication and public relations audits by public relations practitioners reveals that these two related measurement activities are of considerable importance to the practice of public relations. Public relations audits are concerned with exploratory…

  18. 31 CFR 560.510 - Transactions related to the resolution of disputes between the United States or United States... (United States)


    ... Government of Iran of any goods, technology, or services, except to the extent that such exportation or... States Government and the granting of such a license by that agency would be prohibited by law; (3) Financial transactions related to the resolution of disputes at tribunals, including transactions related to...

  19. The relative contributions of social cognition and self-reflectiveness to clinical insight in enduring schizophrenia. (United States)

    Béland, Sophie; Lepage, Martin


    Poor clinical insight represents a major barrier to recovery in schizophrenia. Research suggests that higher-order social cognitive abilities such as theory of mind (TOM) and metacognition contribute to levels of clinical insight. However, few studies have examined whether social cognitive abilities other than TOM are related to clinical insight. Moreover, to date, no investigation has attempted to determine whether the contribution of metacognitive ability to clinical insight can be differentiated from the contribution of higher-order social cognition, despite their conceptual similarity. Therefore, the purpose of this study was to examine the relative contribution of different social cognitive abilities, as well as metacognition, to clinical insight in a large sample of 139 enduring schizophrenia patients, and controlling for established predictors of clinical insight. Hierarchical regression analyses were used to evaluate the portion of variance explained by 3 social cognitive abilities: emotion recognition, TOM, and affective empathy, and the metacognitive ability of self-reflectiveness. Clinical insight levels were assessed using the Schedule for the Assessment of Insight-Expanded version. Results indicated that affective empathy and self-reflectiveness are the strongest predictors of clinical insight. These results provide insights on the development of targeted interventions for improving clinical insight in this population. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Phobias of attachment-related inner states in the psychotherapy of adult survivors of childhood complex trauma. (United States)

    Liotti, Giovanni


    The clinical case described in this article illustrates the value of taking into account the dynamics of disorganized attachment in the assessment of attachment-related phobias (phobia of attachment and phobia of attachment loss) during the psychotherapy of chronically traumatized patients. These seemingly opposite phobias typically coexist in the same patient, appear as phobias of both inner states (affect phobias) and relational experiences, and are linked to dissociated representations of self-with-other. Theory and research on attachment disorganization provide a clinician-friendly conceptual framework for capturing both the intrapsychic (e.g., intrusive and nonintegrated mental states) and the relational (e.g., dramatic unsolvable dilemmas in interpersonal exchanges) aspects of the attachment-related phobias. The therapeutic strategy and the key interventions that logically follow from a case formulation based on this conceptual framework are examined. © 2013 Wiley Periodicals, Inc.

  1. Lithium monotherapy associated clinical improvement effects on amygdala-ventromedial prefrontal cortex resting state connectivity in bipolar disorder. (United States)

    Altinay, Murat; Karne, Harish; Anand, Amit


    This study, for the first time, investigated lithium monotherapy associated effects on amygdala- ventromedial prefrontal cortex (vMPFC) resting-state functional connectivity and correlation with clinical improvement in bipolar disorder (BP) METHODS: Thirty-six medication-free subjects - 24 BP (12 hypomanic BPM) and 12 depressed (BPD)) and 12 closely matched healthy controls (HC), were included. BP subjects were treated with lithium and scanned at baseline, after 2 weeks and 8 weeks. HC were scanned at same time points but were not treated. The effect of lithium was studied for the BP group as a whole using two way (group, time) ANOVA while regressing out effects of state. Next, correlation between changes in amygdala-vMPFC resting-state connectivity and clinical global impression (CGI) of severity and improvement scale scores for overall BP illness was calculated. An exploratory analysis was also conducted for the BPD and BPM subgroups separately. Group by time interaction revealed that lithium monotherapy in patients was associated with increase in amygdala-medial OFC connectivity after 8 weeks of treatment (p = 0.05 (cluster-wise corrected)) compared to repeat testing in healthy controls. Increased amygdala-vMPFC connectivity correlated with clinical improvement at week 2 and week 8 as measured with the CGI-I scale. The results pertain to open-label treatment and do not account for non-treatment related improvement effects. Only functional connectivity was measured which does not give information regarding one regions effect on the other. Lithium monotherapy in BP is associated with modulation of amygdala-vMPFC connectivity which correlates with state-independent global clinical improvement. Copyright © 2017. Published by Elsevier B.V.

  2. The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States. (United States)

    Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R


    Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

  3. What is the impact of a clinically related readmission measure on the assessment of hospital performance? (United States)

    Khouri, Roger K; Hou, Hechuan; Dhir, Apoorv; Andino, Juan J; Dupree, James M; Miller, David C; Ellimoottil, Chad


    The Hospital Readmission Reduction Program (HRRP) penalizes hospitals for high all-cause unplanned readmission rates. Many have expressed concern that hospitals serving patient populations with more comorbidities, lower incomes, and worse self-reported health status may be disproportionately penalized by readmissions that are not clinically related to the index admission. The impact of including clinically unrelated readmissions on hospital performance is largely unknown. We sought to determine if a clinically related readmission measure would significantly alter the assessment of hospital performance. We analyzed Medicare claims for beneficiaries in Michigan admitted for pneumonia and joint replacement from 2011 to 2013. We compared each hospital's 30-day readmission rate using specifications from the HRRP's all-cause unplanned readmission measure to values calculated using a clinically related readmission measure. We found that the mean 30-day readmission rates were lower when calculated using the clinically related readmission measure (joint replacement: all-cause 5.8%, clinically related 4.9%, p impact hospital performance in the HRRP.

  4. Psychological variables potentially implicated in opioid-related mortality as observed in clinical practice. (United States)

    Passik, Steven D; Lowery, Amy


    Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians' assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become "chemical copers" as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose. Wiley Periodicals, Inc.

  5. Acute pain in an emergency clinic: latency of onset and descriptor patterns related to different injuries. (United States)

    Melzack, R; Wall, P D; Ty, T C


    Features of acute pain were examined in patients at an emergency clinic. Patients who had severe, life-threatening injuries or who were agitated, drunk, or 'in shock' were excluded from the study. Of 138 patients who were alert, rational and coherent, 51 (37%) stated that they did not feel pain at the time of injury. The majority of these patients reported onset of pain within an hour of injury, although the delays were as long as 9 h or more in some patients. The predominant emotions of the patients were embarrassment at appearing careless or worry about loss of wages. None expressed any pleasure or indicated any prospect of gain as a result of the injury. The occurrence of delays in pain onset was related to the nature of the injury. Of 46 patients whose injuries were limited to skin (lacerations, cuts, abrasions, burns), 53% had a pain-free period. Of 86 patients with deep-tissue injuries (fractures, sprains, bruises, amputation of a finger, stabs and crushes), only 28% had a pain-free period. The McGill Pain Questionnaire was administered to patients who felt pain immediately after injury or after a delay, and revealed a normal distribution of sensory scores but very low affective scores compared to patients with chronic pain. The results indicate that the relationship between injury and pain is highly variable and complex.

  6. Relative state, social comparison reactions, and the behavioral constellation of deprivation. (United States)

    Novakowski, Dallas; Mishra, Sandeep


    Pepper & Nettle compellingly synthesize evidence indicating that temporal discounting is a functional, adaptive response to deprivation. In this commentary, we underscore the importance of the psychology of relative state, which is an index of relative competitive (dis)advantage. We then highlight two proximate emotional social comparison reactions linked with relative state - personal relative deprivation and envy - that may play an important role in the deprivation-discounting link.

  7. Impact of a State Law on Physician Practice in Sports-Related Concussions. (United States)

    Flaherty, Michael R; Raybould, Toby; Jamal-Allial, Aziza; Kaafarani, Haytham M A; Lee, Jarone; Gervasini, Alice; Ginsburg, Richard; Mandell, Mark; Donelan, Karen; Masiakos, Peter T


    To determine physician-reported adherence to and support of the 2010 Massachusetts youth concussion law, as well as barriers to care and clinical practice in the context of legislation. Primary care physicians (n = 272) in a large pediatric network were eligible for a cross-sectional survey in 2014. Survey questions addressed key policy and practice provisions: concussion knowledge, state regulations and training, practice patterns, referrals, patient characteristics, and barriers to care. Analyses explored relationships between practice and policy, adjusting for physician demographic and practice characteristics. The survey response rate was 64% among all responders (173 of 272). A total of 146 respondents who had evaluated, treated, or referred patients with a suspected sports-related concussion in the previous year were eligible for analysis. The vast majority (90%) of providers agreed that the current Massachusetts laws regarding sports concussions are necessary and support the major provisions. Three-quarters (74%) had taken a required clinician training course on concussions. Those who took training courses were significantly more likely to develop individualized treatment plans (OR, 3.6; 95% CI, 1.1-11.0). Physician training did not improve screening of youth with concussion for depression or substance use. Most physicians (77%) advised patients to refrain from computer, telephone, or television for various time periods. Physicians reported limited communication with schools. Primary care physicians report being comfortable with the diagnosis and management of concussions, and support statewide regulations; however, adherence to mandated training and specific legal requirements varied. Broader and more frequent training may be necessary to align current best evidence with clinical care and state-mandated practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. [Nostalgia as a state of mind and as a clinical form]. (United States)

    Borgna, E


    Psychiatry, as human science, necessarily concerns emotions too and, among these, nostalgia. Nostalgia is not only a mind condition but also a psychopathological and clinical state which can be defined nostalgic depression form. At the beginning of this work, on the base of a clinical case-report, we describe the phenomenological and space-temporal aspects of nostalgia, we analyse some psychopathological situations that, marked by nostalgic emotions, come from moving house, exile and rooting out. Each of these situations go with depression models thematically different, that are explained in the work.

  9. Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison. (United States)

    Andraka-Christou, Barbara; Rager, Joshua B; Brown-Podgorski, Brittany; Silverman, Ross D; Watson, Dennis P


    In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature. We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy. In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions. This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision

  10. The relation between the (N) and (N-1) electrons atomic ground state

    International Nuclear Information System (INIS)

    Briet, P.


    The relation between the ground state of an N and (N-1) electrons atomic system are studied. We show that in some directions of the configuration space, the ratio of the N electrons atomic ground state to the one particle density is asymptotically equivalent to the (N-1) electrons atomic ground state

  11. Cerebral amyloid angiopathy-related inflammation: imaging findings and clinical outcome

    International Nuclear Information System (INIS)

    Martucci, Matia; Sarria, Silvana; Coscojuela, Pilar; Vert, Carla; Siurana, Sahyly; Auger, Cristina; Rovira, Alex; Toledo, Manuel


    We aim to investigate the clinical onset, computed tomography (CT) and magnetic resonance (MR) imaging findings, and follow-up of patients with cerebral amyloid angiopathy (CAA)-related inflammation, an uncommon but clinically striking presentation of CAA. We retrospectively reviewed the clinical manifestations, CT/MR imaging findings, and outcome of ten consecutive patients with CAA-related inflammation. In each patient, a brain CT study was performed at hospital admission, and brain MR imaging was carried out 2 to 4 days later. Clinical and radiologic follow-up findings were evaluated in all patients. The most common clinical onset was rapidly progressive cognitive decline, followed by focal neurological signs. Brain CT/MR showed unenhanced expansive subcortical lesions, corresponding to areas of vasogenic edema, associated with chronic lobar, cortical, or cortical-subcortical micro/macrohemorrhages. Clinical symptoms recovered in a few weeks under treatment in eight patients and spontaneously in the remaining two. MRI follow-up at 2 to 12 months after treatment showed resolution of the lesions. Three patients experienced symptomatic disease recurrence, with new lesions on CT/MR. In the absence of histological data, early recognition of the clinical symptoms and typical radiologic features of CAA-related inflammation is essential to enable timely establishment of proper treatment. (orig.)

  12. Cerebral amyloid angiopathy-related inflammation: imaging findings and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Martucci, Matia [Vall d' Hebron University Hospital, Neuroradiology Unit, Radiology Department (IDI), Barcelona (Spain); Catholic University of Sacred Heart, ' ' A. Gemelli' ' University Hospital, Department of Radiological Sciences, Rome (Italy); Sarria, Silvana; Coscojuela, Pilar; Vert, Carla; Siurana, Sahyly; Auger, Cristina; Rovira, Alex [Vall d' Hebron University Hospital, Neuroradiology Unit, Radiology Department (IDI), Barcelona (Spain); Toledo, Manuel [Vall d' Hebron University Hospital, Epilepsy Unit, Neurology Department, Barcelona (Spain)


    We aim to investigate the clinical onset, computed tomography (CT) and magnetic resonance (MR) imaging findings, and follow-up of patients with cerebral amyloid angiopathy (CAA)-related inflammation, an uncommon but clinically striking presentation of CAA. We retrospectively reviewed the clinical manifestations, CT/MR imaging findings, and outcome of ten consecutive patients with CAA-related inflammation. In each patient, a brain CT study was performed at hospital admission, and brain MR imaging was carried out 2 to 4 days later. Clinical and radiologic follow-up findings were evaluated in all patients. The most common clinical onset was rapidly progressive cognitive decline, followed by focal neurological signs. Brain CT/MR showed unenhanced expansive subcortical lesions, corresponding to areas of vasogenic edema, associated with chronic lobar, cortical, or cortical-subcortical micro/macrohemorrhages. Clinical symptoms recovered in a few weeks under treatment in eight patients and spontaneously in the remaining two. MRI follow-up at 2 to 12 months after treatment showed resolution of the lesions. Three patients experienced symptomatic disease recurrence, with new lesions on CT/MR. In the absence of histological data, early recognition of the clinical symptoms and typical radiologic features of CAA-related inflammation is essential to enable timely establishment of proper treatment. (orig.)

  13. State and Community Responses to Drug-related Violence in Mexico

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

    Extrants. Études. State and community responses to drug-related violence in Mexico. Rapports. Respuestas estatales y comunitarias a la violencia asociada al narcotráfico en México : informe técnico. Rapports. State and community responses to drug-related violence in Mexico ...

  14. Surveillance for travel-related disease--GeoSentinel Surveillance System, United States, 1997-2011. (United States)

    Harvey, Kira; Esposito, Douglas H; Han, Pauline; Kozarsky, Phyllis; Freedman, David O; Plier, D Adam; Sotir, Mark J


    In 2012, the number of international tourist arrivals worldwide was projected to reach a new high of 1 billion arrivals, a 48% increase from 674 million arrivals in 2000. International travel also is increasing among U.S. residents. In 2009, U.S. residents made approximately 61 million trips outside the country, a 5% increase from 1999. Travel-related morbidity can occur during or after travel. Worldwide, 8% of travelers from industrialized to developing countries report becoming ill enough to seek health care during or after travel. Travelers have contributed to the global spread of infectious diseases, including novel and emerging pathogens. Therefore, surveillance of travel-related morbidity is an essential component of global public health surveillance and will be of greater importance as international travel increases worldwide. September 1997-December 2011. GeoSentinel is a clinic-based global surveillance system that tracks infectious diseases and other adverse health outcomes in returned travelers, foreign visitors, and immigrants. GeoSentinel comprises 54 travel/tropical medicine clinics worldwide that electronically submit demographic, travel, and clinical diagnosis data for all patients evaluated for an illness or other health condition that is presumed to be related to international travel. Clinical information is collected by physicians with expertise or experience in travel/tropical medicine. Data collected at all sites are entered electronically into a database, which is housed at and maintained by CDC. The GeoSentinel network membership program comprises 235 additional clinics in 40 countries on six continents. Although these network members do not report surveillance data systematically, they can report unusual or concerning diagnoses in travelers and might be asked to perform enhanced surveillance in response to specific health events or concerns. During September 1997-December 2011, data were collected on 141,789 patients with confirmed or

  15. A Disease-Associated Microbial and Metabolomics State in Relatives of Pediatric Inflammatory Bowel Disease PatientsSummary

    Directory of Open Access Journals (Sweden)

    Jonathan P. Jacobs


    Full Text Available Background & Aims: Microbes may increase susceptibility to inflammatory bowel disease (IBD by producing bioactive metabolites that affect immune activity and epithelial function. We undertook a family based study to identify microbial and metabolic features of IBD that may represent a predisease risk state when found in healthy first-degree relatives. Methods: Twenty-one families with pediatric IBD were recruited, comprising 26 Crohn’s disease patients in clinical remission, 10 ulcerative colitis patients in clinical remission, and 54 healthy siblings/parents. Fecal samples were collected for 16S ribosomal RNA gene sequencing, untargeted liquid chromatography–mass spectrometry metabolomics, and calprotectin measurement. Individuals were grouped into microbial and metabolomics states using Dirichlet multinomial models. Multivariate models were used to identify microbes and metabolites associated with these states. Results: Individuals were classified into 2 microbial community types. One was associated with IBD but irrespective of disease status, had lower microbial diversity, and characteristic shifts in microbial composition including increased Enterobacteriaceae, consistent with dysbiosis. This microbial community type was associated similarly with IBD and reduced microbial diversity in an independent pediatric cohort. Individuals also clustered bioinformatically into 2 subsets with shared fecal metabolomics signatures. One metabotype was associated with IBD and was characterized by increased bile acids, taurine, and tryptophan. The IBD-associated microbial and metabolomics states were highly correlated, suggesting that they represented an integrated ecosystem. Healthy relatives with the IBD-associated microbial community type had an increased incidence of elevated fecal calprotectin. Conclusions: Healthy first-degree relatives can have dysbiosis associated with an altered intestinal metabolome that may signify a predisease microbial

  16. State estimation and optimal long period clinical treatment of HIV seropositive patients

    Directory of Open Access Journals (Sweden)

    Juliana M. Grégio


    Full Text Available Optimal control theory provides a very interesting quantitative method that can be used to assist the decision making process in several areas of application, such as engineering, biology, economics and sociology. The main idea is to determine the values of the manipulated variables, such as drug doses, so that some cost function is minimized, subject to physical constraints. In this work, the cost function reflects the number of CD4+T cells, viral particles and the drug doses. It is worth noticing that high drug doses are related to more intense side-effects, apart from the impact on the actual cost of the treatment. In a previous paper by the authors, the LQR - Linear Quadratic Regulator approach was proposed for the computation of long period maintenance doses for the drugs, which turns out to be of state feedback form. However, it is not practical to determine all the components of the state vector, due to the fact that infected and uninfected CD4+T cells are not microscopically distinguishable. In order to overcome this difficulty, this work proposes the use of Extended Kalman Filter to estimate the state, even though, because of the nonlinear nature of the involved state equations, the separation principle may not be valid. Extensive simulations were then carried out to investigate numerically if the control strategy consisting of the feedback of estimated states yielded satisfactory clinical results.A teoria de controle ótimo apresenta um método quantitativo muito interessante que pode ajudar no processo de tomada de decisão em algumas áreas de aplicação, tais como engenharia, biologia, economia e sociologia. A principal idéia é determinar os valores das variáveis controladas, tais como doses de medicamentos, onde alguma função-custo é minimizada, sujeito às restrições físicas. Neste trabalho, a função-custo reflete o número de células CD4+T, partículas virais e doses de medicamentos. É fato que altas dosagens de

  17. Clinical Social Work. State Laws Governing Independent Practice and Reimbursement of Services. Fact Sheet for the Honorable Daniel K. Inouye, United States Senate. (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This fact sheet on state laws governing the independent practice and reimbursement of services for clinical social workers contains information from questionnaires sent to the state agencies responsible for health insurance regulations and Medicaid and licensing activities. Information on Ohio, the only state which did not respond, is not…

  18. Informatics in clinical research in oncology: current state, challenges, and a future perspective. (United States)

    Chahal, Amar P S


    The informatics landscape of clinical trials in oncology has changed significantly in the last 10 years. The current state of the infrastructure for clinical trial management, execution, and data management is reviewed. The systems, their functionality, the users, and the standards available to researchers are discussed from the perspective of the oncologist-researcher. Challenges in complexity and in the processing of information are outlined. These challenges include the lack of communication and information-interchange between systems, the lack of simplified standards, and the lack of implementation and adherence to the standards that are available. The clinical toxicology criteria from the National Cancer Institute (CTCAE) are cited as a successful standard in oncology, and HTTP on the Internet is referenced for its simplicity. Differences in the management of information standards between industries are discussed. Possible future advances in oncology clinical research informatics are addressed. These advances include strategic policy review of standards and the implementation of actions to make standards free, ubiquitous, simple, and easily interpretable; the need to change from a local data-capture- or transaction-driven model to a large-scale data-interpretation model that provides higher value to the oncologist and the patient; and the need for information technology investment in a readily available digital educational model for clinical research in oncology that is customizable for individual studies. These new approaches, with changes in information delivery to mobile platforms, will set the stage for the next decade in clinical research informatics.

  19. Sleep disturbances and health-related quality of life in adults with steady-state bronchiectasis.

    Directory of Open Access Journals (Sweden)

    Yonghua Gao

    Full Text Available Sleep disturbances are common in patients with chronic lung diseases, but little is known about the prevalence in patients with bronchiectasis. A cross sectional study was conducted to investigate the prevalence and determinants associated with sleep disturbances, and the correlation between sleep disturbances and quality of life (QoL in adults with steady-state bronchiectasis.One hundred and forty-four bronchiectasis patients and eighty healthy subjects were enrolled. Sleep disturbances, daytime sleepiness, and QoL were measured by utilizing the Pittsburgh Sleep Quality Index (PSQI, Epworth Sleepiness Scale (ESS and St. George Respiratory Questionnaire (SGRQ, respectively. Demographic, clinical indices, radiology, spirometry, bacteriology, anxiety and depression were also assessed.Adults with steady-state bronchiectasis had a higher prevalence of sleep disturbances (PSQI>5 (57% vs. 29%, P<0.001, but not daytime sleepiness (ESS≥10 (32% vs. 30%, P = 0.76, compared with healthy subjects. In the multivariate model, determinants associated with sleep disturbances in bronchiectasis patients included depression (OR, 10.09; 95% CI, 3.46-29.37; P<0.001, nocturnal cough (OR, 1.89; 95% CI, 1.13-3.18; P = 0.016, aging (OR, 1.04; 95% CI, 1.01-1.07; P = 0.009 and increased 24-hour sputum volume (OR, 2.01; 95% CI, 1.22-3.33; P = 0.006. Patients with sleep disturbances had more significantly impaired QoL affecting all domains than those without. Only 6.2% of patients reported using a sleep medication at least weekly.In adults with steady-state bronchiectasis, sleep disturbances are more common than in healthy subjects and are related to poorer QoL. Determinants associated with sleep disturbances include depression, aging, nighttime cough and increased sputum volume. Assessment and intervention of sleep disturbances are warranted and may improve QoL.

  20. Quality of optometry referrals to neovascular age-related macular degeneration clinic: a prospective study


    Muen, Wisam J; Hewick, Simon A


    Objectives To evaluate the quality of referrals to a neovascular age-related macular degeneration clinic from optometrists using the standard Rapid Access Referral Form (RARF) from the Royal College of Ophthalmologists. Design A prospective study. Prospective data were gathered from all optometry referrals using the RARF, between the periods of December 2006 to August 2009. These were assessed for accuracy of history, clinical signs and final diagnosis as compared to a macula expert. Setting ...

  1. Phospholipase C-related catalytically inactive protein can regulate obesity, a state of peripheral inflammation

    Directory of Open Access Journals (Sweden)

    Yosuke Yamawaki


    Full Text Available Obesity is defined as abnormal or excessive fat accumulation. Chronic inflammation in fat influences the development of obesity-related diseases. Many reports state that obesity increases the risk of morbidity in many diseases, including hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, sleep apnea, and breast, prostate and colon cancers, leading to increased mortality. Obesity is also associated with chronic neuropathologic conditions such as depression and Alzheimer's disease. However, there is strong evidence that weight loss reduces these risks, by limiting blood pressure and improving levels of serum triglycerides, total cholesterol, low-density lipoprotein (LDL-cholesterol, and high-density lipoprotein (HDL-cholesterol. Prevention and control of obesity is complex, and requires a multifaceted approach. The elucidation of molecular mechanisms driving fat metabolism (adipogenesis and lipolysis aims at developing clinical treatments to control obesity. We recently reported a new regulatory mechanism in fat metabolism: a protein phosphatase binding protein, phospholipase C-related catalytically inactive protein (PRIP, regulates lipolysis in white adipocytes and heat production in brown adipocytes via phosphoregulation. Deficiency of PRIP in mice led to reduced fat accumulation and increased energy expenditure, resulting in a lean phenotype. Here, we evaluate PRIP as a new therapeutic target for the control of obesity.

  2. Clinical neuro-oncology formal education opportunities for medical students in the United States and Canada. (United States)

    Dixit, Karan S; Nicholas, Martin Kelly; Lukas, Rimas V


    To develop an understanding of the availability of the formal clinical neuro-oncology educational opportunities for medical students. The curriculum websites of all medical schools accredited by the Liaison Committee on Medical Education were reviewed for the presence of clinical neuro-oncology electives as well as other relevant data. Ten (6.8%) of medical schools accredited by the Liaison Committee on Medical Education offer formal neuro-oncology electives. Half are clustered in the Midwest. Forty percent are at institutions with neuro-oncology fellowships. All are at institutions with neurosurgery and neurology residency programs. Formal clinical neuro-oncology elective opportunities for medical students in the United States and Canada are limited. Additional such opportunities may be of value in the education of medical students. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Ex vivo lung perfusion in clinical lung transplantation--state of the art. (United States)

    Andreasson, Anders S I; Dark, John H; Fisher, Andrew J


    Ex vivo lung perfusion (EVLP) has emerged as a new technique for assessing and potentially reconditioning human donor lungs previously unacceptable for clinical transplantation with the potential to dramatically push the limits of organ acceptability. With the recent introduction of portable EVLP, a new era in lung preservation may be upon us with the opportunity to also limit organ ischaemic times and potentially improve the outcome of donor lungs already deemed acceptable for transplantation. It took over half a century for the technique to evolve from basic theory to semi-automated circuits fit for clinical use that are now rapidly being adopted in transplant centres across the globe. With this field in constant evolution and many unanswered questions remaining, our review serves as an update on the state of the art of EVLP in clinical lung transplantation. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  4. Transforming the Primary Care Training Clinic: New York State's Hospital Medical Home Demonstration Pilot. (United States)

    Angelotti, Marietta; Bliss, Kathryn; Schiffman, Dana; Weaver, Erin; Graham, Laura; Lemme, Thomas; Pryor, Veronica; Gesten, Foster C


    Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. The 2013-2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P≤.001, and 11%, P=.011, respectively). A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes.

  5. Alternatives to relational database: comparison of NoSQL and XML approaches for clinical data storage. (United States)

    Lee, Ken Ka-Yin; Tang, Wai-Choi; Choi, Kup-Sze


    Clinical data are dynamic in nature, often arranged hierarchically and stored as free text and numbers. Effective management of clinical data and the transformation of the data into structured format for data analysis are therefore challenging issues in electronic health records development. Despite the popularity of relational databases, the scalability of the NoSQL database model and the document-centric data structure of XML databases appear to be promising features for effective clinical data management. In this paper, three database approaches--NoSQL, XML-enabled and native XML--are investigated to evaluate their suitability for structured clinical data. The database query performance is reported, together with our experience in the databases development. The results show that NoSQL database is the best choice for query speed, whereas XML databases are advantageous in terms of scalability, flexibility and extensibility, which are essential to cope with the characteristics of clinical data. While NoSQL and XML technologies are relatively new compared to the conventional relational database, both of them demonstrate potential to become a key database technology for clinical data management as the technology further advances. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. Anxiety and Mood Clinical Profile following Sport-related Concussion: From Risk Factors to Treatment. (United States)

    Sandel, Natalie; Reynolds, Erin; Cohen, Paul E; Gillie, Brandon L; Kontos, Anthony P


    Conceptual models for assessing and treating sport-related concussion (SRC) have evolved from a homogenous approach to include different clinical profiles that reflect the heterogeneous nature of this injury and its effects. There are six identified clinical profiles, or subtypes from SRC, and one such clinical profile is the anxiety/mood profile. Athletes with this profile experience predominant emotional disturbance and anxiety following SRC. The purpose of this targeted review was to present an overview of the empirical evidence to support factors contributing to the anxiety/mood profile, along with methods of evaluation and treatment of this clinical profile following SRC. We discuss the potential underlying mechanisms and risk factors for this clinical profile, describe comprehensive assessments to evaluate concussed athletes with an anxiety/mood clinical profile, and explore behavioral and other interventions for treating these athletes. Although there is limited, but growing empirical evidence for the anxiety/mood clinical profile following SRC, understanding this clinical profile is germane for clinicians who are treating athletes with emotional sequelae after SRC.

  7. Impact of relational coordination on staff and patient outcomes in outpatient surgical clinics. (United States)

    Gittell, Jody Hoffer; Logan, Caroline; Cronenwett, Jack; Foster, Tina C; Freeman, Richard; Godfrey, Marjorie; Vidal, Dale Collins


    Pressures are increasing for clinicians to provide high-quality, efficient care, leading to increased concerns about staff burnout. This study asks whether staff well-being can be achieved in ways that are also beneficial for the patient's experience of care. It explores whether relational coordination can contribute to both staff well-being and patient satisfaction in outpatient surgical clinics where time constraints paired with high needs for information transfer increase both the need for and the challenge of achieving timely and accurate communication. We studied relational coordination among surgeons, nurses, residents, administrators, technicians, and secretaries in 11 outpatient surgical clinics. Data were combined from a staff and a patient survey to conduct a cross-sectional study. Data were analyzed using ordinary least squares and random effects regression models. Relational coordination among all workgroups was significantly associated with staff outcomes, including job satisfaction, work engagement, and burnout. Relational coordination was also significantly associated with patients' satisfaction with staff and their overall visit, though the association between relational coordination and patients' satisfaction with their providers did not reach statistical significance. Even when patient-staff interactions are relatively brief, as in outpatient settings, high levels of relational coordination among interdependent workgroups contribute to positive outcomes for both staff and patients, and low levels tend to have the opposite effect. Clinical leaders can increase the expectation of positive outcomes for both staff and their patients by implementing interventions to strengthen relational coordination.

  8. [Classification of results of studying blood plasma with laser correlation spectroscopy based on semiotics of preclinical and clinical states]. (United States)

    Ternovoĭ, K S; Kryzhanovskiĭ, G N; Musiĭchuk, Iu I; Noskin, L A; Klopov, N V; Noskin, V A; Starodub, N F


    The usage of laser correlation spectroscopy for verification of preclinical and clinical states is substantiated. Developed "semiotic" classifier for solving the problems of preclinical and clinical states is presented. The substantiation of biological algorithms as well as the mathematical support and software for the proposed classifier for the data of laser correlation spectroscopy of blood plasma are presented.

  9. Clean Energy-Related Economic Development Policy across the States: Establishing a 2016 Baseline

    Energy Technology Data Exchange (ETDEWEB)

    Cook, Jeffrey J. [National Renewable Energy Lab. (NREL), Golden, CO (United States)


    States implement clean energy-related economic development policy to spur innovation, manufacturing, and to address other priorities. This report focuses on those policies most directly related to expanding new and existing manufacturing. The extent to which states invest in this policymaking depends on political drivers and jurisdictional economic development priorities. To date, no one source has collected all of the clean energy-related economic development policies available across the 50 states. Thus, it is unclear how many policies exist within each state and how these policies, when implemented, can drive economic development. Establishing the baseline of existing policy is a critical first step in determining the potential holistic impact of these policies on driving economic growth in a state. The goal of this report is to document the clean energy-related economic development policy landscape across the 50 states with a focus on policy that seeks to expand new or existing manufacturing within a state. States interested in promoting clean energy manufacturing in their jurisdictions may be interested in reviewing this landscape to determine how they compare to peers and to adjust their policies as necessary. This report documents over 900 existing clean energy-related economic development laws, financial incentives (technology-agnostic and clean energy focused), and other policies such as agency-directed programs and initiatives across the states.

  10. Recent results of clinical therapeutic trials for gastrointenstinal malignancies conducted in the United States

    International Nuclear Information System (INIS)

    Kisner, D.L.; Schein, P.S.; Macdonald, J.S.


    Gastrointestinal tract cancer is the leading cause of cancer mortality in the United States, causing more than 100,000 deaths a year. Carcinoma of the pancreas is increasing in incidence in the United States. Carcinoma of the stomach has progressively decreased in incidence. Because of the high rate of primary unresectability and recurrence after resection most patients at some time in their course become candidates for therapy directed at locoregional or metastatic disease. Recent clinical research in the United States has been aimed at identifying and confirming the activity of chemotherapy or combined modality treatments for patients with advanced metastatic disease for future application in the locoregional or surgical adjuvant setting. The purpose of this report is to highlight the pertinent recent data and outline ongoing studies of interest. (orig./BWU)

  11. Adherence to clinic recommendations among patients with phenylketonuria in the United States. (United States)

    Jurecki, E R; Cederbaum, S; Kopesky, J; Perry, K; Rohr, F; Sanchez-Valle, A; Viau, K S; Sheinin, M Y; Cohen-Pfeffer, J L


    Assess current management practices of phenylketonuria (PKU) clinics across the United States (US) based on the key treatment metrics of blood phenylalanine (Phe) concentrations and blood Phe testing frequency, as well as patient adherence to their clinic's management practice recommendations. An online survey was conducted with medical professionals from PKU clinics across the US from July to September 2015. Forty-four clinics participated in the survey and account for approximately half of PKU patients currently followed in clinics in the US (Berry et al., 2013). The majority of PKU clinics recommended target blood Phe concentrations to be between 120 and 360μM for all patients; the upper threshold was relaxed by some clinics for adult patients (from 360 to 600μM) and tightened for patients who are pregnant/planning to become pregnant (to 240μM). Patient adherence to these recommendations (percentage of patients with blood Phe below the upper recommended threshold) was age-dependent, decreasing from 88% in the 0-4years age group to 33% in adults 30+ years. Patient adherence to recommendations for blood testing frequency followed a similar trend. Higher staffing intensity (specialists per 100 PKU patients) was associated with better patient adherence to clinics' blood Phe concentrations recommendations. Clinic recommendations of target blood Phe concentrations in the US are now stricter compared to prior years, and largely reflect recent guidelines by the American College of Medical Genetics and Genomics (Vockley et al., 2014). Adherence to recommended Phe concentrations remains suboptimal, especially in older patients. However, despite remaining above the guidelines, actual blood Phe concentrations in adolescents and adults are lower than those reported in the past (Walter et al., 2002; Freehauf et al., 2013). Continued education and support for PKU patients by healthcare professionals, including adequate clinic staffing, are needed to improve adherence

  12. Advanced musculoskeletal physiotherapists in post arthroplasty review clinics: a state wide implementation program evaluation. (United States)

    Harding, Paula; Burge, Angela; Walter, Kerrie; Shaw, Bridget; Page, Carolyn; Phan, Uyen; Terrill, Desiree; Liew, Susan


    To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  13. State information needs related to onshore and nearshore effects of OCS petroleum development

    Energy Technology Data Exchange (ETDEWEB)

    Williams, D.C.; Stang, P.R.; Hyde, B.


    The United States currently has underway a program to develop tracts on the Outer Continental Shelf (OCS) for their petroleum resources that can have significant impact on and near the shore. The potentially affected States bordering the Atlantic and Pacific Oceans and the Gulf of Mexico have expressed serious concerns about the availability and adequacy of the information they need to make planning and management decisions about onshore activities and impacts related to OCS petroleum development. This report discusses state policies, major concerns, organization, planning approaches and relation to other state planning efforts.

  14. Orally active growth hormone secretagogues: state of the art and clinical perspectives. (United States)

    Ghigo, E; Arvat, E; Camanni, F


    Growth hormone secretagogues (GHS) are synthetic, non-natural peptidyl and nonpeptidyl molecules with potent stimulatory effect on somatotrope secretion. They have no structural homology with growth hormone-releasing hormone (GHRH) and act via a specific receptor, which has now been cloned and is present at both the pituitary and hypothalamic level. This evidence strongly suggests the existence of a still unknown natural GHS-like ligand. Several data favour the hypothesis that GHS could counteract somatostatinergic activity at both the pituitary and hypothalamic level and/or, at least partially, via a GHRH-mediated mechanism. However, the possibility that they act via an unknown hypothalamic factor remains open. GH-releasing peptide-6 (GHRP-6) is the first hexapeptide studied extensively in humans. More recently, peptidyl superanalogues GHRP-1, GHRP-2 and hexarelin, and nonpeptidyl mimetics, such as the spiroindoline derivative MK-677, have been synthesized and their effects have been studied in humans. The GH-releasing activity of GHS is marked, dose related and reproducible after intravenous, subcutaneous, intranasal and even oral administration. The effect of GHS is partially desensitized but prolonged, intermittent oral administration increases insulin-like growth factor I (IGF-I) levels. The GH-releasing effect of GHS undergoes age-related variations; it increases from birth to puberty, remains similar in adulthood and decreases with ageing. The effect of GHS on GH release is synergistic with that of GHRH, while it is only partially refractory to inhibitory influences, which nearly abolish the effect of GHRH. GHS maintain their GH-releasing activity in some somatotrope hypersecretory states such as acromegaly, anorexia nervosa, hyperthyroidism and critical illness. The GH response to GHS has been reported clear although reduced in GH deficiency, obesity and hypothyroidism, while it is strongly reduced in patients with pituitary stalk disconnection or Cushing

  15. Quantitative comparison of OSEM and penalized likelihood image reconstruction using relative difference penalties for clinical PET

    International Nuclear Information System (INIS)

    Ahn, Sangtae; Asma, Evren; Cheng, Lishui; Manjeshwar, Ravindra M; Ross, Steven G; Miao, Jun; Jin, Xiao; Wollenweber, Scott D


    Ordered subset expectation maximization (OSEM) is the most widely used algorithm for clinical PET image reconstruction. OSEM is usually stopped early and post-filtered to control image noise and does not necessarily achieve optimal quantitation accuracy. As an alternative to OSEM, we have recently implemented a penalized likelihood (PL) image reconstruction algorithm for clinical PET using the relative difference penalty with the aim of improving quantitation accuracy without compromising visual image quality. Preliminary clinical studies have demonstrated visual image quality including lesion conspicuity in images reconstructed by the PL algorithm is better than or at least as good as that in OSEM images. In this paper we evaluate lesion quantitation accuracy of the PL algorithm with the relative difference penalty compared to OSEM by using various data sets including phantom data acquired with an anthropomorphic torso phantom, an extended oval phantom and the NEMA image quality phantom; clinical data; and hybrid clinical data generated by adding simulated lesion data to clinical data. We focus on mean standardized uptake values and compare them for PL and OSEM using both time-of-flight (TOF) and non-TOF data. The results demonstrate improvements of PL in lesion quantitation accuracy compared to OSEM with a particular improvement in cold background regions such as lungs. (paper)

  16. Clinical Competence and Its Related Factors of Nurses in Neonatal Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Jila Mirlashari


    Full Text Available Introduction: Clinical competence of nurses working in the neonatal intensive care units together with advancements in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, evaluating the clinical competence of nurses seems necessary. This study aimed to evaluate the clinical competence of nurses in the neonatal intensive care units. Methods: In this cross-sectional study, 117 nurses working in the neonatal intensive care units of the hospitals affiliated to Tehran University of Medical Sciences were selected by census method. The research tool was Development of Competency Inventory for Registered Nurses questionnaire which completed by self-assessment. The mean clinical competence scores of participants categorized into 3 levels: weak: 273. Data were analyzed by SPSS version 13 using the Pearson correlation coefficient, t-test and Chi-square test. Results: The highest levels of competence were related to critical thinking and research attitude and interpersonal relationships, and the lowest level was related to training and mentoring. There was a direct statistically significant relationship between marital status, employment status, level of interest in working in the neonatal intensive-care units and the clinical competence of nurses. Conclusion: Since the clinical competence of nurses in the Neonatal Intensive Care Units is vital, some variables such as interest in the nursing profession, employment status, the neonatal intensive theoretical and practical training courses and the amount of overtime working hours should be taken into consideration.

  17. The words we work with that work on us: clinical paradigm and cumulative relational trauma. (United States)

    Heuer, Birgit


    This paper addresses a gap between analytic clinical theory and practice which emerges when examining the words we work with via textual and narrative research of case histories. Both subject matter and methodology fit with the remit of conceptual research in psychoanalysis, currently ranging from inductive to nomothetical approaches. Research of clinical language reveals an implicit account of human nature and the world which undergirds clinical practice. Based in the critical philosophy of the previous century, this is termed clinical paradigm. Such implicit views are induced rather than explicitly taught during analytic training, and need to be spelled out in order to become available to discourse and difference of opinion. Textual research shows these implicit pre-clinical attitudes to be inherently pessimistic and thus too similar to the views of self and others found in cumulative relational trauma. Moreover, clinical accounts tend to normalize subtly antagonistic forms of relating, recently recognised as micro-trauma. Importantly, this contravenes the agapic orientation of our theories and ethics. Paradigmatic reflection as a form of professional individuation addresses this gap. This includes a more optimistic outlook which can be traced through the philosophical implications of quantum theory. © 2017, The Society of Analytical Psychology.

  18. Electronic health records to support obesity-related patient care: Results from a survey of United States physicians. (United States)

    Bronder, Kayla L; Dooyema, Carrie A; Onufrak, Stephen J; Foltz, Jennifer L


    Obesity-related electronic health record functions increase the rates of measuring Body Mass Index, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related electronic health record functions in clinical practice and analyzes characteristics associated with increased obesity-related electronic health record sophistication. Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their electronic health record has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related electronic health record sophistication. Of the 88% of providers with an electronic health record, 83% of electronic health records calculate Body Mass Index, 52% calculate pediatric Body Mass Index percentile, and 32% flag patients with abnormal Body Mass Index values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated electronic health record include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. Few electronic health records optimally supported physician's obesity-related clinical care. The low rates of obesity-related electronic health record functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. More work can be done to develop, implement, and promote the effective utilization of obesity-related electronic health record functions to improve obesity treatment and prevention efforts. Published by Elsevier Inc.

  19. Fact sheets relating to use of geothermal energy in the United States

    Energy Technology Data Exchange (ETDEWEB)



    A compilation of data relating to geothermal energy in each of the 50 states is presented. The data are summarized on one page for each state. All summary data sheets use a common format. Following the summary data sheet there are additional data on the geology of each state pertaining to possible hydrothermal/geothermal resources. Also there is a list of some of the reports available pertaining to the state and state energy contacts. The intent of these documents is to present in a concise form reference data for planning by the Department of Energy.

  20. Gender-related differences in clinical characteristics and outcomes in patients with diabetic ketoacidosis. (United States)

    Barski, Leonid; Harman-Boehm, Ilana; Nevzorov, Roman; Rabaev, Elena; Zektser, Miri; Jotkowitz, Alan B; Zeller, Lior; Shleyfer, Elena; Almog, Yaniv


    Diabetic ketoacidosis (DKA) is 1 of the most common and serious complications of diabetes, and is a significant cause of morbidity and mortality. There is a paucity of data regarding gender-related differences in clinical characteristics and outcomes of patients hospitalized for DKA. The purpose of this study was to assess whether gender plays a role in clinical characteristics and outcome of DKA. We performed a retrospective cohort study of patients hospitalized with DKA between January 1, 2003 and January 1, 2010. The outcomes of male and female patients were compared. The primary outcome was in-hospital all-cause mortality. The secondary outcomes were 30-day all-cause mortality and rate of complications: sepsis, respiratory failure, multiple organ failure, stroke, and myocardial infarction. Eighty-nine men and 131 women with DKA were included in the study. Male patients had higher rates of chronic renal failure compared with women (16.9% vs 3.1%; P = 0.001), whereas more women than men received oral hypoglycemic therapy (19.8% vs 9.0%; P = 0.046); women also had higher glycosated hemoglobin levels before admission (11.9% [1.7%] vs 9.9% [2.2%]; P = 0.025). The in-hospital mortality rate was not significantly different for both genders (4.5% in the male group vs 3.8% in the female group; P = 1.0). We did not find significant differences between the 2 groups in the 30-day mortality rate (4.5% vs 6.1%; P = 0.7) or the rate of complications (5.6% vs 6.9%; P = 0.9). Advanced age, mechanical ventilation, and bedridden state were independent predictors of 30-day mortality. In our study we did not find statistically significant differences in the in-hospital mortality, 30-day all-cause mortality, or rate of complications between men and women hospitalized with DKA. However, women with poorly controlled type 2 diabetes mellitus receiving oral hypoglycemic therapy required particular attention and might benefit from earlier introduction and intensification of insulin

  1. Abnormalities of resting state functional connectivity are related to sustained attention deficits in MS.

    Directory of Open Access Journals (Sweden)

    Marisa Loitfelder

    Full Text Available OBJECTIVES: Resting state (RS functional MRI recently identified default network abnormalities related to cognitive impairment in MS. fMRI can also be used to map functional connectivity (FC while the brain is at rest and not adhered to a specific task. Given the importance of the anterior cingulate cortex (ACC for higher executive functioning in MS, we here used the ACC as seed-point to test for differences and similarities in RS-FC related to sustained attention between MS patients and controls. DESIGN: Block-design rest phases of 3 Tesla fMRI data were analyzed to assess RS-FC in 31 patients (10 clinically isolated syndromes, 16 relapsing-remitting, 5 secondary progressive MS and 31 age- and gender matched healthy controls (HC. Participants underwent extensive cognitive testing. OBSERVATIONS: In both groups, signal changes in several brain areas demonstrated significant correlation with RS-activity in the ACC. These comprised the posterior cingulate cortex (PCC, insular cortices, the right caudate, right middle temporal gyrus, angular gyri, the right hippocampus, and the cerebellum. Compared to HC, patients showed increased FC between the ACC and the left angular gyrus, left PCC, and right postcentral gyrus. Better cognitive performance in the patients was associated with increased FC to the cerebellum, middle temporal gyrus, occipital pole, and the angular gyrus. CONCLUSION: We provide evidence for adaptive changes in RS-FC in MS patients compared to HC in a sustained attention network. These results extend and partly mirror findings of task-related fMRI, suggesting FC may increase our understanding of cognitive dysfunction in MS.

  2. Characterization of drug-related problems identified by clinical pharmacy staff at Danish hospitals

    DEFF Research Database (Denmark)

    Kjeldsen, Lene Juel; Birkholm, Trine; Fischer, Hanne


    Background In 2010, a database of drug related problems (DRPs) was implemented to assist clinical pharmacy staff in documenting clinical pharmacy activities locally. A study of quality, reliability and generalisability showed that national analyses of the data could be conducted. Analyses...... at the national level may help identify and prevent DRPs by performing national interventions. Objective The aim of the study was to explore the DRP characteristics as documented by clinical pharmacy staff at hospital pharmacies in the Danish DRP-database during a 3-year period. Setting Danish hospital pharmacies....... Method Data documented in the DRP-database during the initial 3 years after implementation were analyzed retrospectively. The DRP-database contains DRPs reported at hospitals by clinical pharmacy staff. The analyses focused on DRP categories, implementation rates and drugs associated with the DRPs. Main...

  3. Who is Distressed Applying the Diabetes Related Distress Scale in a Diabetes Clinic (United States)


    59 MDW /SGVU SUBJECT: Professional Presentation Approval 7APR 2017 1. Your paper, entitled Who is Distressed? Applying the Diabetes -Related Distress...Scale in A Diabetes Clinic presented at/published to American Diabetes Association 2017 Meeting, San Francisco, CA (National Conference), 9-16 a publication/presentation, a new 59 MOW Form 3039 must be submitted for review and approval.) Using the Diabetes -Related Distress Scale in

  4. C9orf72-related disorders: expanding the clinical and genetic spectrum of neurodegenerative diseases

    Directory of Open Access Journals (Sweden)

    Paulo Victor Sgobbi de Souza


    Full Text Available Neurodegenerative diseases represent a heterogeneous group of neurological conditions primarily involving dementia, motor neuron disease and movement disorders. They are mostly related to different pathophysiological processes, notably in family forms in which the clinical and genetic heterogeneity are lush. In the last decade, much knowledge has been acumulated about the genetics of neurodegenerative diseases, making it essential in cases of motor neuron disease and frontotemporal dementia the repeat expansions of C9orf72 gene. This review analyzes the main clinical, radiological and genetic aspects of the phenotypes related to the hexanucleotide repeat expansions (GGGGCC of C9orf72 gene. Future studies will aim to further characterize the neuropsychological, imaging and pathological aspects of the extra-motor features of motor neuron disease, and will help to provide a new classification system that is both clinically and biologically relevant.

  5. Beyond individualism: Is there a place for relational autonomy in clinical practice and research? (United States)

    Dove, Edward S; Kelly, Susan E; Lucivero, Federica; Machirori, Mavis; Dheensa, Sandi; Prainsack, Barbara


    The dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of 'relational autonomy' in particular have argued that people's identities, needs, interests - and indeed autonomy - are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangible and positive impact on clinical practice and research. These solutions leave the ultimate decision to the person most affected, but encourage and facilitate the consideration of this person's care and responsibility for connected others.

  6. Influence of the curve density relative electron in dosimetry clinic in treatments stereo tactics

    International Nuclear Information System (INIS)

    Moreno Saiz, C.; Benitez Villegas, E. M.; Casado Villalon, F. J.; Parra Osorio, V.; Bodineau Gil, C.; Garcia Pareja, S.


    The objective of this study is to analyze the difference between clinical dosimetry in the treatments with radiosurgery and stereotactic radiotherapy fractional obtained from the relative Electron density curve (Schneider 1996) tabulated and provided with the scanner's radiation therapy. (Author)

  7. The relational clinical database: a possible solution to the star wars in registry systems. (United States)

    Michels, D K; Zamieroski, M


    In summary, having data from other service areas available in a relational clinical database could resolve many of the problems existing in today's registry systems. Uniting sophisticated information systems into a centralized database system could definitely be a corporate asset in managing the bottom line.

  8. CDC73-Related Disorders: Clinical Manifestations and Case Detection in Primary Hyperparathyroidism

    NARCIS (Netherlands)

    van der Tuin, Karin; Tops, Carli M. J.; Adank, Muriel A.; Cobben, Jan-Maarten; Hamdy, Neveen A. T.; Jongmans, Marjolijn C.; Menko, Fred H.; van Nesselrooij, Bernadette P. M.; Netea-Maier, Romana T.; Oosterwijk, Jan C.; Valk, Gerlof D.; Wolffenbuttel, Bruce H. R.; Hes, Frederik J.; Morreau, Hans


    Context: Heterozygous pathogenic germline variants in CDC73 predispose to the development of primary hyperparathyroidism (pHPT) and, less frequently, ossifying fibroma of the jaw and renal and uterine tumors. Clinical information on CDC73-related disorders has so far been limited to small case

  9. Neuropsychology and Rehabilitation Services in the United States: Brief Report from a Survey of Clinical Neuropsychologists. (United States)

    Block, Cady; Santos, Octavio A; Flores-Medina, Yvonne; Rivera Camacho, Diego Fernando; Arango-Lasprilla, Juan Carlos


    To provide a brief presentation of preliminary data on rehabilitation services provided by clinical neuropsychologists within the United States. This survey utilized data extracted from a larger international research study conducted in 39 countries including N = 173 professionals who reported to engage in neuropsychological rehabilitative services within the past year (63.6% female, 44.36 ± 11.83 years of age) took part in the study. Neuropsychologists providing rehabilitation services in the United States in the past year were more likely to provide individual versus group therapy, likely to employ technology (e.g., personal computers, mobile phones/smartphones) as part of treatment services, see a range of diagnostic groups most prominently traumatic brain injury and stroke/vascular conditions, and work to address a range of both cognitive (e.g., memory, attention/concentration, and executive functioning) and psychological (e.g., emotional/behavioral adjustment and well-being, awareness of disability/disease) issues. Prior published surveys suggest that clinical neuropsychologists have a growing involvement in rehabilitation services within the United States but with little clarity as to the actual characteristics of actual professional activities and practices. The present study aimed to provide such information and hopefully will be helpful in promoting additional systematic studies in this area. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  10. World of Warcraft™ and the State of Territory in International Relations

    DEFF Research Database (Denmark)

    Strandsbjerg, Jeppe

    According to conventional knowledge, the realist tradition in International Relations has maintained the world of International Politics in a perpetual state of ‘warcraft’ between sovereign territorial states. Since the early 1990s arguments associated with Historical Sociology have sought...... and transformative effect on the political role of territory. This is key to understand to spatial nature of the modern state and thus, also, the transformative possibilities within international relations...... to counter such a timeless image of states and politics. Yet, while this has done much to historicise state institutions and the international system, one of the fundamental features of the modern state remains poorly understood: that of territory. This is because, I argue, that the concept of space remains...

  11. NIH State-of-the-Science Conference Statement on management of menopause-related symptoms. (United States)

    To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the management of menopause-related symptoms. A non-DHHS, nonadvocate 12-member panel representing the fields of obstetrics and gynecology, general internal medicine, endocrinology, rheumatology, family and health psychology, geriatric medicine, health services research, demography, biochemistry, epidemiology, clinical research, and biostatistics. In addition, 26 experts in fields related to the conference topic presented data to the panel and to the conference audience. Presentations by experts and a systematic review of the medical literature prepared by the Oregon Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience. Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. A final copy of this statement is available, along with other recent conference statements, at the same web address of Menopause is the permanent cessation of menstrual periods that occurs naturally in women, usually in their early 50s. Many women have few or no symptoms; these women are not in need of medical treatment. Premenopausal or perimenopausal women who have menopause induced by surgery, chemotherapy, or radiation are more likely to experience bothersome and even disabling symptoms. These

  12. Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations. (United States)

    Kelly, A S; Fox, C K; Rudser, K D; Gross, A C; Ryder, J R


    Despite the increasing number of medications recently approved to treat obesity among adults, few agents have been formally evaluated in children or adolescents for this indication. Moreover, there is a paucity of guidance in the literature addressing best practices with regard to pediatric obesity pharmacotherapy clinical trial design, and only general recommendations have been offered by regulatory agencies on this topic. The purposes of this article are to (1) offer a background of the current state of the field of pediatric obesity medicine, (2) provide a brief review of the literature summarizing pediatric obesity pharmacotherapy clinical trials, and (3) highlight and discuss some of the unique aspects that should be considered when designing and conducting high-quality clinical trials evaluating the safety and efficacy of obesity medications in children and adolescents. Suggestions are offered in the areas of target population and eligibility criteria, clinical trial end-point selection, trial duration, implementation of lifestyle modification therapy and recruitment and retention of participants. Efforts should be made to design and conduct trials appropriately to ensure that high-quality evidence is generated on the safety and efficacy of various medications used to treat pediatric obesity.

  13. Increase in Clostridium difficile-related Mortality Rates, United States, 1999-2004

    Centers for Disease Control (CDC) Podcasts

    Deaths related to Clostridium difficile are on the rise in the United States. Matthew Redelings from the Los Angeles County Department of Health discusses the increase and what can be done to prevent this infection.

  14. Status of Credentialing Structures Related to Secondary Transition: A State-Level Policy Analysis (United States)

    Simonsen, Monica L.; Novak, Jeanne A.; Mazzotti, Valerie L.


    To understand the current status of transition-related credentialing systems in driving personnel preparation, it is necessary to identify which state education and rehabilitation services agencies are currently providing certification and licensure in the area of secondary transition. The purpose of this study was to examine the current state of…

  15. Mother and Infant Talk about Mental States Relates to Desire Language and Emotion Understanding (United States)

    Taumoepeau, Mele; Ruffman, Ted


    This study assessed the relation between mother mental state language and child desire language and emotion understanding in 15--24-month-olds. At both times point, mothers described pictures to their infants and mother talk was coded for mental and nonmental state language. Children were administered 2 emotion understanding tasks and their mental…

  16. The relation between religion and state in Islam and Christianity in the rise of ISIS

    Directory of Open Access Journals (Sweden)

    Timothy A. van Aarde


    Full Text Available The recent development of the Islamic State (ISIS 2010–2014 and IS 2014 is a radicalisation of the relation between religion and state in Islam. The relation of religion and state to Christianity has been shaped by the philosophy of dualism and Greek thought in the West. The relation of religion and state in Islam, however, has been shaped by a completely different tradition and conflicting view than Western thought and is based on the codified system of Shari’a law in Arabic thought. One of the most debated topics in Islamic studies is the inseparable nature of religion and state in Islam and the role of Shari’a law to the state. In the West the historical debate concerns the indiscriminate blending of church and state and the separation of church and state as indispensable to democracy and the modern question of the relation of Christian morality and public law. Islamic fundamentalism is a political and religious reform movement that indiscriminately blends the political and religious.

  17. Trends in State and Federal land use law relating to inventories, monitoring and evaluation (United States)

    Lamb, C. M.


    A description and analysis of selected State and Federal laws relating to land use inventories, monitoring, and evaluation is presented. Legal requirements and information systems for land use in the following states are reviewed: Colorado, Delaware, Florida, Hawaii, Indiana, Kansas, Maine, Mississippi, Missouri, Oklahoma, Pennsylvania, Tennessee, Utah, Vermont, and West Virginia.

  18. The state in industrial relations: The politics of minimum wage in Turkey and the USA

    NARCIS (Netherlands)

    Koçer, R.G.; Visser, J.


    In this article the direct role of the state in industrial relations is scrutinized by focusing on the political basis of decisions regarding the minimum wage. We argue that in order to ensure stability and growth, any state must balance the interests of capital and labour when taking this kind of

  19. TNF-related apoptosis-inducing ligand (TRAIL) for bone sarcoma treatment: Pre-clinical and clinical data. (United States)

    Gamie, Zakareya; Kapriniotis, Konstantinos; Papanikolaou, Dimitra; Haagensen, Emma; Da Conceicao Ribeiro, Ricardo; Dalgarno, Kenneth; Krippner-Heidenreich, Anja; Gerrand, Craig; Tsiridis, Eleftherios; Rankin, Kenneth Samora


    Bone sarcomas are rare, highly malignant mesenchymal tumours that affect teenagers and young adults, as well as older patients. Despite intensive, multimodal therapy, patients with bone sarcomas have poor 5-year survival, close to 50%, with lack of improvement over recent decades. TNF-related apoptosis-inducing ligand (TRAIL), a member of the tumour necrosis factor (TNF) ligand superfamily (TNFLSF), has been found to induce apoptosis in cancer cells while sparing nontransformed cells, and may therefore offer a promising new approach to treatment. We cover the existing preclinical and clinical evidence about the use of TRAIL and other death receptor agonists in bone sarcoma treatment. In vitro studies indicate that TRAIL and other death receptor agonists are generally potent against bone sarcoma cell lines. Ewing's sarcoma cell lines present the highest sensitivity, whereas osteosarcoma and chondrosarcoma cell lines are considered less sensitive. In vivo studies also demonstrate satisfactory results, especially in Ewing's sarcoma xenograft models. However, the few clinical trials in the literature show only low or moderate efficacy of TRAIL in treating bone sarcoma. Potential strategies to overcome the in vivo resistance reported include co-administration with other drugs and the potential to deliver TRAIL on the surface of primed mesenchymal or immune cells and the use of targeted single chain antibodies such as scFv-scTRAIL. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Knowledge, attitude and practice towards child adoption amongst women attending infertility clinics in Lagos State, Nigeria

    Directory of Open Access Journals (Sweden)

    Adenike O. Omosun


    Full Text Available Background: Child adoption is a recommended alternative form of infertility management. Infertility is of public health importance in Nigeria and many other developing nations. This is a result of its high prevalence and especially because of its serious social implications as the African society places a passionate premium on procreation in any family setting. Objectives: The aim of this study was to determine the knowledge, attitude and practice of child adoption amongst women attending infertility clinics in teaching hospitals in Lagos State and to determine the factors that influence their attitude and practice towards it. Method: A cross-sectional descriptive design was used. Data were collected by using a structured questionnaire which was interviewer-administered. The study was conducted in the two teaching hospitals in Lagos State (LUTH [Lagos University Teaching Hospital] and LASUTH [Lagos State University Teaching Hospital] from amongst 350 women attending the gynaecological clinics. All the patients under management for infertility at the gynaecology clinics during the period of the study were interviewed. Results: Many respondents (85.7% had heard of child adoption and 59.3% of them knew the correct meaning of the term. More than half of the respondents (68.3% said that they could love an adopted child but less than half of them (33.7% were willing to consider adoption. Only 13.9% has ever adopted a child. The major reason given for their unwillingness to adopt was their desire to have their own biological child. Factors that were favourable towards child adoption were Igbo tribe identity, an age above 40 years, duration of infertility above 15 years, and knowing the correct meaning of child adoption. Conclusion: There is a poor attitude to adoption even amongst infertile couples. Interventions need to be implemented to educate the public on child adoption, to improve their attitude towards adoption and to make it more acceptable.

  1. Factors related to coping strategies during Japanese physical therapy students' clinical practice. (United States)

    Higuchi, Daisuke; Echigo, Ayumi


    [Purpose] This study aimed to identify social skills and support that are related to the coping strategies Janpanese physical therapy students use during their clinical practice. [Subjects and Methods] Third-year students who were finished with their clinical practice participated. Self-administered questionnaires were used, including the daily life skill scale, social support scale, and tri-axial coping scale. Spearman's partial correlation coefficients were calculated between social skills, support of daily living, and coping strategies used during the clinical practice, while controlling for gender. [Results] A total of 56 completed questionnaires (median of age: 21 years; 27 males). Social skills during personal situations-knowledge summarization, self-esteem, and positive thinking-were significantly, positively correlated with planning and affirmative interpreting strategies to approach stressors regarding clinical practice, and negatively related to giving up strategies to avoid stressors. Intimacy, leadership, and empathy (social skills during interpersonal situations) were significantly, positively correlated with the following responses to approach stressors: catharsis, information gathering, and affirmative interpreting. Moreover, emotional/companionship social support was significantly, positively correlated with all avoidant coping strategies. [Conclusion] Japanese physical therapy students who had low personal and interpersonal social skills and excess emotional/companionship support in daily life tend to select avoidance, not approach, coping strategies during clinical practice.

  2. Provider-Related Linkages Between Primary Care Clinics and Community-Based Senior Centers Associated With Diabetes-Related Outcomes. (United States)

    Noël, Polly Hitchcock; Wang, Chen-Pin; Finley, Erin P; Espinoza, Sara E; Parchman, Michael L; Bollinger, Mary J; Hazuda, Helen P


    The Institute of Medicine (IOM) suggests that linkages between primary care practices and community-based resources can improve health in lower income and minority patients, but examples of these are rare. We conducted a prospective, mixed-methods observational study to identify indicators of primary care-community linkage associated with the frequency of visits to community-based senior centers and improvements in diabetes-related outcomes among 149 new senior center members (72% Hispanic). We used semistructured interviews at baseline and 9-month follow-up, obtaining visit frequency from member software and clinical assessments including hemoglobin A1c (HbA1c) from colocated primary care clinics. Members' discussion of their activities with their primary care providers (PCPs) was associated with increased visits to the senior centers, as well as diabetes-related improvements. Direct feedback from the senior centers to their PCPs was desired by the majority of members and may help to reinforce use of community resources for self-management support.

  3. Clinical evaluation of the mini-mental state exam with culturally deaf senior citizens. (United States)

    Dean, Pamela M; Feldman, David M; Morere, Donna; Morton, Diane


    The Mini-Mental State Exam (MMSE) is commonly used to screen cognitive function in a clinical setting. The measure has been published in over 50 languages; however, the validity and reliability of the MMSE has yet to be assessed with the culturally Deaf elderly population. Participants consisted of 117 Deaf senior citizens, aged 55-89 (M = 69.44, SD = 8.55). Demographic information, including state of residence, age, and history of depression, head injury, and dementia diagnoses, were collected. A standard form of the MMSE was used with modification of test administration and stimuli including translation of English test items into a sign-based form and alteration of two items in order to make them culturally and linguistically appropriate. Significant correlations were observed between overall test score and education level (r = .23, p = .01) as well as test score and age (r = -.33, p validate the use of this measure with the culturally Deaf population.

  4. Clinical and imaging diagnosis of IgG4-related disease in the head and neck

    International Nuclear Information System (INIS)

    Yu Changliang; Liu Bin; Yu Yongqiang


    IgG4-related disease in the head and neck is a newly recognized multi-organ system disease characterized by elevated serum IgG4, infiltration of numerous IgG4-positive plasma cells, tissue fibrosis, and dramatic response to corticosteroid treatment. IgG4-related disease of the head and neck has some relative characteristics on CT and MRI, which can provide valuable information for the diagnosis and differential diagnosis, and are helpful for the clinical treatment, evaluation of therapeutic effects and prediction of prognosis. (authors)

  5. Length of Recovery From Sports-Related Concussions in Pediatric Patients Treated at Concussion Clinics. (United States)

    Thomas, Donald J; Coxe, Kathryn; Li, Hongmei; Pommering, Thomas L; Young, Julie A; Smith, Gary A; Yang, Jingzhen


    We quantified the length of recovery time by week in a cohort of pediatric sports-related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery. A retrospective, cohort design. Seven concussion clinics at a Midwest children's hospital. Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury. Length of recovery by week. Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week. Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length. High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery. The median length of recovery is 17 days among pediatric sports-related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.

  6. Modeling the relations of ethical leadership and clinical governance with psychological empowerment in nurses

    Directory of Open Access Journals (Sweden)

    Goona Fathi


    Full Text Available Background: Ethical leadership appeared as a new approach in the leadership perspective and provided the ground for promoting individual and organizational efficiency by giving priorities to ethics in organizations. In this regard, the present study was conducted with the aim of modeling the relations of ethical leadership and clinical governance with psychological empowerment among nurses of public hospitals in Kermanshah in 2014. Methods: the research method was descriptive survey. The study sample consisted of all nurses (n=550 working in public hospitals of Kermanshah University of Medical Science for whom 163 nurses were selected using simple random sampling. The tools for data collection were ethical leadership, clinical governance and psychology empowerment questionnaires whose validity and reliability were confirmed. The structural equation modeling was used to analyze the data. Results: The results showed a significant relationship between ethical leadership and clinical governance (P<0.01 and psychological empowerment (P<0.01. Moreover, there was a significant correlation between clinical governance and psychological empowerment (P<0.05. Based on the results of the research, ethical leadership directly and through clinical governance affected the nurses’ psychological empowerment (P<0.05. Conclusion: reliance on ethics and ethical leadership in hospitals, in addition to providing the space and ground for improving the effectiveness of clinical governance approach, can promote the feeling of psychological empowerment in nurses. Accordingly, the ethical issues are required to be taken into consideration in hospitals.

  7. Clinical usefulness and feasibility of time-frequency analysis of chemosensory event-related potentials. (United States)

    Huart, C; Rombaux, Ph; Hummel, T; Mouraux, A


    The clinical usefulness of olfactory event-related brain potentials (OERPs) to assess olfactory function is limited by the relatively low signal-to-noise ratio of the responses identified using conventional time-domain averaging. Recently, it was shown that time-frequency analysis of the obtained EEG signals can markedly improve the signal-to-noise ratio of OERPs in healthy controls, because it enhances both phase-locked and non phase-locked EEG responses. The aim of the present study was to investigate the clinical usefulness of this approach and evaluate its feasibility in a clinical setting. We retrospectively analysed EEG recordings obtained from 45 patients (15 anosmic, 15 hyposmic and 15 normos- mic). The responses to olfactory stimulation were analysed using conventional time-domain analysis and joint time-frequency analysis. The ability of the two methods to discriminate between anosmic, hyposmic and normosmic patients was assessed using a Receiver Operating Characteristic analysis. The discrimination performance of OERPs identified using conventional time-domain averaging was poor. In contrast, the discrimination performance of the EEG response identified in the time-frequency domain was relatively high. Furthermore, we found a significant correlation between the magnitude of this response and the psychophysical olfactory score. Time-frequency analysis of the EEG responses to olfactory stimulation could be used as an effective and reliable diagnostic tool for the objective clinical evaluation of olfactory function in patients.

  8. Towards meaningful medication-related clinical decision support: recommendations for an initial implementation. (United States)

    Phansalkar, S; Wright, A; Kuperman, G J; Vaida, A J; Bobb, A M; Jenders, R A; Payne, T H; Halamka, J; Bloomrosen, M; Bates, D W


    Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings.

  9. Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects

    Directory of Open Access Journals (Sweden)

    Wilma Batista de Matos


    Full Text Available INTRODUCTION: The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS: This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP from 2004 to 2010. RESULTS: Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05. The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%. At CREDIP, 29 cases were diagnosed, of which 26 (89.6% had multifocal manifestations. Mucous tissues were involved more (75.8% frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS: The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.

  10. Dressing-related trauma: clinical sequelae and resource utilization in a UK setting

    Directory of Open Access Journals (Sweden)

    Charlesworth B


    Full Text Available Bruce Charlesworth,1 Claire Pilling,1 Paul Chadwick,2 Martyn Butcher31Adelphi Values, Macclesfield, 2Salford Royal Foundation Trust, Salford, 3Northern Devon Healthcare Trust, Devon, UKBackground: Dressings are the mainstay of wound care management; however, adherence of the dressing to the wound or periwound skin is common and can lead to dressing-related pain and trauma. Dressing-related trauma is recognized as a clinical and economic burden to patients and health care providers. This study was conducted to garner expert opinion on clinical sequelae and resource use associated with dressing-related trauma in a UK setting.Methods: This was an exploratory study with two phases: qualitative pilot interviews with six wound care specialists to explore dressing-related trauma concepts, sequelae, and resource utilization; and online quantitative research with 30 wound care specialists to validate and quantify the concepts, sequelae, and resource utilization explored in the first phase of the study. Data were collected on mean health care professional time, material costs, pharmaceutical costs, and inpatient management per sequela occurrence until resolution. Data were analyzed to give total costs per sequela and concept occurrence.Results: The results demonstrate that dressing-related trauma is a clinically relevant concept. The main types of dressing-related trauma concepts included skin reactions, adherence to the wound, skin stripping, maceration, drying, and plugging of the wound. These were the foundation for a number of clinical sequelae, including wound enlargement, increased exudate, bleeding, infection, pain, itching/excoriation, edema, dermatitis, inflammation, and anxiety. Mean total costs range from £56 to £175 for the complete onward management of each occurrence of the six main concepts.Conclusion: These results provide insight into the hidden costs of dressing-related trauma in a UK setting. This research successfully conceptualized

  11. Chance Encounters: Rap Music as a Relational and Pedagogical Resource in Clinical Pastoral Education. (United States)

    Gilmore, Jeremy


    Music has long been regarded as a valuable tool for educators. Over the last three decades, rap music has grown to become a global phenomenon. However, due to historical and cultural factors, rap music is often underutilized in Clinical Pastoral Education. This article discusses the social significance of rap music, highlights how rap music informed my supervision of a clinical pastoral education student, and examines Chance the Rapper's mixtape Coloring Book as a case study on the utilization of rap music as a relational and pedagogical resource in spiritual education.

  12. Interleukin-1 antagonism moderates the inflammatory state associated with Type 1 diabetes during clinical trials conducted at disease onset. (United States)

    Cabrera, Susanne M; Wang, Xujing; Chen, Yi-Guang; Jia, Shuang; Kaldunski, Mary L; Greenbaum, Carla J; Mandrup-Poulsen, Thomas; Hessner, Martin J


    It was hypothesized that IL-1 antagonism would preserve β-cell function in new onset Type 1 diabetes (T1D). However, the Anti-Interleukin-1 in Diabetes Action (AIDA) and TrialNet Canakinumab (TN-14) trials failed to show efficacy of IL-1 receptor antagonist (IL-1Ra) or canakinumab, as measured by stimulated C-peptide response. Additional measures are needed to define immune state changes associated with therapeutic responses. Here, we studied these trial participants with plasma-induced transcriptional analysis. In blinded analyses, 70.2% of AIDA and 68.9% of TN-14 participants were correctly called to their treatment arm. While the transcriptional signatures from the two trials were distinct, both therapies achieved varying immunomodulation consistent with IL-1 inhibition. On average, IL-1 antagonism resulted in modest normalization relative to healthy controls. At endpoint, signatures were quantified using a gene ontology-based inflammatory index, and an inverse relationship was observed between measured inflammation and stimulated C-peptide response in IL-1Ra- and canakinumab-treated patients. Cytokine neutralization studies showed that IL-1α and IL-1β additively contribute to the T1D inflammatory state. Finally, analyses of baseline signatures were indicative of later therapeutic response. Despite the absence of clinical efficacy by IL-1 antagonist therapy, transcriptional analysis detected immunomodulation and may yield new insight when applied to other clinical trials. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features




    Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to...

  14. Clinical Correlations With Lewy Body Pathology in LRRK2-Related Parkinson Disease (United States)

    Kalia, Lorraine V.; Lang, Anthony E.; Hazrati, Lili-Naz; Fujioka, Shinsuke; Wszolek, Zbigniew K.; Dickson, Dennis W.; Ross, Owen A.; Van Deerlin, Vivianna M.; Trojanowski, John Q.; Hurtig, Howard I.; Alcalay, Roy N.; Marder, Karen S.; Clark, Lorraine N.; Gaig, Carles; Tolosa, Eduardo; Ruiz-Martínez, Javier; Marti-Masso, Jose F.; Ferrer, Isidre; de Munain, Adolfo López; Goldman, Samuel M.; Schüle, Birgitt; Langston, J. William; Aasly, Jan O.; Giordana, Maria T.; Bonifati, Vincenzo; Puschmann, Andreas; Canesi, Margherita; Pezzoli, Gianni; De Paula, Andre Maues; Hasegawa, Kazuko; Duyckaerts, Charles; Brice, Alexis; Stoessl, A. Jon; Marras, Connie


    IMPORTANCE Mutations in leucine-rich repeat kinase 2 (LRRK2) are the most common cause of genetic Parkinson disease (PD) known to date. The clinical features of manifesting LRRK2 mutation carriers are generally indistinguishable from those of patients with sporadic PD. However, some PD cases associated with LRRK2 mutations lack Lewy bodies (LBs), a neuropathological hallmark of PD. We investigated whether the presence or absence of LBs correlates with different clinical features in LRRK2-related PD. OBSERVATIONS We describe genetic, clinical, and neuropathological findings of 37 cases of LRRK2-related PD including 33 published and 4 unpublished cases through October 2013. Among the different mutations, the LRRK2 p.G2019S mutation was most frequently associated with LB pathology. Nonmotor features of cognitive impairment/dementia, anxiety, and orthostatic hypotension were correlated with the presence of LBs. In contrast, a primarily motor phenotype was associated with a lack of LBs. CONCLUSIONS AND RELEVANCE To our knowledge, this is the first report of clinicopathological correlations in a series of LRRK2-related PD cases. Findings from this selected group of patients with PD demonstrated that parkinsonian motor features can occur in the absence of LBs. However, LB pathology in LRRK2-related PD may be a marker for a broader parkinsonian symptom complex including cognitive impairment. PMID:25401511

  15. Clinical and pathological study on 10 cases of cerebral lobe hemorrhage related with cerebral amyloid angiopathy

    Directory of Open Access Journals (Sweden)

    Xiao-qi LI


    Full Text Available Objective To summarize the clinical data and pathological features of 10 cases of cerebral lobar hemorrhage related with cerebral amyloid angiopathy (CAA diagnosed pathologically, thereby to improve the knowledge and diagnosis of the disease. Methods The clinical data of 10 cases of cerebral lobar hemorrhage related with CAA, collected in the General Hospital of Shenyang Command from 1983 up to now, were retrospectively analyzed, and the clinical and neuropathological features of these cases were summarized. Results Of the 10 patients, 2 suffered from single lobar hemorrhage and 8 multiple lobar hemorrhage, all of them were confirmed pathologically to have ruptured into the subarachnoid space. Pathological examination revealed microaneurysm in 2 cases, "double barrel" change in 4 cases, multiple arteriolar clusters in 5 cases, obliterative onion-liked intima change in 4 cases, and fibrinoid necrosis of vessel wall in 7 cases. In addition, neurofibrillary tangles were found in 8 cases, and senile plaque was observed in 5 cases. Conclusions Cerebral lobar hemorrhage related with CAA is mainly located in the parietal, temporal and occipital lobes, readily breaking into the subarachnoid space, and it is often multiple and recurrent. The CAA associated microvasculopathy was found frequently in the autopsy sample of CAA related cerebral lobar hemorrhage, and it may contribute to the pathogenesis of cerebral hemorrhage. DOI: 10.11855/j.issn.0577-7402.2015.07.04


    Directory of Open Access Journals (Sweden)

    Cristian Moisoiu


    Full Text Available This paper is trying to present the hypothesis of nation-state’s return as a relevant actor in foreign relations. Globalization, together with pax Americana, as a main nuclei of globalization, have extrapolated the idea of natural order and market economy, as it seemed that any discussion related to the role of state becomes obsolete. The recent events, with political and economic resonance, the market failures and instability, which required interventionist measures of the state for recovery and stability, major changes and trends of political spectrum, especially in the Western world have contradicted the prospect of natural order. Nevertheless, the discussion surrounding the role of state in economy, the invigoration of nation-state in international relations with possible future implications is regaining momentum.

  17. Why Not Wait? Eight Institutions Share Their Experiences Moving United States Medical Licensing Examination Step 1 After Core Clinical Clerkships. (United States)

    Daniel, Michelle; Fleming, Amy; Grochowski, Colleen O'Conner; Harnik, Vicky; Klimstra, Sibel; Morrison, Gail; Pock, Arnyce; Schwartz, Michael L; Santen, Sally


    The majority of medical students complete the United States Medical Licensing Examination Step 1 after their foundational sciences; however, there are compelling reasons to examine this practice. This article provides the perspectives of eight MD-granting medical schools that have moved Step 1 after the core clerkships, describing their rationale, logistics of the change, outcomes, and lessons learned. The primary reasons these institutions cite for moving Step 1 after clerkships are to foster more enduring and integrated basic science learning connected to clinical care and to better prepare students for the increasingly clinical focus of Step 1. Each school provides key features of the preclerkship and clinical curricula and details concerning taking Steps 1 and 2, to allow other schools contemplating change to understand the landscape. Most schools report an increase in aggregate Step 1 scores after the change. Despite early positive outcomes, there may be unintended consequences to later scheduling of Step 1, including relatively late student reevaluations of their career choice if Step 1 scores are not competitive in the specialty area of their choice. The score increases should be interpreted with caution: These schools may not be representative with regard to mean Step 1 scores and failure rates. Other aspects of curricular transformation and rising national Step 1 scores confound the data. Although the optimal timing of Step 1 has yet to be determined, this article summarizes the perspectives of eight schools that changed Step 1 timing, filling a gap in the literature on this important topic.

  18. Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome. Dutch Guillain-Barré study group

    NARCIS (Netherlands)

    L.H. Visser (Leendert); F.G.A. van der Meché (Frans); J. Meulstee (Jan); P.A. van Doorn (Pieter)


    textabstractThe risk factors for treatment related clinical fluctuations, relapses occurring after initial therapeutic induced stabilisation or improvement, were evaluated in a group of 172 patients with Guillain-Barre syndrome. Clinical, laboratory, and electrodiagnostic features

  19. Physical therapists' perceptions of sexual boundaries in clinical practice in the United States. (United States)

    Roush, Susan E; Cox, Kenneth; Garlick, John; Kane, Molly; Marchand, Lauren


    Physical therapists' perceptions of sexual boundaries in clinic settings in the United States have not been studied. Given the magnitude of potential consequences of sexual boundary violations, examination of this topic is imperative. The purpose of this study was to describe the perceptions of sexual boundaries among licensed physical therapists in the United States. Licensed physical therapists from Arkansas, Kansas, Maine, Ohio, and Oregon were contacted by email and asked to complete a sexual boundaries questionnaire via Survey Monkey™; 967 surveys (7.3%) were returned. While most physical therapists practice within the profession's Code of Ethics, there are practitioners who date current and former patients, and condone patients' sexual banter in the clinic. Almost half (42%) of the participants acknowledged feeling sexually attracted to a patient. While gender differences were seen throughout the analyses, generally, the demographic and professional variables did not account for meaningful variance. Results were similar to previous research on physiotherapists in other countries. Sexuality is part of the physical therapy practice environment and physical therapists' understanding of sexual boundaries is ambiguous. These data can inform professional conversation on sexual boundaries in physical therapy practice leading to greater understanding and decreased potential for violations.


    Directory of Open Access Journals (Sweden)

    O. N. Semenova


    Full Text Available Aim. To study the differences in views on treatment among patients with cardiovascular diseases in state and private outpatient clinics, as well as the motivation for choosing one of these outpatient clinics.Material and methods. Anonymous and voluntary survey of cardiology patients (n=90 in 2 state (57.7% and 3 private outpatient clinics (42.2% was conducted in Saratov.Results. 33.3% of respondents were men; the median age was 65 years. Patients of state outpatient clinics were more likely to have retirement age (p=0.0008, low income (p=0.0006, history of hypertensive crises (p=0.0129 and chronic heart failure (p=0.0001. Patients of private outpatient clinics were more likely to have mental work (p=0.0001, higher education (p=0.0001, moderate income (p=0.0006. The difference in views on the disease and the attitude towards a doctor among patients of state and private clinics was shown.Conclusion. Patients of private outpatient clinics were more active, young, aimed at continuation of life. They are more likely to have higher education, mental work and moderate income. Patients of state outpatient clinics are "infatuated with their illness"; it is their “lifestyle”. Paternalistic model of communication with doctors is expressed in all the patients.

  1. Identification of Action Units Related to Affective States in a Tutoring System for Mathematics (United States)

    Padrón-Rivera, Gustavo; Rebolledo-Mendez, Genaro; Parra, Pilar Pozos; Huerta-Pacheco, N. Sofia


    Affect is an important element of the learning process both in the classroom and with educational technology. This paper presents analyses in relation to the identification of Action Units (AUs) related to affective states and their impact on learning with a tutoring system. To assess affect, a tool was devised to identify AUs on pictures of human…

  2. Survey of Indian issues in the state of New Mexico relating to uranium mining and milling

    International Nuclear Information System (INIS)

    Vandevender, S.G.; Barsumian, L.; Gurbaxani, S.H.


    Estimates of Indian uranium resources range from 11 to 50% of the US total resources. About 17% of New Mexico's reserves are known to be on Indian lands. New Mexico has produced almost half of the nation's uranium supply; over half of the known reserves are located within the state. However, the state has virtually no jurisdiction over development of Indian uranium. As a result, economic and environmental impacts on the state are beyond its control. The lack of state and federal control over these impacts is influencing how the Indians allow development to proceed. The impacts of Indian uranium development also influence state control of non-Indian. To the extent that these controls affect the availability of uranium concentrate, DOE needs to understand the issues involved. This issue paper identifies some of the related problems for both the Indians and the state and explores the reasons behind them

  3. Patterns of clinical care in radiation therapy in the United States

    International Nuclear Information System (INIS)

    Kramer, S.


    Results of the first nationwide evaluation of radiation therapy in the United States with respect to its quality and accessibility are presented. The Patterns of Care Study (PCS) is financially supported by the National Cancer Institute and has served as a model for other oncology-related disciplines. The PCS has determined criteria by which to evaluate radiation therapy care in 10 disease sites in which curative radiation therapy plays a major role. The sampling design identified the institution to be surveyed and included all types of practice in the U.S. This paper examines results related to carcinomas of the cervix, larynx and prostate

  4. Time Reversibility, Correlation Decay and the Steady State Fluctuation Relation for Dissipation

    Directory of Open Access Journals (Sweden)

    Denis J. Evans


    Full Text Available Steady state fluctuation relations for nonequilibrium systems are under intense investigation because of their important practical implications in nanotechnology and biology. However the precise conditions under which they hold need clarification. Using the dissipation function, which is related to the entropy production of linear irreversible thermodynamics, we show time reversibility, ergodic consistency and a recently introduced form of correlation decay, called T-mixing, are sufficient conditions for steady state fluctuation relations to hold. Our results are not restricted to a particular model and show that the steady state fluctuation relation for the dissipation function holds near or far from equilibrium subject to these conditions. The dissipation function thus plays a comparable role in nonequilibrium systems to thermodynamic potentials in equilibrium systems.

  5. Fundamental concepts and relations for reliability analysis of multi-state systems

    International Nuclear Information System (INIS)

    Murchland, J.D.


    The fundamental concepts and relations that should be used in the reliability analysis of systems with numerous components are discussed, with an emphasis on calculable quantities. These are: (1) the average probability of being in a state, (2) the average transition rates between states, in the long run or as time functions, and (3) the integrals of the transition rates, which are the expected numbers of transitions. These quantities are related by the net transition relations, and the calculationally vital transition rate relation when the inputs of an item are statistically independent. Assumptions necessary for the existence of these quantities and for the relations are listed, and proofs given. The importance of exploiting the closeness to ''simple'' structure which systems may possess, and the versatility for different problems of a computational technique of ''reduction'' and ''expansion'' are discussed. The key relations for the latter are formally derived. Applications are made to fault trees, structure networks, undirected and directed communication networks

  6. Clinical Applications of a CT Window Blending Algorithm: RADIO (Relative Attenuation-Dependent Image Overlay). (United States)

    Mandell, Jacob C; Khurana, Bharti; Folio, Les R; Hyun, Hyewon; Smith, Stacy E; Dunne, Ruth M; Andriole, Katherine P


    A methodology is described using Adobe Photoshop and Adobe Extendscript to process DICOM images with a Relative Attenuation-Dependent Image Overlay (RADIO) algorithm to visualize the full dynamic range of CT in one view, without requiring a change in window and level settings. The potential clinical uses for such an algorithm are described in a pictorial overview, including applications in emergency radiology, oncologic imaging, and nuclear medicine and molecular imaging.

  7. Interhemispheric functional connectivity and its relationships with clinical characteristics in major depressive disorder: a resting state fMRI study.

    Directory of Open Access Journals (Sweden)

    Li Wang

    Full Text Available BACKGROUND: Abnormalities in large-scale, structural and functional brain connectivity have been increasingly reported in patients with major depressive disorder (MDD. However, MDD-related alterations in functional interaction between the cerebral hemispheres are still not well understood. Resting state fMRI, which reveals spontaneous neural fluctuations in blood oxygen level dependent signals, provides a means to detect interhemispheric functional coherence. We examined the resting state functional connectivity (RSFC between the two hemispheres and its relationships with clinical characteristics in MDD patients using a recently proposed measurement named "voxel-mirrored homotopic connectivity (VMHC". METHODOLOGY/PRINCIPAL FINDINGS: We compared the interhemispheric RSFC, computed using the VMHC approach, of seventeen first-episode drug-naive patients with MDD and seventeen healthy controls. Compared to the controls, MDD patients showed significant VMHC decreases in the medial orbitofrontal gyrus, parahippocampal gyrus, fusiform gyrus, and occipital regions including the middle occipital gyrus and cuneus. In MDD patients, a negative correlation was found between VMHC of the fusiform gyrus and illness duration. Moreover, there were several regions whose VMHC showed significant negative correlations with the severity of cognitive disturbance, including the prefrontal regions, such as middle and inferior frontal gyri, and two regions in the cereballar crus. CONCLUSIONS/SIGNIFICANCE: These findings suggest that the functional coordination between homotopic brain regions is impaired in MDD patients, thereby providing new evidence supporting the interhemispheric connectivity deficits of MDD. The significant correlations between the VMHC and clinical characteristics in MDD patients suggest potential clinical implication of VMHC measures for MDD. Interhemispheric RSFC may serve as a useful screening method for evaluating MDD where neural connectivity is

  8. Baseline brain activity changes in patients with clinically isolated syndrome revealed by resting-state functional MRI

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Yaou; Duan, Yunyun; Liang, Peipeng; Jia, Xiuqin; Yu, Chunshui [Dept. of Radiology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Ye, Jing [Dept. of Neurology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Butzkueven, Helmut [Dept. of Medicine, Univ. of Melbourne, Melbourne (Australia); Dong, Huiqing [Dept. of Neurology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Li, Kuncheng [Dept. of Radiology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Beijing Key Laboratory of MRI and Brain Informatics, Beijing (China)], E-mail:


    Background A clinically isolated syndrome (CIS) is the first manifestation of multiple sclerosis (MS). Previous task-related functional MRI studies demonstrate functional reorganization in patients with CIS. Purpose To assess baseline brain activity changes in patients with CIS by using the technique of regional amplitude of low frequency fluctuation (ALFF) as an index in resting-state fMRI. Material and Methods Resting-state fMRIs data acquired from 37 patients with CIS and 37 age- and sex-matched normal controls were compared to investigate ALFF differences. The relationships between ALFF in regions with significant group differences and the EDSS (Expanded Disability Status Scale), disease duration, and T2 lesion volume (T2LV) were further explored. Results Patients with CIS had significantly decreased ALFF in the right anterior cingulate cortex, right caudate, right lingual gyrus, and right cuneus (P < 0.05 corrected for multiple comparisons using Monte Carlo simulation) compared to normal controls, while no significantly increased ALFF were observed in CIS. No significant correlation was found between the EDSS, disease duration, T2LV, and ALFF in regions with significant group differences. Conclusion In patients with CIS, resting-state fMRI demonstrates decreased activity in several brain regions. These results are in contrast to patients with established MS, in whom ALFF demonstrates several regions of increased activity. It is possible that this shift from decreased activity in CIS to increased activity in MS could reflect the dynamics of cortical reorganization.

  9. Formation of UAE State and Factors for Development of International Relations between UAE and African Countries

    Directory of Open Access Journals (Sweden)

    A K Voronkov


    Full Text Available The article focuses on analyses of formation of UAE state and features formation of international relations between UAE and African countries including low level of political and economic ties between UAE and African countries and dominant role of economic and humanitarian assistance in their relations provided both through international organizations and on bilateral basis by Abu Dhabi Fund for Development. Islam and traditional values of Arab culture are considered defining factors for formation of such structure of international relations.

  10. Tic-Related Versus Tic-Free Obsessive-Compulsive Disorder : Clinical Picture and 2-Year Natural Course

    NARCIS (Netherlands)

    de Vries, Froukje E; Cath, Danielle C; Hoogendoorn, Adriaan W; van Oppen, Patricia; Glas, Gerrit; Veltman, Dick J; van den Heuvel, Odile A; van Balkom, Anton J L M


    OBJECTIVE: The tic-related subtype of obsessive-compulsive disorder (OCD) has a distinct clinical profile. The course of tic-related OCD has previously been investigated in treatment studies, with inconclusive results. This study aimed to compare clinical profiles between tic-related and tic-free

  11. Risk factors related to heartburn in pregnant women attending the antenatal care clinic, Rajavithi Hospital. (United States)

    Kovavisarach, Ekachai; Phromsila, Raweewan


    To determine the risk factors related to heartburn in pregnant women attending the antenatal care clinic, Rajavithi Hospital. Self-reporting questionnaire about demographic data and risk factors related to heartburn in those pregnant women between May 1 and July 31, 2010. Heartburn was found in 55 out of 452 pregnant women (12.2%). There were no significant differences in demographic characteristics and risk factors between the heartburn and non-heartburn groups. Consumption of alcoholic drinks was a reversely significant risk factor of heartburn (OR 0.11, CI 0.01 to 0.78) (p = 0.005). Heartburn was not uncommon, and no associated factors were demonstrated.

  12. Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression. (United States)

    Nordanskog, P; Larsson, M R; Larsson, E-M; Johanson, A


    In a previous magnetic resonance imaging (MRI) study, we found a significant increase in hippocampal volume immediately after electroconvulsive therapy (ECT) in patients with depression. The aim of this study was to evaluate hippocampal volume up to 1 year after ECT and investigate its possible relation to clinical and cognitive outcome. Clinical and cognitive outcome in 12 in-patients with depression receiving antidepressive pharmacological treatment referred for ECT were investigated with the Montgomery-Asberg Depression Rating Scale (MADRS) and a broad neuropsychological test battery within 1 week before and after ECT. The assessments were repeated 6 and 12 months after baseline in 10 and seven of these patients, respectively. Hippocampal volumes were measured on all four occasions with 3 Tesla MRI. Hippocampal volume returned to baseline during the follow-up period of 6 months. Neither the significant antidepressant effect nor the significant transient decrease in executive and verbal episodic memory tests after ECT could be related to changes in hippocampal volume. No persistent cognitive side effects were observed 1 year after ECT. The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome. © 2013 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

  13. Clinical efficacy of Ranibizumab in the treatment of wet age-related macular degeneration

    Directory of Open Access Journals (Sweden)

    Ling-Jun Wei


    Full Text Available AIM:To analyze the clinical efficacy of Ranibizumab in the treatment of wet age-related macular degeneration(ARMD.METHODS: Clinical data of patients with wet age-related macular degeneration received treatment of ranibizumab at our hospital from 2015 to 2017 were analyzed. At 1mo after treatment, the clinical efficacy, ocular hemodynamics and ocular inflammation were evaluated. RESULTS: A total of 41 patients were analyzed. After treatment, patients got significantly increased in LogMAR(0.651±0.067 vs 0.321±0.049; t=25.460, Pvs 452.9±69.8μm; t=15.740, Pvs 16.1±3.5ng/L; t=3.563, Pvs 13.8±2.5ng/L; t=3.467, PP>0.05. CONCLUSION: In the treatment of wet age-related macular degeneration, the ranibizumab shows a good therapeutic effect without serious adverse drug reactions.

  14. Parkinson's disease-related fatigue: A case definition and recommendations for clinical research. (United States)

    Kluger, Benzi M; Herlofson, Karen; Chou, Kelvin L; Lou, Jau-Shin; Goetz, Christopher G; Lang, Anthony E; Weintraub, Daniel; Friedman, Joseph


    Fatigue is one of the most common and disabling symptoms in Parkinson's disease (PD). Since fatigue was first described as a common feature of PD 20 years ago, little progress has been made in understanding its causes or treatment. Importantly, PD patients attending the 2013 World Parkinson Congress voted fatigue as the leading symptom in need of further research. In response, the Parkinson Disease Foundation and ProjectSpark assembled an international team of experts to create recommendations for clinical research to advance this field. The working group identified several areas in which shared standards would improve research quality and foster progress including terminology, diagnostic criteria, and measurement. Terminology needs to (1) clearly distinguish fatigue from related phenomena (eg, sleepiness, apathy, depression); (2) differentiate subjective fatigue complaints from objective performance fatigability; and (3) specify domains affected by fatigue and causal factors. We propose diagnostic criteria for PD-related fatigue to guide participant selection for clinical trials and add rigor to mechanistic studies. Recommendations are made for measurement of subjective fatigue complaints, performance fatigability, and neurophysiologic changes. We also suggest areas in which future research is needed to address methodological issues and validate or optimize current practices. Many limitations in current PD-related fatigue research may be addressed by improving methodological standards, many of which are already being successfully applied in clinical fatigue research in other medical conditions (eg, cancer, multiple sclerosis). © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  15. Relating dynamic brain states to dynamic machine states: Human and machine solutions to the speech recognition problem.

    Directory of Open Access Journals (Sweden)

    Cai Wingfield


    Full Text Available There is widespread interest in the relationship between the neurobiological systems supporting human cognition and emerging computational systems capable of emulating these capacities. Human speech comprehension, poorly understood as a neurobiological process, is an important case in point. Automatic Speech Recognition (ASR systems with near-human levels of performance are now available, which provide a computationally explicit solution for the recognition of words in continuous speech. This research aims to bridge the gap between speech recognition processes in humans and machines, using novel multivariate techniques to compare incremental 'machine states', generated as the ASR analysis progresses over time, to the incremental 'brain states', measured using combined electro- and magneto-encephalography (EMEG, generated as the same inputs are heard by human listeners. This direct comparison of dynamic human and machine internal states, as they respond to the same incrementally delivered sensory input, revealed a significant correspondence between neural response patterns in human superior temporal cortex and the structural properties of ASR-derived phonetic models. Spatially coherent patches in human temporal cortex responded selectively to individual phonetic features defined on the basis of machine-extracted regularities in the speech to lexicon mapping process. These results demonstrate the feasibility of relating human and ASR solutions to the problem of speech recognition, and suggest the potential for further studies relating complex neural computations in human speech comprehension to the rapidly evolving ASR systems that address the same problem domain.

  16. Aerosol container-related eye injuries in the United States: 1997-2009. (United States)

    Seidman, Carly J; Linakis, James G; Mello, Michael J; Greenberg, Paul B


    To quantify and characterize eye injuries related to aerosol container consumer products treated in United States hospital emergency departments (EDs) from 1997 through 2009. Retrospective study. Descriptive analysis of aerosol container-related eye injury data derived from the National Electronic Injury Surveillance System, a stratified probability sample of hospital-affiliated United States EDs. Data collected included demographic variables (gender and age), locale, diagnoses, and hospital disposition associated with aerosol container-related eye injuries treated in United States EDs from 1997 through 2009. Products associated with injury and mechanisms of injury also were extracted and analyzed. There were an estimated 10 765 (95% confidence interval [CI], 9842 to 11 688) visits to United States EDs for aerosol container-related eye injuries during the study period; 6756 (95% CI, 5771 to 7742; 63%) patients were male; 5927 (95% CI, 4956 to 6897; 55%) injuries occurred in children (age container-related eye injuries in the United States occur in men and children and that self-inflicted spray to the eye is the most common mechanism of injury. Further research is needed to devise effective prevention strategies for these types of injuries. Published by Elsevier Inc.

  17. Markers of neuroinflammation and neuronal injury in bipolar disorder: Relation to prospective clinical outcomes. (United States)

    Isgren, Anniella; Sellgren, Carl; Ekman, Carl-Johan; Holmén-Larsson, Jessica; Blennow, Kaj; Zetterberg, Henrik; Jakobsson, Joel; Landén, Mikael


    Neuroimmune mechanisms have been linked to the pathophysiology of bipolar disorder based on studies of biomarkers in plasma, cerebrospinal fluid (CSF), and postmortem brain tissue. There are, however, no longitudinal studies investigating if CSF markers of neuroinflammation and neuronal injury predict clinical outcomes in patients with bipolar disorder. We have in previous studies found higher CSF concentrations of interleukin-8 (IL-8), monocyte chemoattractant protein 1 (MCP-1/CCL-2), chitinase-3-like protein 1 (CHI3L1/YKL-40), and neurofilament light chain (NF-L) in euthymic patients with bipolar disorder compared with controls. Here, we investigated the relationship of these CSF markers of neuroinflammation and neuronal injury with clinical outcomes in a prospective study. 77 patients with CSF analyzed at baseline were followed for 6-7years. Associations of baseline biomarkers with clinical outcomes (manic/hypomanic and depressive episodes, suicide attempts, psychotic symptoms, inpatient care, GAF score change) were investigated. Baseline MCP-1 concentrations were positively associated with manic/hypomanic episodes and inpatient care during follow-up. YKL-40 concentrations were negatively associated with manic/hypomanic episodes and with occurrence of psychotic symptoms. The prospective negative association between YKL-40 and manic/hypomanic episodes survived multiple testing correction. Concentrations of IL-8 and NF-L were not associated with clinical outcomes. High concentrations of these selected CSF markers of neuroinflammation and neuronal injury at baseline were not consistently associated with poor clinical outcomes in this prospective study. The assessed proteins may be involved in adaptive immune processes or reflect a state of vulnerability for bipolar disorder rather than being of predictive value for disease progression. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Setting Up an ePathology Service at Cleveland Clinic Abu Dhabi: Joint Collaboration With Cleveland Clinic, United States. (United States)

    Nahal, Ayoub; Batac, Crystal Mildred O; Slaw, Renee J; Bauer, Thomas W


    - The production of whole slide images is the most advanced form of digital pathology, in which a high-resolution digital scanner is used to rapidly scan glass microscope slides and produce a computer-generated whole slide image that can be saved, stored in a network-attached storage device, and accessed through slide management software within the hospital domain and remotely by authorized users. Digital transformation of glass slides has revolutionized the practice of anatomic pathology by facilitating and expediting consultative services, improving clinical workflow, and becoming an indispensable tool in education and research. - To highlight the institutional need of Cleveland Clinic Abu Dhabi (Abu Dhabi, United Arab Emirates) and the cultural background for obtaining the United Arab Emirates' first comprehensive digital pathology program; to describe a multiphase road map for achieving full implementation of this platform; and to describe the system's clinical applications and its future potential growth. - At Cleveland Clinic Abu Dhabi, we prioritized our efforts to initiate digital consultations (eConsultations) and digital immunohistochemistry services (eIHC) with Cleveland Clinic Laboratories (Cleveland, Ohio). After this, we established an internal archiving system together with a subspecialty-based, organ-specific digital library of pathologic diseases. - We describe the strategic adoption and implementation of digital pathology into the clinical workflow of the pathology and laboratory medicine institute of Cleveland Clinic Abu Dhabi, and we highlight its impact on clinical operations, educational activities, and patient care.

  19. Lower Functional Connectivity of the Periaqueductal Gray Is Related to Negative Affect and Clinical Manifestations of Fibromyalgia

    Directory of Open Access Journals (Sweden)

    Marie-Andrée Coulombe


    Full Text Available Fibromyalgia (FM syndrome is characterized by chronic widespread pain, muscle tenderness and emotional distress. Previous studies found reduced endogenous pain modulation in FM. This deficiency of pain modulation may be related to the attributes of chronic pain and other clinical symptoms experienced in patients with FM. Thus, we tested whether there is a link between the clinical symptoms of FM and functional connectivity (FC of the periaqueductal gray (PAG, a key node of pain modulation. We acquired resting state 3T functional MRI (rsfMRI data from 23 female patients with FM and 16 age- and sex- matched healthy controls (HC and assessed FM symptoms with the Brief Pain Inventory (BPI, Fibromyalgia Impact Questionnaire (FIQ, Hospital Anxiety and Depression Scale (HADS and Pain Catastrophizing Scale (PCS. We found that patients with FM exhibit statistically significant disruptions in PAG FC, particularly with brain regions implicated in negative affect, self-awareness and saliency. Specifically, we found that, compared to HCs, the FM patients had stronger PAG FC with the lingual gyrus and hippocampus but weaker PAG FC with regions associated with motor/executive functions, the salience (SN and default mode networks (DMN. The attenuated PAG FC was also negatively correlated with FIQ scores, and positively correlated with the magnification subscale of the PCS. These alterations were correlated with emotional and behavioral symptoms of FM. Our study implicates the PAG as a site of dysfunction contributing to the clinical manifestations and pain in FM.

  20. Expanding the "ports of entry" for speech-language pathologists: a relational and reflective model for clinical practice. (United States)

    Geller, Elaine; Foley, Gilbert M


    To outline an expanded framework for clinical practice in speech-language pathology. This framework broadens the focus on discipline-specific knowledge and infuses mental health constructs within the study of communication sciences and disorders, with the objective of expanding the potential "ports or points of entry" (D. Stern, 1995) for clinical intervention with young children who are language impaired. Specific mental health constructs are highlighted in this article. These include relationship-based learning, attachment theory, working dyadically (the client is the child and parent), reflective practice, transference-countertransference, and the use of self. Each construct is explored as to the way it has been applied in traditional and contemporary models of clinical practice. The underlying premise in this framework is that working from a relationally based and reflective perspective augments change and growth in both client and parent(s). The challenge is for speech-language pathologists to embed mental health constructs within their discipline-specific expertise. This leads to paying attention to both observable aspects of clients' behaviors as well as their internal affective states.

  1. Relative clinical effectiveness of carbon ion radiotherapy. Theoretical modelling for H and N tumours

    International Nuclear Information System (INIS)

    Antonovic, Laura; Toma-Dasu, Iuliana; Dasu, Alexandru; Furusawa, Yoshiya


    Comparison of the efficiency of photon and carbon ion radiotherapy (RT) administered with the same number of fractions might be of limited clinical interest, since a wide range of fractionation patterns are used clinically today. Due to advanced photon treatment techniques, hypofractionation is becoming increasingly accepted for prostate and lung tumours, whereas patients with head and neck tumours still benefit from hyperfractionated treatments. In general, the number of fractions is considerably lower in carbon ion RT. A clinically relevant comparison would be between fractionation schedules that are optimal within each treatment modality category. In this in silico study, the relative clinical effectiveness (RCE) of carbon ions was investigated for human salivary gland tumours, assuming various radiation sensitivities related to their oxygenation. The results indicate that, for hypoxic tumours in the absence of reoxygenation, the RCE (defined as the ratio of D 50 for photons to carbon ions) ranges from 3.5 to 5.7, corresponding to carbon ion treatments given in 36 and 3 fractions, respectively, and 30 fractions for photons. Assuming that interfraction local oxygenation changes take place, results for RCE are lower than that for an oxic tumour if only a few fractions of carbon ions are used. If the carbon ion treatment is given in more than 12 fractions, the RCE is larger for the hypoxic than for the well-oxygenated tumour. In conclusion, this study showed that in silico modelling enables the study of a wide range of factors in the clinical considerations and could be an important step towards individualisation of RT treatments. (author)

  2. Clinical Management of Ebola Virus Disease in the United States and Europe. (United States)

    Uyeki, Timothy M; Mehta, Aneesh K; Davey, Richard T; Liddell, Allison M; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R; Evans, Laura; Hewlett, Angela L; Brantsaeter, Arne B; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie


    Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal

  3. Divergent cellular responses during asymptomatic subclinical and clinical states of disease in cows naturally infected with Mycobacterium avium subsp. paratuberculosis (United States)

    Infection of the host with Mycobacterium avium subsp. paratuberculosis (MAP) results in a chronic and progressive enteritis that traverses both subclinical and clinical stages. The mechanism(s) for the shift from asymptomatic subclinical disease state to advanced clinical disease are not fully under...

  4. Preschool-aged children’s understanding of gratitude: Relations with emotion and mental state knowledge (United States)

    Nelson, Jackie A.; de Lucca Freitas, Lia Beatriz; O’Brien, Marion; Calkins, Susan D.; Leerkes, Esther M.; Marcovitch, Stuart


    Developmental precursors to children’s early understanding of gratitude were examined. A diverse group of 263 children were tested for emotion and mental state knowledge at ages 3 and 4, and their understanding of gratitude was measured at age 5. Children varied widely in their understanding of gratitude, but most understood some aspects of gratitude-eliciting situations. A model-building path analysis approach was used to examine longitudinal relations among early emotion and mental state knowledge and later understanding of gratitude. Children with a better early understanding of emotions and mental states understand more about gratitude. Mental state knowledge at age 4 mediated the relation between emotion knowledge at age 3 and gratitude understanding at age 5. The current study contributes to the scant literature on the early emergence of children’s understanding of gratitude. PMID:23331105

  5. Number-Phase Wigner Representation and Entropic Uncertainty Relations for Binomial and Negative Binomial States

    International Nuclear Information System (INIS)

    Amitabh, J.; Vaccaro, J.A.; Hill, K.E.


    We study the recently defined number-phase Wigner function S NP (n,θ) for a single-mode field considered to be in binomial and negative binomial states. These states interpolate between Fock and coherent states and coherent and quasi thermal states, respectively, and thus provide a set of states with properties ranging from uncertain phase and sharp photon number to sharp phase and uncertain photon number. The distribution function S NP (n,θ) gives a graphical representation of the complimentary nature of the number and phase properties of these states. We highlight important differences between Wigner's quasi probability function, which is associated with the position and momentum observables, and S NP (n,θ), which is associated directly with the photon number and phase observables. We also discuss the number-phase entropic uncertainty relation for the binomial and negative binomial states and we show that negative binomial states give a lower phase entropy than states which minimize the phase variance

  6. Novel Variants in Individuals with RYR1-Related Congenital Myopathies: Genetic, Laboratory, and Clinical Findings

    Directory of Open Access Journals (Sweden)

    Joshua J. Todd


    Full Text Available The ryanodine receptor 1-related congenital myopathies (RYR1-RM comprise a spectrum of slow, rare neuromuscular diseases. Affected individuals present with a mild-to-severe symptomatology ranging from proximal muscle weakness, hypotonia and joint contractures to scoliosis, ophthalmoplegia, and respiratory involvement. Although there is currently no FDA-approved treatment for RYR1-RM, our group recently conducted the first clinical trial in this patient population (NCT02362425. This study aimed to characterize novel RYR1 variants with regard to genetic, laboratory, muscle magnetic resonance imaging (MRI, and clinical findings. Genetic and histopathology reports were obtained from participant’s medical records. Alamut Visual Software was used to determine if participant’s variants had been previously reported and to assess predicted pathogenicity. Physical exams, pulmonary function tests, T1-weighted muscle MRI scans, and blood measures were completed during the abovementioned clinical trial. Six novel variants (two de novo, three dominant, and one recessive were identified in individuals with RYR1-RM. Consistent with established RYR1-RM histopathology, cores were observed in all biopsies, except Case 6 who exhibited fiber-type disproportion. Muscle atrophy and impaired mobility with Trendelenburg gait were the most common clinical symptoms and were identified in all cases. Muscle MRI revealed substantial inter-individual variation in fatty infiltration corroborating the heterogeneity of the disease. Two individuals with dominant RYR1 variants exhibited respiratory insufficiency: a clinical symptom more commonly associated with recessive RYR1-RM cases. This study demonstrates that a genetics-led approach is suitable for the diagnosis of suspected RYR1-RM which can be corroborated through histopathology, muscle MRI and clinical examination.

  7. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings

    International Nuclear Information System (INIS)

    Robinson, P.; Barron, D.A.; Grainger, A.J.; O'Connor, P.J.; Parsons, W.; Schilders, E.M.G.


    To evaluate gadolinium-enhanced MR imaging in athletes with chronic groin pain and correlate with the clinical features. MR examinations performed in 52 athletes (51 male, 1 female; median age 26 years) with chronic groin pain and 6 asymptomatic control athletes (6 male; median age 29 years) were independently reviewed by two radiologists masked to the clinical details. Symptom duration (median 6 months) and clinical side of severity were recorded. Anatomical areas in the pelvis were scored for abnormality (as normal, mildly abnormal or abnormal) and an overall assessment for side distribution of abnormality was recorded, initially without post-gadolinium sequences and then, 3 weeks later (median 29 days), the post-gadolinium sequences only. Correlation between radiological and clinical abnormality was calculated by Spearman's correlation. Abnormal anterior pubis and enthesis enhancement significantly correlated with clinical side for both radiologists (both P=0.008). Abnormal anterior pubis and adductor longus enthesis oedema was significant for one radiologist (P=0.009). All other features showed no significant correlation (P>0.05). In the control cases there was no soft tissue abnormality but symphyseal irregularity was present (n=2). For both radiologists assessment of imaging side severity significantly correlated with clinical side for post-gadolinium (P=0.048 and P=0.023) but not non-gadolinium sequences (P>0.05). The extent and side of anterior pubis and adductor longus enthesis abnormality on MR imaging significantly and reproducibly correlates with the athletes' current symptoms in chronic adductor-related groin pain. (orig.)

  8. Prospective Genomic Profiling of Prostate Cancer Across Disease States Reveals Germline and Somatic Alterations That May Affect Clinical Decision Making. (United States)

    Abida, Wassim; Armenia, Joshua; Gopalan, Anuradha; Brennan, Ryan; Walsh, Michael; Barron, David; Danila, Daniel; Rathkopf, Dana; Morris, Michael; Slovin, Susan; McLaughlin, Brigit; Curtis, Kristen; Hyman, David M; Durack, Jeremy C; Solomon, Stephen B; Arcila, Maria E; Zehir, Ahmet; Syed, Aijazuddin; Gao, Jianjiong; Chakravarty, Debyani; Vargas, Hebert Alberto; Robson, Mark E; Joseph, Vijai; Offit, Kenneth; Donoghue, Mark T A; Abeshouse, Adam A; Kundra, Ritika; Heins, Zachary J; Penson, Alexander V; Harris, Christopher; Taylor, Barry S; Ladanyi, Marc; Mandelker, Diana; Zhang, Liying; Reuter, Victor E; Kantoff, Philip W; Solit, David B; Berger, Michael F; Sawyers, Charles L; Schultz, Nikolaus; Scher, Howard I


    A long natural history and a predominant osseous pattern of metastatic spread are impediments to the adoption of precision medicine in patients with prostate cancer. To establish the feasibility of clinical genomic profiling in the disease, we performed targeted deep sequencing of tumor and normal DNA from patients with locoregional, metastatic non-castrate, and metastatic castration-resistant prostate cancer (CRPC). Patients consented to genomic analysis of their tumor and germline DNA. A hybridization capture-based clinical assay was employed to identify single nucleotide variations, small insertions and deletions, copy number alterations and structural rearrangements in over 300 cancer-related genes in tumors and matched normal blood. We successfully sequenced 504 tumors from 451 patients with prostate cancer. Potentially actionable alterations were identified in DNA damage repair (DDR), PI3K, and MAP kinase pathways. 27% of patients harbored a germline or a somatic alteration in a DDR gene that may predict for response to PARP inhibition. Profiling of matched tumors from individual patients revealed that somatic TP53 and BRCA2 alterations arose early in tumors from patients who eventually developed metastatic disease. In contrast, comparative analysis across disease states revealed that APC alterations were enriched in metastatic tumors, while ATM alterations were specifically enriched in CRPC. Through genomic profiling of prostate tumors representing the disease clinical spectrum, we identified a high frequency of potentially actionable alterations and possible drivers of disease initiation, metastasis and castration-resistance. Our findings support the routine use of tumor and germline DNA profiling for patients with advanced prostate cancer, for the purpose of guiding enrollment in targeted clinical trials and counseling families at increased risk of malignancy.

  9. Linking public relations processes and organizational effectiveness at a state health department. (United States)

    Wise, Kurt


    This qualitative case study explored a state health department's relationships with strategic constituencies from a public relations perspective. The relationships were explored within the theoretical framework of the Excellence Theory, the dominant paradigm in public research. Findings indicate application of the Excellence Theory has the potential to increase organizational effectiveness at public health entities. With respect to the case investigated, findings indicate that the state health department could increase its organizational effectiveness through the adoption of recommendations based on the Excellence Theory.

  10. Relative entropy of excited states in two dimensional conformal field theories

    Energy Technology Data Exchange (ETDEWEB)

    Sárosi, Gábor [Department of Theoretical Physics, Institute of Physics, Budapest University of Technology,Budapest, H-1521 (Hungary); Ugajin, Tomonori [Kavli Institute for Theoretical Physics, University of California,Santa Barbara,CA 93106 (United States)


    We study the relative entropy and the trace square distance, both of which measure the distance between reduced density matrices of two excited states in two dimensional conformal field theories. We find a general formula for the relative entropy between two primary states with the same conformal dimension in the limit of a single small interval and find that in this case the relative entropy is proportional to the trace square distance. We check our general formulae by calculating the relative entropy between two generalized free fields and the trace square distance between the spin and disorder operators of the critical Ising model. We also give the leading term of the relative entropy in the small interval expansion when the two operators have different conformal dimensions. This turns out to be universal when the CFT has no primaires lighter than the stress tensor. The result reproduces the previously known special cases.

  11. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. (United States)

    Pittman, Joyce; Rawl, Susan M; Schmidt, C Max; Grant, Marcia; Ko, Clifford Y; Wendel, Christopher; Krouse, Robert S


    The purpose of this study is to describe demographic, clinical, and quality-of-life variables related to ostomy complications (skin irritation, leakage, and difficulty adjusting to an ostomy) in a veteran population in the United States. The original study employed a descriptive crosssectional study using a mixed method design. This secondary analysis used the quantitative data collected. Two hundred thirty-nine veterans with intestinal ostomies from 3 Veteran's Administration hospitals participated in the study. Instruments used for this investigation included the City of Hope Quality of Life: Ostomy Instrument. Demographic and medical history data were collected from the survey, the Veteran's Administration health information system, and the Tumor Registry database. A self-administered survey questionnaire (mCOH-QOL-Ostomy) was mailed to each participant. The severity of skin irritation, problems with leakage, and difficulty adjusting were significantly related to demographic, clinical, and quality-of-life domains. Univariate analyses showed that age, income, employment, preoperative care (stoma site marking and education), having a partner, ostomy type, reason for ostomy, time since surgery, total quality-of-life scores and scores on all 4 domains of quality of life were related to the severity of these ostomy complications. Age was inversely related to severity of all 3 ostomy complications (skin irritation, leakage, and difficulty adjusting). Having an ileostomy, rather than a colostomy, was associated with higher severity of skin irritation. Having had the stoma site marked preoperatively was associated with less difficulty adjusting to an ostomy, and having had preoperative ostomy education was associated with less severe problems with skin irritation and leakage. Severity of each ostomy complication predicted total quality-of-life scores. Difficulty adjusting to the ostomy was related to all 4 quality-of-life domains (physical, psychological, social, and

  12. Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI

    Directory of Open Access Journals (Sweden)

    Allan R. Martin


    Conclusions: State-of-the-art spinal cord MRI techniques are emerging with great potential to improve the diagnosis and management of various spinal pathologies, but the current body of evidence has only showed limited clinical utility to date. Among these imaging tools DTI is the most mature, but further work is necessary to standardize and validate its use before it will be adopted in the clinical realm. Large, well-designed studies with a priori hypotheses, standardized acquisition methods, detailed clinical data collection, and robust automated analysis techniques are needed to fully demonstrate the potential of these rapidly evolving techniques.

  13. [Myocardial infarction related to sport. Acute clinical and coronary angiographic characteristics in 16 cases]. (United States)

    Halna du Fretay, X; Akoudad, H; Nejjari, M; Benamer, H


    Determination of clinical and angiographic characteristics of myocardial infarctions related to sport. Retrospective study of acute coronary syndromes with ST elevation related to sport treated with interventional cardiology from 2006 to 2013. Sixteen patients were included. They are mostly men (15/16), aged 24-65 years (over 35 years old in 13 cases) with few cardiovascular risk factors, most frequently heredity or smoking. Myocardial infarctions usually occur during the practice of sports (13/16), with serious rhythmic complications in three of the cases. On angiography, most patients have single vessel disease (12/16). Myocardial infarction related to sports affects a male population aged over 35 years old with few cardiovascular risk factors, most often single vessel disease, making the preventative screening uneasy. Other studies investigating larger populations, assessing previous clinical events (symptoms, results of stress tests), evaluating the impact of competition and integrating sudden deaths would improve the screening and the treatment of sport-related myocardial infarctions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.


    Kim, Jong Min; Kang, Se Woong; Son, Dae Yong; Bae, Kunho


    To investigate the risk factors associated with prechoroidal cleft occurrence after treatment for neovascular age-related macular degeneration (nAMD) and to elucidate its clinical significance. Two hundred thirty-four subjects who were treated for neovascular age-related macular degeneration were assessed to identify prechoroidal cleft on optical coherence tomography. Clinical variables were compared between patients manifesting a cleft (cleft group) and patients who did not (control group). Prechoroidal cleft was detected in 29 of 234 patients (8.1%). Although the baseline visual acuity was not different between the 2 groups, logMAR visual acuity at final visit was 0.89 ± 0.74 (with approximate Snellen equivalent of 20/160) in the cleft group and 0.65 ± 0.69 (with approximate Snellen equivalent of 20/100) in controls (P age-related macular degeneration (P age-related macular degeneration, and a submacular hemorrhage treated by pneumatic displacement were the independent risk factors for development of prechoroidal cleft. Eyes with a cleft, especially clefts that develop early, generally had worse prognoses than eyes without clefts.

  15. Clinical characteristics of impulse control and related disorders in Chinese Parkinson's disease patients. (United States)

    Zhang, Yu; He, An Qi; Li, Lin; Chen, Wei; Liu, Zhen Guo


    Impulse control and related disorders (ICRDs) are clinically complications in Parkinson's disease (PD). However, the clinical characteristics of ICRDs in Chinese PD patients were rarely reported. We aimed to explore the prevalence and the clinical profile of ICRDs in Chinese patients with PD. 142 Chinese PD patients were consecutively enrolled. The symptoms of ICRDs were assessed with the Questionnaire for Impulsive-Compulsive Disorders. The clinical characteristics of patients with ICRDs and without ICRDs were compared. ICRDs were present in 31% of our patients. The most common ICRDs were compulsive medication use (11.3%) and punding (9.2%); the least frequent were walkabout (1.4%). Variables independently associated with ICRDs were earlier onset of the disease (≤55 years), severe cognitive impairment (MMSE 10-20), the dose of dopamine agonist (>1 mg/d) and dyskinesia. ICRDs was commonly found in Chinese PD patients. Earlier onset of the disease, the dose of dopamine agonist, severe cognitive impairment and dyskinesia are independent factors associated with ICRDs. Our results will be benefit for clinicians to assess the risk of developing ICRDs before delivering dopaminergic medication.

  16. Health-related physical fitness measures: reference values and reference equations for use in clinical practice. (United States)

    Tveter, Anne Therese; Dagfinrud, Hanne; Moseng, Tuva; Holm, Inger


    To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice. Cross-sectional design. General community. Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway. Not applicable. The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test). The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants clinical practice. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. Prolongevity medicine: Antagonic-Stress drug in distress, geriatrics, and related diseases. II. Clinical review--2003. (United States)

    Riga, S; Riga, D; Schneider, F


    Distress and senescence, their reciprocal aggravating-quickening connections, and their related pathologies have a large worldwide impact on healthcare systems in this new millennium. For this reason, Antagonic-Stress (AS)--an advanced integrative therapy, with specific synergistic composition, and patented internationally--represents a significant strategy in health, aging, and longevity. Clinical research with AS proves the drug's efficacy in the management of distress (neurotic, stress-related, and affective disorders; behavioral syndromes associated with physiological disturbances and physical factors; mental and behavioral disorders due to psychoactive substance uses) and psychogeriatrics [organic, including symptomatic, mental disorders (OMD)]. Specific multiaxial psychopathological instruments and psychometric tests in multiple assessments used for gerontopsychiatry demonstrated strong improvements after AS administration in early-moderate stages of Alzheimer or vascular dementia, as well as in other OMD. In addition, comparative clinical studies evinced the superiority of AS (synergistic multitherapy) versus monotherapy [meclofenoxate (MF), piracetam (PA), pyritinol (PT), and nicergoline (NE), respectively]. These comparative clinical trials agreed closely with comparative preclinical research and confirmed AS synergistic homeostatic, adaptogenic, antioxidative, cerebrovascular, neurometabolic, and nootropic actions. Also, the AS protective actions against oxidative stress recommend this orthomolecular therapy in stress, aging, and free radical pathology.

  18. Correlation of microdosimetric measurements with relative biological effectiveness from clinical experience for two neutron therapy beams

    International Nuclear Information System (INIS)

    Stinchcomb, T.G.; Kuchnir, F.T.; Myrianthopoulos, L.C.; Horton, J.L. Jr.; Roberts, W.K.


    Microdosimetric measurements were made for the neutron therapy beams at the University of Chicago and at the Cleveland Clinic with the same geometry and phantom material using the same tissue-equivalent spherical proportional counter and standard techniques. The energy deposition spectra (dose distributions in lineal energy) are compared for these beams and for their scattered components (direct beam blocked). The model of dual radiation action (DRA) of Kellerer and Rossi is employed to interpret these data in terms of biological effectiveness over this limited range of radiation qualities. The site-diameter parameter of the DRA theory is determined for the Cleveland beam by setting the biological effectiveness (relative to 60 Co gamma radiation) equal to the relative biological effectiveness value deduced from radiobiology experiments and clinical experience. The resulting value of this site-diameter parameter is then used to predict the biological effectiveness of the Chicago beam. The prediction agrees with the value deduced from radiobiology and clinical experience. The biological effectiveness of the scattered components of both beams is also estimated using the model

  19. Update on Clinical Trials in Dry Age-related Macular Degeneration (United States)

    Taskintuna, Ibrahim; Elsayed, M. E. A. Abdalla; Schatz, Patrik


    This review article summarizes the most recent clinical trials for dry age-related macular degeneration (AMD), the most common cause of vision loss in the elderly in developed countries. A literature search through websites and, both accessed no later than November 04, 2015, was performed. We identified three Phase III clinical trials that were completed over the recent 5 years Age-Related Eye Disease Study 2 (AREDS2), implantable miniature telescope and tandospirone, and several other trials targeting a variety of mechanisms including, oxidative stress, complement inhibition, visual cycle inhibition, retinal and choroidal blood flow, stem cells, gene therapy, and visual rehabilitation. To date, none of the biologically oriented therapies have resulted in improved vision. Vision improvement was reported with an implantable mini telescope. Stem cells therapy holds a potential for vision improvement. The AREDS2 formulas did not add any further reduced risk of progression to advanced AMD, compared to the original AREDS formula. Several recently discovered pathogenetic mechanisms in dry AMD have enabled development of new treatment strategies, and several of these have been tested in recent clinical trials and are currently being tested in ongoing trials. The rapid development and understanding of pathogenesis holds promise for the future. PMID:26957835

  20. Mental and somatic symptoms related to suicidal ideation in patients visiting a psychosomatic clinic in Japan

    Directory of Open Access Journals (Sweden)

    Kouichi Yoshimasu


    Full Text Available Kouichi Yoshimasu1, Tetsuya Kondo2,4, Shoji Tokunaga3, Yoshio Kanemitsu2, Hideyo Sugahara2, Mariko Akamine2, Kanichiro Fujisawa2, Kazuhisa Miyashita1, Chiharu Kubo21Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama, Japan; 2Department of Psychosomatic Medicine, Graduate school of Medical Sciences, Kyushu University, Fukuoka, Japan; 3Department of Medical Informatics, Kyushu University Hospital, Fukuoka, Japan; 4Department of Acupuncture and Moxibustion, Kansai University of Health Sciences, Osaka, JapanAbstract: Patients with suicidal ideation (SI have various mental or somatic symptoms. A questionnaire-based interview elicited details concerning mental and somatic symptoms in patients visiting a psychosomatic clinic in Japan. Univariate logistic regression analyses followed by multiple regression models using a stepwise method were selected for identifying the candidate symptoms. Overall, symptoms related to depression were associated with SI in both sexes. Although women showed more various somatic symptoms associated with SI than men, many of those associations were diminished once severity of the depression was controlled. The current results suggest that a variety of self-reported symptoms, mainly related to depression, might reveal suicidal risk in outpatients with an urban hospital clinical setting.Keywords: suicidal ideation, psychosomatic clinic, subjective symptoms

  1. Changes in patient satisfaction related to hospital renovation: experience with a new clinical building. (United States)

    Siddiqui, Zishan K; Zuccarelli, Rebecca; Durkin, Nowella; Wu, Albert W; Brotman, Daniel J


    There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction. To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility. Natural experiment utilizing a pre-post design with concurrent controls. Academic tertiary care hospital. We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls. Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities. The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores. The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical

  2. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample. (United States)

    Witherow, Marta Parkanyi; Chandraiah, Shambhavi; Seals, Samantha R; Sarver, Dustin E; Parisi, Kathryn E; Bugan, Antal


    Relational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability. To investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings. Using a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration. Patients completed the Female Sexual Function Index, the Couple's Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test. Mediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration. Findings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning. The importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are

  3. Relative entropy of excited states in conformal field theories of arbitrary dimensions

    Energy Technology Data Exchange (ETDEWEB)

    Sárosi, Gábor [Theoretische Natuurkunde, Vrije Universiteit Brussels and International Solvay Institutes,Pleinlaan 2, Brussels, B-1050 (Belgium); David Rittenhouse Laboratory, University of Pennsylvania,Philadelphia, PA 19104 (United States); Ugajin, Tomonori [Kavli Institute for Theoretical Physics, University of California, Santa Barbara, CA 93106 (United States)


    Extending our previous work, we study the relative entropy between the reduced density matrices obtained from globally excited states in conformal field theories of arbitrary dimensions. We find a general formula in the small subsystem size limit. When one of the states is the vacuum of the CFT, our result matches with the holographic entanglement entropy computations in the corresponding bulk geometries, including AdS black branes. We also discuss the first asymmetric part of the relative entropy and comment on some implications of the results on the distinguishability of black hole microstates in AdS/CFT.

  4. Epilepsy-related clinical factors and psychosocial functions in pediatric epilepsy. (United States)

    Eom, Soyong; Eun, So-Hee; Kang, Hoon-Chul; Eun, Baik-Lin; Nam, Sang Ook; Kim, Sun Jun; Chung, Hee Jung; Kwon, Soon Hak; Lee, Young-Mock; Lee, Joon Soo; Kim, Dong Wook; Oh, Kyung Ja; Kim, Heung Dong


    The aim of this study was to identify the different influencing patterns of demographic and epilepsy-related variables on various aspects of psychosocial function in pediatric epilepsy. Five hundred ninety-eight patients with pediatric epilepsy between the ages of 4 and 18 years (boys=360, 60% and girls=238, 40%) and their parents participated in the study. Parents completed the Social Maturity Scale (SMS), the Korean version of the Child Behavior Checklist (K-CBCL), and the Korean version of the Quality of Life in Childhood Epilepsy Questionnaire (K-QOLCE) to assess daily living function, behavior, and quality of life. The Children's Global Assessment Scale (CGAS) was completed by clinicians to assess general adaptive function. Demographic variables, such as age and sex of child, and epilepsy-related clinical variables, including seizure type, seizure frequency, duration of epilepsy, and number of medications, were obtained from medical records. Demographic and epilepsy-related clinical variables had a strong influence (22-32%) on the cognition-related domain such as general adaptive function, school/total competence, and quality of life for cognitive function while a comparatively smaller effect (2-16%) on the more psychological domain including behavioral, emotional, and social variables. Younger age, shorter duration of illness, and smaller number of medications showed a strong positive impact on psychosocial function in pediatric epilepsy, particularly for adaptive function, competence, and quality-of-life aspects. Given the wide range of impact of demographic and clinical variables on various facets of psychosocial functions, more specific understanding of the various aspects of factors and their particular pattern of influence may enable more effective therapeutic approaches that address both the medical and psychological needs in pediatric epilepsy. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. One state's effort to improve recruitment, retention, and practice through multifaceted clinical supervision interventions. (United States)

    Collins-Camargo, Crystal; Sullivan, Dana J; Washeck, Bonnie; Adams, Jeff; Sundet, Paul


    The professional literature has described the critical role child welfare supervisors play in the recruitment and retention (R&R) of a competent workforce and in practice enhancement to produce positive outcomes for children and families. Building on findings from a federally funded demonstration project related to implementation of clinical supervision in the child welfare setting, this article provides a description of a comprehensive approach to achievement of these outcomes: an integrated implementation of an employee selection protocol, 360-degree evaluation and employee development planning, and peer consultation and support groups for supervisors. An outline of the evaluation designed to assess relative effectiveness of each component on organizational culture, staff R&R, and practice is provided.

  6. Validation of a risk stratification tool for fall-related injury in a state-wide cohort. (United States)

    McCoy, Thomas H; Castro, Victor M; Cagan, Andrew; Roberson, Ashlee M; Perlis, Roy H


    A major preventable contributor to healthcare costs among older individuals is fall-related injury. We sought to validate a tool to stratify such risk based on readily available clinical data, including projected medication adverse effects, using state-wide medical claims data. Sociodemographic and clinical features were drawn from health claims paid in the state of Massachusetts for individuals aged 35-65 with a hospital admission for a period spanning January-December 2012. Previously developed logistic regression models of hospital readmission for fall-related injury were refit in a testing set including a randomly selected 70% of individuals, and examined in a training set comprised of the remaining 30%. Medications at admission were summarised based on reported adverse effect frequencies in published medication labelling. The Massachusetts health system. A total of 68 764 hospitalised individuals aged 35-65 years. Hospital readmission for fall-related injury defined by claims code. A total of 2052 individuals (3.0%) were hospitalised for fall-related injury within 90 days of discharge, and 3391 (4.9%) within 180 days. After recalibrating the model in a training data set comprised of 48 136 individuals (70%), model discrimination in the remaining 30% test set yielded an area under the receiver operating characteristic curve (AUC) of 0.74 (95% CI 0.72 to 0.76). AUCs were similar across age decades (0.71 to 0.78) and sex (0.72 male, 0.76 female), and across most common diagnostic categories other than psychiatry. For individuals in the highest risk quartile, 11.4% experienced fall within 180 days versus 1.2% in the lowest risk quartile; 57.6% of falls occurred in the highest risk quartile. This analysis of state-wide claims data demonstrates the feasibility of predicting fall-related injury requiring hospitalisation using readily available sociodemographic and clinical details. This translatable approach to stratification allows for identification of

  7. Use of a Relational Database to Support Clinical Research: Application in a Diabetes Program (United States)

    Lomatch, Diane; Truax, Terry; Savage, Peter


    A database has been established to support conduct of clinical research and monitor delivery of medical care for 1200 diabetic patients as part of the Michigan Diabetes Research and Training Center (MDRTC). Use of an intelligent microcomputer to enter and retrieve the data and use of a relational database management system (DBMS) to store and manage data have provided a flexible, efficient method of achieving both support of small projects and monitoring overall activity of the Diabetes Center Unit (DCU). Simplicity of access to data, efficiency in providing data for unanticipated requests, ease of manipulations of relations, security and “logical data independence” were important factors in choosing a relational DBMS. The ability to interface with an interactive statistical program and a graphics program is a major advantage of this system. Out database currently provides support for the operation and analysis of several ongoing research projects.

  8. Strategy for clinical evaluation and screening of sudden cardiac death relatives

    DEFF Research Database (Denmark)

    Ferrero-Miliani, Laura; Holst, Anders Gaarsdal; Pehrson, Steen


    Sudden cardiac death (SCD) may be the first and final manifestation of several heart diseases. In the young, SCD is often caused by a hereditary cardiac disease. As the most frequently seen inherited cardiac diseases have an autosomal-dominant pattern of inheritance, half of the first......-degree relatives are at risk of having or developing the same disease. Therefore, screening of these high-risk relatives is a rational approach to reduce the incidence of SCD. To offer family screening and counseling, the cause of death should be carefully established. Autopsy is only performed in a limited number...... a limited number of inherited cardiac diseases associated with SCD are without any structural changes. In other cases, the autopsy may reveal noncardiac causes of death, which is also important for reassuring the relatives. However, in cases with no autopsy or negative findings, thorough clinical...


    Directory of Open Access Journals (Sweden)

    Lindsay Stewart


    Full Text Available Relational needs are the emotional needs which underlie our social connectedness and help sustain and nurture our attachments to others. In doing psychotherapy, therapists must be attuned not only to the needs of the client, but also to their own relational needs. Through self awareness and knowledge of healthy and appropriate boundaries, therapists can ensure the best interest of the client is kept foremost. In this article, the influence of the therapist’s own relational needs in the psychotherapy process is examined in terms of the possible benefits and disruptions to the client’s emotional growth. This is discussed in the context of the Integrative Psychotherapy model based on the core concepts of inquiry, involvement and attunement. Clinical supervision is seen as an important part of working through counter-transference.

  10. Impaired exercise-related myocardial uptake of technetium-99m-tetrofosmin in relation to coronary narrowing and diabetic state

    International Nuclear Information System (INIS)

    Sasao, Hisataka; Nakata, Tomoaki; Tsuchihashi, Kazufumi; Wakabayashi, Takeru; Nakahara, Norifumi; Doi, Atsushi; Hashimoto, Akiyoshi; Kobayashi, Hiroshi; Shimamoto, Kazuaki


    Despite the diagnostic efficacy of stress myocardial perfusion imaging, the correlation between the actual perfusion tracer activity and diseased state of a coronary artery has not been studied in detail. We estimated exercise-related perfusion augmentation in relation to disease states of a coronary artery in diabetic and non-diabetic patients by a newly developed quantitative technetium (Tc)-99m-tetrofosmin myocardial imaging technique. Tc-99m-tetrofosmin tomographic imaging with an exercise-rest protocol was performed in 26 stable coronary patients and in 8 age-matched controls. Percent increase (%IR) in myocardial count during symptom-limited submaximal exercise-stress was calculated in 16 non-infarcted polar map segments and in each coronary territory by a subtraction technique with corrections for physical decay and injected tracer doses, and the results were compared with those of angiographically quantified coronary diameter stenosis (%DS). Percent IR and peak heart rate during exercise showed a positive linear correlation both in coronary territories with significant stenosis (%DS≥75%) and in control or non-stenotic (%DS<75%) territories. The regression line in stenotic regions was, however, significantly (p<0.01) shifted downward compared to that in non-stenotic regions. Percent IR in stenotic regions showed a significant inverse correlation with %DS. Coronary stenosis of 75% or more was identified by a %IR cutoff value of 40% with 77% sensitivity, 70% specificity, and an accuracy of 72%. In coronary territories with a %DS of less than 75%, %IR in diabetic patients was significantly lower (46±15%) than that in non-diabetic patients (61±25%). Thus, blunted exercise-related augmentation of myocardial uptake of Tc-99m-tetrofosmin correlates with the severity of coronary narrowing and diabetic state. (author)

  11. [Effectiveness assessment of public clinical laboratories: the case of Belo Horizonte, Minas Gerais State]. (United States)

    Sancho, Leyla Gomes; Vargens, José Muniz da Costa; Sancho, Rafael Gomes


    The organization of public clinical laboratories is experiencing changes without, however, an organizational assessment of its effectiveness. The study aimed to determine a parameter of effectiveness for public clinical laboratories of Belo Horizonte, Minas Gerais State, and set cut-off points for the sections of these laboratories. In order to do so, the total production and number of hours worked during a period of 7 months in the year 2008 were consolidated. Due to the entrance of the workers in the mode of production in the laboratories network, it could be observed a variability regarding the performance of these workers. The effectiveness parameter of the network was established in 29.90 tests per hour. As a consequence of this first analysis, the cut-off points are: 15.50 for the hematology section; 67.29 for chemistry; 6.45 for parasitology; 11.35 for urinalysis; 4.94 for microbiology and 19.03 for immunology. From these results, it was concluded that the working process in laboratories can generate a decrease in effectiveness.

  12. The scope and impact of mobile health clinics in the United States: a literature review. (United States)

    Yu, Stephanie W Y; Hill, Caterina; Ricks, Mariesa L; Bennet, Jennifer; Oriol, Nancy E


    As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation's overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population. This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics , the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there

  13. Immunoliposomes in clinical oncology: State of the art and future perspectives. (United States)

    Merino, María; Zalba, Sara; Garrido, María J


    Liposomal formulations entrapping a vast number of molecules have improved cancer therapies overcoming certain pharmacokinetic (PK) and pharmacodynamic limitations, many of which are associated with tumor characteristics. In this context, immunoliposomes represent a new strategy that has been widely investigated in preclinical cancer models with promising results, although few have reached the stage of clinical trials. This contrasts with the emerging clinical application of monoclonal antibodies (mAbs). This formulation allows the conjugation of different mAbs or antibody derivatives, such as monovalent variable fragments Fab', to the polymers covering the surface of liposomes. The combination of this targeting strategy together with drug encapsulation in a single formulation may contribute to enhance the efficacy of these associated agents, reducing their toxicities. In this paper we will consider how factors such as particle size, lipid composition and charge, lipid-polymer conjugation, method of production and type of ligand for liposome coupling influence the efficacy of these formulations. Furthermore, the high inter-individual variability in the tumor microenvironment, as well as the poor experimental designs for the PK characterization of liposomes, make the establishment of the relationship between plasma or tumor concentrations and efficacy difficult. Thus, adequate dosing regimens and patient stratification regarding the target expression may contribute to enhance the possibility of incorporating these immunoliposomes into the therapeutic arsenal for cancer treatments. All these issues will be briefly dealt with here, together with a section showing the state of the art of those targeted liposomes that are coming up for testing in clinical trials. Finally, some insights into future developments such as the combination of specificity and controlled release, based on the application of different stimuli, for the manipulation of stability and cargo release

  14. Family life clinics for Gulf state: Bahrain FPA helps bring a family planning breakthrough. (United States)


    Family life clinics which will provide family planning services alongside maternal and child health services and general counseling are opening in health centers throughout Bahrain and in the main hospital at Manama. Bahrain, a small island in the Arabian Gulf, formed its first Family Planning Association (FPA) just 4 years ago; and this new initiative is seen as a direct result of cooperation between FPA and the government. To spread family planning awareness and services particularly to the poorer section of the population, Bahrain's FPA developed in various stages. Stage 1, in 1975, was to attract and educate volunteers and channel their interest into special committees dealing with programs; public relations; child welfare; legal and medical affairs; research; and conferences and education. Stage 2 came with the need to coordinate the work and set up a 2-person staff and an office. Stage 3 developed with the first field campaign. Door-to-door visiting was tried but was not popular with volunteers or residents. Approaching the population through community clubs and institutions was tried with much success. The new family life clinics are the latest stage of a fruitful cooperation between FPA and the Ministry of Labor and Social Affairs. In addition to the new family life clinics, an active effort to improve family planning awareness has continued using national seminars and mass media. Fund-raising is under way for a mobile,clinic which will provide health services and methods of contraception, to which there is still substantial resistance, to many on the island who have no exposure to the mass media. Wide acceptance of the need for family planning for the sake of mothers, the family, and the child is growing in Bahrain.

  15. Cerebral arteriovenous malformations. the relationship between clinical related events and rCBF SPECT imaging

    International Nuclear Information System (INIS)

    Sun Bo; Shi Xiangen


    To evaluate the relationship between clinical related events and rCBF SPECT imaging in patients with arteriovenous malformations (AVMs), the radioactive counting difference between normal and lesion site was divided by regional pixel considered as ischemic index (II). II was measured in 20 AVM cases and compared with patients' age, sex,neurological history and the size of lesions. The degree of rCBF reduction correlated with clinical neurological manifestation and showed no significant relationship with the age, sex and size of malformed vessels. II in patients with seizures was higher than that in patients with hemorrhage. The rCBF SPECT imaging may be useful for evaluation of the hemodynamics in AVMs

  16. Clinical Perspectives of Urocortin and Related Agents for the Treatment of Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Keiichi Ikeda


    Full Text Available The effects of corticotropin-releasing hormone, also known as corticotropin-releasing factor (CRF, on the cardiovascular system have been intensively researched since its discovery. Moreover, the actions of urocortin (Ucn I on the cardiovascular system have also been intensively scrutinized following the cloning and identification of its receptor, CRF receptor type 2 (CRFR2, in peripheral tissues including the heart. Given the cardioprotective actions of CRFR2 ligands, the clinical potential of not only Ucn I but also Ucn II and III, which were later identified as more specific ligands for CRFR2, has received considerable attention from researchers. In addition, recent work has indicated that CRF type 1 receptor may be also involved in cardioprotection against ischemic/reperfusion injury. Here we provide a historical overview of research on Ucn I and related agents, their effects on the cardiovascular system, and the clinical potential of the use of such agents to treat cardiovascular diseases.

  17. Clinical Utilisation and Usefullness of the Rating Scale of Mixed States, ("Gt-Msrs"): a Multicenter Study. (United States)

    Tavormina, Giuseppe; Franza, Francesco; Stranieri, Giuseppe; Juli, Luigi; Juli, Maria Rosaria


    The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of the clinician psychiatrists, by enabling them to make an early "general" diagnosis of mixed states. The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders going to the dysphoric state. This study is the second validation study of the "G.T. MSRS" rating scale, in order to demonstrate its usefullness.

  18. Geographic distribution of trauma centers and injury-related mortality in the United States. (United States)

    Brown, Joshua B; Rosengart, Matthew R; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L


    Regionalized trauma care improves outcomes; however, access to care is not uniform across the United States. The objective was to evaluate whether geographic distribution of trauma centers correlates with injury mortality across state trauma systems. Level I or II trauma centers in the contiguous United States were mapped. State-level age-adjusted injury fatality rates per 100,000 people were obtained and evaluated for spatial autocorrelation. Nearest neighbor ratios (NNRs) were generated for each state. A NNR less than 1 indicates clustering, while a NNR greater than 1 indicates dispersion. NNRs were tested for difference from random geographic distribution. Fatality rates and NNRs were examined for correlation. Fatality rates were compared between states with trauma center clustering versus dispersion. Trauma center distribution and population density were evaluated. Spatial-lag regression determined the association between fatality rate and NNR, controlling for state-level demographics, population density, injury severity, trauma system resources, and socioeconomic factors. Fatality rates were spatially autocorrelated (Moran's I = 0.35, p center distribution. Fatality rate and NNR were correlated (ρ = 0.34, p = 0.03). Clustered states had a lower median injury fatality rate compared with dispersed states (56.9 [IQR, 46.5-58.9] vs. 64.9 [IQR, 52.5-77.1]; p = 0.04). Dispersed compared with clustered states had more counties without a trauma center that had higher population density than counties with a trauma center (5.7% vs. 1.2%, p distribution of trauma centers correlates with injury mortality, with more clustered state trauma centers associated with lower fatality rates. This may be a result of access relative to population density. These results may have implications for trauma system planning and require further study to investigate underlying mechanisms. Therapeutic/care management study, level IV.

  19. 28 CFR 0.109 - Implementation of the Treaty of Friendship and General Relations Between the United States and... (United States)


    ... Friendship and General Relations Between the United States and Spain. 0.109 Section 0.109 Judicial... Service § 0.109 Implementation of the Treaty of Friendship and General Relations Between the United States... States within the meaning of Article XXIV of the Treaty of Friendship and General Relations Between the...

  20. Entropy-power uncertainty relations: towards a tight inequality for all Gaussian pure states

    International Nuclear Information System (INIS)

    Hertz, Anaelle; Jabbour, Michael G; Cerf, Nicolas J


    We show that a proper expression of the uncertainty relation for a pair of canonically-conjugate continuous variables relies on entropy power, a standard notion in Shannon information theory for real-valued signals. The resulting entropy-power uncertainty relation is equivalent to the entropic formulation of the uncertainty relation due to Bialynicki-Birula and Mycielski, but can be further extended to rotated variables. Hence, based on a reasonable assumption, we give a partial proof of a tighter form of the entropy-power uncertainty relation taking correlations into account and provide extensive numerical evidence of its validity. Interestingly, it implies the generalized (rotation-invariant) Schrödinger–Robertson uncertainty relation exactly as the original entropy-power uncertainty relation implies Heisenberg relation. It is saturated for all Gaussian pure states, in contrast with hitherto known entropic formulations of the uncertainty principle. (paper)

  1. State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications

    Energy Technology Data Exchange (ETDEWEB)

    Viallon, Magalie [Universite de Lyon, CREATIS, UMR CNRS 5220 - INSERM U1044, INSA de Lyon, Lyon (France); Universite de Lyon-Saint-Etienne, Department of Radiology, Centre Hospitalier Universitaire de Saint-Etienne, Saint Etienne (France); Cuvinciuc, Victor; Barnaure-Nachbar, Isabelle; Lovblad, Karl-Olof; Haller, Sven [University Hospital of Geneva, Department of Neuroradiology, Geneva (Switzerland); Delattre, Benedicte; Toso-Patel, Seema; Becker, Minerva [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); Merlini, Laura [University Hospital of Geneva, Department of Pediatric Radiology, Geneva (Switzerland)


    This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging. (orig.)

  2. State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications

    International Nuclear Information System (INIS)

    Viallon, Magalie; Cuvinciuc, Victor; Barnaure-Nachbar, Isabelle; Lovblad, Karl-Olof; Haller, Sven; Delattre, Benedicte; Toso-Patel, Seema; Becker, Minerva; Merlini, Laura


    This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging. (orig.)

  3. Relationship between drug interactions and drug-related negative clinical outcomes in two community pharmacies

    Directory of Open Access Journals (Sweden)

    Gonzalo M


    Full Text Available Drug interactions may represent an iatrogenic risk that should be controlled in community pharmacies at the dispensing level. Aim: We analyzed the association between potential drug-drug interactions (DDIs and negative clinical outcomes.Methods: We used dispensing data from two community pharmacies: instances where drug dispensing was associated with a potential DDI and a comparison group of randomized dispensing operations with no potential DDI. In cases where potential DDIs were detected, we analyzed the underlying negative clinical outcomes. Age and gender data were included in the analysis.Results: During the study period, we registered 417 potential DDIs. The proportion of women and age were higher in the study group than in the comparison group. The average potential DDIs per patient was 1.31 (SD=0.72. The Consejo General de Colegios Oficiales de Farmacéuticos (CGCOF database did not produce an alert in 2.4% of the cases. Over-the-counter medication use was observed in 5% of the potential DDI cases. The drugs most frequently involved in potential DDIs were acenocoumarol, calcium salts, hydrochlorothiazide, and alendronic acid, whereas the most predominant potential DDIs were calcium salts and bisphosphonates, oral antidiabetics and thiazide diuretics, antidiabetics and glucose, and oral anticoagulant and paracetamol. The existence of a drug-related negative clinical outcome was observed only in 0.96% of the potential DDI cases (50% safety cases and 50% effectiveness cases. Conclusions: Only a small proportion of the detected potential DDIs lead to medication negative outcomes. Considering the drug-related negative clinical outcomes encountered, tighter control would be recommended in potential DDIs with NSAIDs or benzodiazepines.

  4. Formaldehyde-related clinical symptoms reported by medical students during gross anatomy cadaver dissection

    Directory of Open Access Journals (Sweden)

    Łukasz Pietrzyk


    Full Text Available Introduction . Formaldehyde is a noxious gas used as a tissue preservative of cadavers in autopsy rooms. Therefore, exposure to higher concentrations applies particularly to laboratory staff, anatomists and medical students. Prolonged exposure to formaldehyde is associated with clinical complications. Objective. To assess whether exposure to repeated inhalation of low concentrations of formaldehyde (FA experienced during a gross anatomy course triggers subjective clinical symptoms in medical students. Material and methods . All 198 first-year medical students of the Medical University of Lublin, Poland (28% with allergy history and 72% without allergy history; 69% male and 31% female responded to a questionnaire concerning their subjective FA-related clinical symptoms. Differences in proportions of experienced symptoms between allergic vs. nonallergic, and female vs. males were compared by the Mann-Whitney U test. Results . Even though formaldehyde concentrations in the gross anatomy laboratory were relatively low (0.47–0.57 mg/m3, medical students experienced various reactions (lacrimation in 85.9%, red eyes, dry and itchy eyes, runny nose, sneezing, and headache in > 50% of students, cough in 44%, and dry throat or throat irritation in 42% of students. Among students with a history of allergy, eye, nose, skin and respiratory system symptoms occurred more frequently in comparison to nonallergic students. Female individuals demonstrated higher sensitivity to FA exposure. Conclusions . Exposure to formaldehyde may result in development of clinical symptoms in medical students. Particularly unpleasant symptoms may be experienced by individuals with allergy history. It is necessary to decrease formaldehyde concentrations in the anatomy dissection laboratory.

  5. Clinical skills-related learning goals of senior medical students after performance feedback. (United States)

    Chang, Anna; Chou, Calvin L; Teherani, Arianne; Hauer, Karen E


    Lifelong learning is essential for doctors to maintain competence in clinical skills. With performance feedback, learners should be able to formulate specific and achievable learning goals in areas of need. We aimed to determine: (i) the type and specificity of medical student learning goals after a required clinical performance examination; (ii) differences in goal setting among low, average and high performers, and (iii) whether low performers articulate learning goals that are concordant with their learning needs. We conducted a single-site, multi-year, descriptive comparison study. Senior medical students were given performance benchmarks, individual feedback and guidelines on learning goals; each student was subsequently instructed to write two clinical skills learning goals. Investigators coded the learning goals for specificity, categorised the goals, and performed statistical analyses to determine their concordance with student performance level (low, average or high) in data gathering (history taking and physical examination) or communication skills. All 208 students each wrote two learning goals and most (n=200, 96%) wrote two specific learning goals. Nearly two-thirds of low performers in data gathering wrote at least one learning goal that referred to history taking or physical examination; one-third wrote learning goals pertaining to the organisation of the encounter. High performers in data gathering wrote significantly more patient education goals and significantly fewer history-taking goals than average or low performers. Only 50% of low performers in communication wrote learning goals related to communication skills. Low performers in communication were significantly more likely than average or high performers to identify learning goals related to improving performance in future examinations. The provision of performance benchmarking, individual feedback and brief written guidelines helped most senior medical students in our study to write specific

  6. Estimation of utility weights for human papilloma virus-related health states according to disease severity. (United States)

    Ock, Minsu; Park, Jeong-Yeol; Son, Woo-Seung; Lee, Hyeon-Jeong; Kim, Seon-Ha; Jo, Min-Woo


    A cost-utility study of a human papilloma virus (HPV) vaccine requires that the utility weights for HPV-related health states (i.e., cervical intraepithelial neoplasia (CIN), cervical cancer, and condyloma) be evaluated. The aim of the present study was to determine the utility weights for HPV-related health states. Hypothetical standardised health states related to HPV were developed based on patient education material and previous publications. To fully reflect disease progression from diagnosis to prognosis, each health state comprised four parts (diagnosis, symptoms, treatment, and progression and prognosis). Nine-hundred members from the Korean general population evaluated the HPV-related health states using a visual analogue scale (VAS) and a standard gamble (SG) approach, which were administered face-to-face via computer-assisted interview. The mean utility values were calculated for each HPV-related health state. According to the VAS, the highest utility (0.73) was HPV-positive status, followed by condyloma (0.66), and CIN grade I (0.61). The lowest utility (0.18) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.42). SG revealed that the highest utility (0.83) was HPV-positive status, followed by condyloma (0.78), and CIN grade I (0.77). The lowest utility (0.43) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.60). This study was based on a large sample derived from the general Korean population; therefore, the calculated utility weights might be useful for evaluating the economic benefit of cancer screening and HPV vaccination programs.

  7. Estimating the clinical benefits of vaccinating boys and girls against HPV-related diseases in Europe

    International Nuclear Information System (INIS)

    Marty, Rémi; Roze, Stéphane; Bresse, Xavier; Largeron, Nathalie; Smith-Palmer, Jayne


    HPV is related to a number of cancer types, causing a considerable burden in both genders in Europe. Female vaccination programs can substantially reduce the incidence of HPV-related diseases in women and, to some extent, men through herd immunity. The objective was to estimate the incremental benefit of vaccinating boys and girls using the quadrivalent HPV vaccine in Europe versus girls-only vaccination. Incremental benefits in terms of reduction in the incidence of HPV 6, 11, 16 and 18-related diseases (including cervical, vaginal, vulvar, anal, penile, and head and neck carcinomas and genital warts) were assessed. The analysis was performed using a model constructed in Microsoft®Excel, based on a previously-published dynamic transmission model of HPV vaccination and published European epidemiological data on incidence of HPV-related diseases. The incremental benefits of vaccinating 12-year old girls and boys versus girls-only vaccination was assessed (70% vaccine coverage were assumed for both). Sensitivity analyses around vaccine coverage and duration of protection were performed. Compared with screening alone, girls-only vaccination led to 84% reduction in HPV 16/18-related carcinomas in females and a 61% reduction in males. Vaccination of girls and boys led to a 90% reduction in HPV 16/18-related carcinomas in females and 86% reduction in males versus screening alone. Relative to a girls-only program, vaccination of girls and boys led to a reduction in female and male HPV-related carcinomas of 40% and 65%, respectively and a reduction in the incidence of HPV 6/11-related genital warts of 58% for females and 71% for males versus girls-only vaccination. In Europe, the vaccination of 12-year old boys and girls against HPV 6, 11, 16 and 18 would be associated with substantial additional clinical benefits in terms of reduced incidence of HPV-related genital warts and carcinomas versus girls-only vaccination. The incremental benefits of adding boys vaccination are

  8. Glycolysis in contracting rat skeletal muscle is controlled by factors related to energy state

    DEFF Research Database (Denmark)

    Ørtenblad, Niels; Macdonald, Will A; Sahlin, Kent


    The control of glycolysis in contracting muscle is not fully understood. The aim of the present study was to examine whether activation of glycolysis is mediated by factors related to the energy state or by a direct effect of Ca2+ on the regulating enzymes. Extensor digitorum longus muscles from...... and 58% of those in Con respectively. Glycolytic rate in BTS was only 51% of that in Con but the relative contribution of ATP derived from PCr (phosphocreatine) and glycolysis and the relation between muscle contents of PCr and Lac (lactate) were not different. Prolonged cyanide incubation of quiescent...... contribution of energy delivered from PCr and glycolysis during both conditions suggests that the glycolytic rate is controlled by factors related to energy state....

  9. Prediction of clinical depression scores and detection of changes in whole-brain using resting-state functional MRI data with partial least squares regression.

    Directory of Open Access Journals (Sweden)

    Kosuke Yoshida

    Full Text Available In diagnostic applications of statistical machine learning methods to brain imaging data, common problems include data high-dimensionality and co-linearity, which often cause over-fitting and instability. To overcome these problems, we applied partial least squares (PLS regression to resting-state functional magnetic resonance imaging (rs-fMRI data, creating a low-dimensional representation that relates symptoms to brain activity and that predicts clinical measures. Our experimental results, based upon data from clinically depressed patients and healthy controls, demonstrated that PLS and its kernel variants provided significantly better prediction of clinical measures than ordinary linear regression. Subsequent classification using predicted clinical scores distinguished depressed patients from healthy controls with 80% accuracy. Moreover, loading vectors for latent variables enabled us to identify brain regions relevant to depression, including the default mode network, the right superior frontal gyrus, and the superior motor area.

  10. Accidents caused by Bothrops and Bothropoides in the State of Paraiba: epidemiological and clinical aspects. (United States)

    Oliveira, Fagner Neves; Brito, Monalisa Taveira; Morais, Isabel Cristina Oliveira de; Fook, Sayonara Maria Lia; Albuquerque, Helder Neves de


    Bothrops and Bothropoides snakes cause 70% of the ophidic accidents in Brazil. The species that cause ophidic accidents in State of Paraíba are Bothropoides erythromelas, Bothrops leucurus and Bothropoides neuwiedi. This is a prospective and transverse study, following a quantitative approach of accidents involving Bothrops and Bothropoides admitted to the Toxicological Assistance and Information Centers of Campina Grande and João Pessoa (Ceatox-CG and Ceatox-JP), aimed at identifying the epidemiological and clinical profile of such accidents. All of the patients admitted had medical diagnoses and were monitored at Ceatox-CG or Ceatox-JP. The genera Bothrops and Bothropoides caused 91.7% of the ophidic accidents reported. Snake bites were frequent in men (75.1%), rural workers (65.1%), literate individuals (69%) between 11 and 20 years-old (21.7%), and toes the most common area attacked (52.7%). Most (86.6%) patients were admitted within 6 hours after the accident/bite, with a predominance of mild cases (64.6%). The annual occurrence in Paraíba was 5.5 accidents/100,000 inhabitants and lethality was 0.2%. Positive changes in the profiles of these accidents were verified, such as the non-application of inadequate solutions, including the use of tourniquet, coffee grounds, garlic, suction and/or cutting the bitten area. Moreover, the Itinerant Laboratory project, linked to Paraíba State University in partnership with Ceatox-CG, has contributed positively, providing several cities of the state with information regarding the prevention of accidents involving venomous animals. The local press has also contributed, reporting the educational work developed by the centers.

  11. Academic versus Clinical Productivity of Cardiac Surgeons in the State of New York: Who Publishes More and Who Operates More. (United States)

    Rosati, Carlo Maria; Gaudino, Mario; Vardas, Panos N; Weber, Daniel J; Blitzer, David; Hameedi, Fawad; Koniaris, Leonidas G; Girardi, Leonard N


    We investigated whether/how cardiac surgeons can be productive both academically and clinically. Using online resources (New York State Adult Cardiac Surgery database, SCOPUS), we collected individual clinical volumes (operations performed/year), academic metrics (ongoing publications, role as author), practice setting, and seniority for all cardiac surgeons in the State of New York from 1994 to 2011. Over time, individual clinical volumes decreased (median operations/year: 193 in 1995 vs 126 in 2010; P published more worked at hospitals with higher clinical volumes (Spearman's correlation coefficient: 0.16; P publishing at all; ∼45 per cent operating less, but publishing a little; ∼15 per cent clinically very productive (operating as much as the nonpublishers) and publishing a lot; and ∼1 per cent operating the least, but publishing the most.

  12. Clinical and genetic analysis of Indian patients with NDP-related retinopathies. (United States)

    Sudha, Dhandayuthapani; Ganapathy, Aparna; Mohan, Puja; Mannan, Ashraf U; Krishna, Shuba; Neriyanuri, Srividya; Swaminathan, Meenakshi; Rishi, Pukhraj; Chidambaram, Subbulakshmi; Arunachalam, Jayamuruga Pandian


    NDP-related retinopathies are a group of X-linked disorders characterized by degenerative and proliferative changes of the neuroretina, occasionally accompanied with varying degrees of mental retardation and sensorineural hearing loss. NDP is the predominant gene associated with NDP-related retinopathies. The purpose of this study was to report the clinical and genetic findings in three unrelated patients diagnosed with NDP-related retinopathies. The patients underwent complete ophthalmic examination followed by genetic analyses. NDP gene was screened by direct sequencing approach. Targeted resequencing of several other ocular genes was carried out in patient samples that either indicated NDP gene deletion or tested negative for NDP mutation. Gene quantitation analysis was performed using real-time PCR. The whole NDP gene was deleted in patient I, while a missense NDP mutation, c.205T>C, was identified in patient II, and both had classical Norrie disease ocular phenotype (with no other systemic defects). Patient III who was diagnosed with familial exudative vitreoretinopathy did not show any mutation in the known candidate genes as well as in other ocular genes tested. The patient with whole NDP gene deletion did not exhibit any apparent extraocular defects (like mental retardation or sensorineural hearing loss) during his first decade of life, and this is considered to be a notable finding. Our study also provides evidence emphasizing the need for genetic testing which could eliminate ambiguities in clinical diagnosis and detect carrier status, thereby aiding the patient and family members during genetic counseling.

  13. Clinical outcomes assessment for the management of sport-related concussion. (United States)

    Valovich McLeod, Tamara C; Register-Mihalik, Johna K


    PATIENT SCENARIO: An adolescent female youth soccer athlete, with a previous concussion history, suffered a second concussion 4 wk ago. Her postconcussive symptoms are affecting her school performance and social and family life. CLINICAL OUTCOMES ASSESSMENT: Concussion is typically evaluated via symptoms, cognition, and balance. There is no specific patient-oriented outcomes measure for concussion. Clinicians can choose from a variety of generic and specific outcomes instruments aimed at assessing general health-related quality of life or various concussion symptoms and comorbidities such as headache, migraine, fatigue, mood disturbances, depression, anxiety, and concussion-related symptoms. CLINICAL DECISION MAKING: The data obtained from patient self-report instruments may not actively help clinicians make return-to-play decisions; however, these scales may be useful in providing information that may help the athlete return to school, work, and social activities. The instruments may also serve to identify issues that may lead to problems down the road, including depression or anxiety, or serve to further explore the nature of an athlete's symptoms. Concussion results in numerous symptoms that have the potential to linger and has been associated with depression and anxiety. The use of outcomes scales to assess health-related quality of life and the effect of other symptoms that present with a concussion may allow clinicians to better evaluate the effects of concussion on physical, cognitive, emotional, social, school, and family issues, leading to better and more complete management.

  14. Clinical analysis of firework-related ocular injuries during Spring Festival 2009. (United States)

    Jing, Yuan; Yi-qiao, Xing; Yan-ning, Yang; Ming, Ai; An-huai, Yang; Lian-hong, Zhou


    To document the clinical features, management and visual outcome of fireworks-related ocular injuries during the Spring Festival. A retrospective analysis of all patients with fireworks-related ocular injuries attending the Department of Ophthalmology in Renmin Hospital of Wuhan University from January 20 to February 10, 2009. Age, gender, laterality, type of fireworks, location of incident, initial best-corrected visual acuity (BCVA), diagnosis, management, and final BCVA at last follow-up were documented. Relevant clinical features and visual outcome were evaluated. We observed 25 eyes in 24 patients. Injuries were more frequent in children (ten, 41.7%), males (19, 79.2%), and as open globe injury (15, 62.5%). The most common pyrotechnical products causing accidents were firecrackers (12, 50%). Rural residents had significantly higher rates of injury compared to urban residents (P = 0.023). Of 25 eyes, the most common injuries were corneal/scleral/corneoscleral open globe trauma (15, 60%), traumatic cataract (14, 56%), vitreous hemorrhage (seven, 28%) and retinal detachment (seven, 28%). Most eyes (23, 92%) received surgical intervention, including one (4%) eye enucleation. Vitrectomy was the most surgical treatment. After management, visual outcomes showed statistically significant improvement (P = 0.008). Initial BCVA correlated strongly with final BCVA (P = 0.010). Fireworks-related ocular injuries occur mainly in children, males and rural settings, are frequently severe and visually devastating. Therefore, preventive measures should be strengthened, including public education and legal restriction on the sale and use of fireworks.

  15. State-related functional integration and functional segregation brain networks in schizophrenia. (United States)

    Yu, Qingbao; Sui, Jing; Kiehl, Kent A; Pearlson, Godfrey; Calhoun, Vince D


    Altered topological properties of brain connectivity networks have emerged as important features of schizophrenia. The aim of this study was to investigate how the state-related modulations to graph measures of functional integration and functional segregation brain networks are disrupted in schizophrenia. Firstly, resting state and auditory oddball discrimination (AOD) fMRI data of healthy controls (HCs) and schizophrenia patients (SZs) were decomposed into spatially independent components (ICs) by group independent component analysis (ICA). Then, weighted positive and negative functional integration (inter-component networks) and functional segregation (intra-component networks) brain networks were built in each subject. Subsequently, connectivity strength, clustering coefficient, and global efficiency of all brain networks were statistically compared between groups (HCs and SZs) in each state and between states (rest and AOD) within group. We found that graph measures of negative functional integration brain network and several positive functional segregation brain networks were altered in schizophrenia during AOD task. The metrics of positive functional integration brain network and one positive functional segregation brain network were higher during the resting state than during the AOD task only in HCs. These findings imply that state-related characteristics of both functional integration and functional segregation brain networks are impaired in schizophrenia which provides new insight into the altered brain performance in this brain disorder. © 2013.

  16. Relations of the Big-Five personality dimensions to autodestructive behavior in clinical and non-clinical adolescent populations. (United States)

    Kotrla Topic, Marina; Perkovic Kovacevic, Marina; Mlacic, Boris


    To examine the relationship between the Big-Five personality model and autodestructive behavior symptoms, namely Autodestructiveness and Suicidal Depression in two groups of participants: clinical and non-clinical adolescents. Two groups of participants, clinical (adolescents with diagnosis of psychiatric disorder based on clinical impression and according to valid diagnostic criteria, N=92) and non-clinical (high-school students, N=87), completed two sets of questionnaires: the Autodestructiveness Scale which provided data on Autodestructiveness and Suicidal Depression, and the International Personality Item Pool (IPIP), which provided data on the Big -Five personality dimensions. Clinical group showed significantly higher values on the Autodestructiveness scale in general, as well as on Suicidal Depression, Aggressiveness, and Borderline subscales than the non-clinical group. Some of the dimensions of the Big-Five personality model, ie, Emotional Stability, Conscientiousness, and Agreeableness showed significant relationship (hierarchical regression analyses, P values for β coefficients from 0.000 to 0.021) with Autodestructiveness and Suicidal Depression, even after controlling for the sex and group effects or, when analyzing Suicidal Depression, after controlling the effect of other subscales. The results indicate that dimensions of the Big-Five model are important when evaluating adolescent psychiatric patients and adolescents from general population at risk of self-destructive behavior.

  17. Relations of the Big-Five personality dimensions to autodestructive behavior in clinical and non-clinical adolescent populations (United States)

    Kotrla Topić, Marina; Perković Kovačević, Marina; Mlačić, Boris


    Aim To examine the relationship between the Big-Five personality model and autodestructive behavior symptoms, namely Autodestructiveness and Suicidal Depression in two groups of participants: clinical and non-clinical adolescents. Methods Two groups of participants, clinical (adolescents with diagnosis of psychiatric disorder based on clinical impression and according to valid diagnostic criteria, N = 92) and non-clinical (high-school students, N = 87), completed two sets of questionnaires: the Autodestructiveness Scale which provided data on Autodestructiveness and Suicidal Depression, and the International Personality Item Pool (IPIP), which provided data on the Big -Five personality dimensions. Results Clinical group showed significantly higher values on the Autodestructiveness scale in general, as well as on Suicidal Depression, Aggressiveness, and Borderline subscales than the non-clinical group. Some of the dimensions of the Big-Five personality model, ie, Emotional Stability, Conscientiousness, and Agreeableness showed significant relationship (hierarchical regression analyses, P values for β coefficients from Big-Five model are important when evaluating adolescent psychiatric patients and adolescents from general population at risk of self-destructive behavior. PMID:23100207

  18. The Adequacy of the Q Methodology for Clinical Validation of Nursing Diagnoses Related to Subjective Foci. (United States)

    Miguel, Susana; Caldeira, Sílvia; Vieira, Margarida


    This article describes the adequacy of the Q methodology as a new option for the validation of nursing diagnoses related to subjective foci. Discussion paper about the characteristics of the Q methodology. This method has been used in nursing research particularly related to subjective concepts and includes both a quantitative and qualitative dimension. The Q methodology seems to be an adequate and innovative method for the clinical validation of nursing diagnoses. The validation of nursing diagnoses related to subjective foci using the Q methodology could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and for the planning of effective interventions. Descrever a adequação da metodologia Q como uma nova opção para a validação clínica de diagnósticos de enfermagem relacionados com focos subjetivos. MÉTODOS: Artigo de discussão sobre as características da metodologia Q. Este método tem sido utilizado na pesquisa em enfermagem relacionada com conceitos subjetivos e inclui em simultâneo uma vertente qualitativa e quantitativa. CONCLUSÕES: A metodologia Q parece ser uma opção metodológica adequada para a validação clínica de diagnósticos de enfermagem. IMPLICAÇÕES PARA A PRÁTICA: A utilização da metodologia Q na validação clínica de diagnósticos de enfermagem relacionados com focos subjetivos pode melhorar o nível e evidência e facilitar o raciocínio clínico dos enfermeiros, ao providenciar indicadores clínicos também necessários ao desenvolvimento de intervenções efetivas. © 2016 NANDA International, Inc.

  19. Reward-related decision making in older adults: relationship to clinical presentation of depression. (United States)

    McGovern, Amanda R; Alexopoulos, George S; Yuen, Genevieve S; Morimoto, Sarah Shizuko; Gunning-Dixon, Faith M


    Impairment in reward processes has been found in individuals with depression and in the aging population. The purpose of this study was twofold: (1) to use an affective neuroscience probe to identify abnormalities in reward-related decision making in late-life depression; and (2) to examine the relationship of reward-related decision making abnormalities in depressed, older adults to the clinical expression of apathy in depression. We hypothesized that relative to older, healthy subjects, depressed, older patients would exhibit impaired decision making and that apathetic, depressed patients would show greater impairment in decision making than non-apathetic, depressed patients. We used the Iowa Gambling Task to examine reward-related decision making in 60 non-demented, older patients with non-psychotic major depression and 36 older, psychiatrically healthy participants. Apathy was quantified using the Apathy Evaluation Scale. Of those with major depression, 18 individuals reported clinically significant apathy, whereas 42 participants did not have apathy. Older adults with depression and healthy comparison participants did not differ in their performance on the Iowa Gambling Task. However, apathetic, depressed older adults adopted an advantageous strategy and selected cards from the conservative decks compared with non-apathetic, depressed older adults. Non-apathetic, depressed patients showed a failure to adopt a conservative strategy and persisted in making risky decisions throughout the task. This study indicates that apathy in older, depressed adults is associated with a conservative response style on a behavioral probe of the systems involved in reward-related decision making. This conservative response style may be the result of reduced sensitivity to rewards in apathetic individuals. Copyright © 2014 John Wiley & Sons, Ltd.

  20. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    Directory of Open Access Journals (Sweden)

    Sonja E. Raaum


    Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

  1. Clinical evaluation and evolution of colic cases associated with Panicum maximum in Mato Grosso State, Brazil

    Directory of Open Access Journals (Sweden)

    Renata Gebara Sampaio Dória


    Full Text Available ABSTRACT. Dória R.G.S., Freitas S.H., Laskoski L.M., Carvalho M.B., Monteiro A.O.N., Camplesi A.C. & Valadão C.A.A. [Clinical evaluation and evolution of colic cases associated with Panicum maximum in Mato Grosso State, Brazil.] Avaliação clínica e da evolução dos casos de cólica associados a Panicum maximum no Estado de Mato Grosso, Brasil. Revista Brasileira de Medicina Veterinária, 37(4:303-308, 2015. Departamento de Medicina Veterinária, Curso de Medicina Veterinária, Faculdade de Zootecnia e Engenharia de Alimentos, Universidade de São Paulo, Av. Duque de Caxias Norte, 225, Centro, Pirassununga, SP 13635-900, Brasil. E-mail: An acute disease characterized by colic and timpanism was reported in Pará and Rondônia after horses fed with Panicum maximum cultivars Momba- ça, Tanzânia and Massai pasture grazing. In this study an acute abdomen case was experimentally reproduced after the ingestion of Panicum maximum var Massai pasture based on twenty two clinic and surgical cases of acute timpanic colic cases reported in a farm in the city of Cuiabá – MT, fed with Panicum maximum var Massai pasture, confirming the etiology and accompanying the clinical evolution of the disease. A horse kept in a stall fed only with Massai pasture was daily evaluated and it was verified that the animal presented as result a clinic perfil of pain, high cardiac frequency, respiratory difficulty, intestinal motility absence and exaggerated distention of the stomach and bowels by gas, seeing during the necropsy the stomach and bowels fully distended by gas with liquefied content except by small colon where the feces presented dry and with mucus characterizing the intestinal atony. The necessity of studies that search the identification of the agent responsible for the intestinal atony and gas accumulation in horses fed with Panicum maximum is exposed.

  2. Clinical examination and physical assessment of hip joint-related pain in athletes

    DEFF Research Database (Denmark)

    Reiman, Michael P; Thorborg, Kristian


    UNLABELLED: Evidence-based clinical examination and assessment of the athlete with hip joint related pain is complex. It requires a systematic approach to properly differentially diagnose competing potential causes of athletic pain generation. An approach with an initial broad focus (and hence use...... of highly sensitive tests/measures) that then is followed by utilizing more specific tests/measures to pare down this imprecise differential diagnosis list is suggested. Physical assessment measures are then suggested to discern impairments, activity and participation restrictions for athletes with hip...

  3. Some features of excited states density matrix calculation and their pairing relations in conjugated systems

    International Nuclear Information System (INIS)

    Giambiagi, M.S. de; Giambiagi, M.


    Direct PPP-type calculations of self-consistent (SC) density matrices for excited states are described and the corresponding 'thawn' molecular orbitals (MO) are discussed. Special attention is addressed to particular solutions arising in conjugated systems of a certain symmetry, and to their chemical implications. The U(2) and U(3) algebras are applied respectively to the 4-electron and 6-electron cases: a natural separation of excited states in different cases follows. A simple approach to the convergence problem for excited states is given. The complementarity relations, an alternative formulation of the pairing theorem valid for heteromolecules and non-alternant systems, allow some fruitful experimental applications. Together with the extended pairing relations shown here, they may help to rationalize general trends. (Author) [pt

  4. Conservation priorities for tree crop wild relatives in the United States (United States)

    Colin K. Khoury; Stephanie L. Greene; Karen A. Williams; Chrystian C. Sosa; Chris. Richards


    Crop wild relatives native to the United States have proved useful as genetic resources in breeding more productive, nutritious, and resilient crops. Their utilization is expected to increase with better information about the species and improving breeding tools. But this utilization may be constrained by their limited representation in genebanks and the ongoing loss...

  5. Problems and Issues in Higher Education: Perspectives on Iran-United States Educational Relations and Influences. (United States)

    Fereshteh, M. Hussein

    This review evaluates the writings and opinions of Americans and Iranians on relations and influences between institutions of higher education in Iran and the United States before and after the 1979 revolution. The review explores the arrival of modern western education in Iran, Egypt, and Turkey where a traditional education system had prevailed…

  6. Coherent states related with SU(N) and SU(N,1) groups

    International Nuclear Information System (INIS)

    Gitman, D.M.; Shelepin, A.L.


    The basis of coherent state (CS) for symmetric presentations of groups SU(N) and SU(N,1) is plotted, its properties being investigated. Evolution of CS is considered. Relation between CS of groups SU(N) and Glauber is ascertained

  7. Key Issues in the United States-Iranian Relations 1980 – 2012 ...

    African Journals Online (AJOL)

    In the views of Palmer and Perkins, (2007) “these are times that try men's souls”. The statement corroborates the America relations with Iran since the mid-1980s, when the United States, Israel and other Western Powers started accusing Iran of Uranium enrichment toward pursuing a nuclear weapons capability, a situation ...

  8. Increase in Clostridium difficile-related Mortality Rates, United States, 1999-2004

    Centers for Disease Control (CDC) Podcasts


    Deaths related to Clostridium difficile are on the rise in the United States. Matthew Redelings from the Los Angeles County Department of Health discusses the increase and what can be done to prevent this infection.  Created: 1/8/2008 by Emerging Infectious Diseases.   Date Released: 1/8/2008.

  9. A Proposal for Testing Local Realism Without Using Assumptions Related to Hidden Variable States (United States)

    Ryff, Luiz Carlos


    A feasible experiment is discussed which allows us to prove a Bell's theorem for two particles without using an inequality. The experiment could be used to test local realism against quantum mechanics without the introduction of additional assumptions related to hidden variables states. Only assumptions based on direct experimental observation are needed.

  10. State-related differences in heart rate variability in bipolar disorder

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, Maria; Brage, Søren; Kessing, Lars Vedel


    Heart rate variability (HRV) is a validated measure of sympato-vagal balance in the autonomic nervous system. HRV appears decreased in patients with bipolar disorder (BD) compared with healthy individuals, but the extent of state-related alterations has been sparingly investigated. The present...... bipolar disorder and could...

  11. Regional cerebral blood flow changes related to affective speech presentation in persistent vegetative state

    NARCIS (Netherlands)

    deJong, BM; Willemsen, ATM; Paans, AMJ

    A story told by his mother was presented on tape to a trauma patient in persistent vegetative state (PVS). During auditory presentation, measurements of regional cerebral blood flow (rCBF) were performed by means of positron emission tomography (PET). Changes in rCBF related to this stimulus

  12. Relating adaptive genetic traits to climate for Sandberg bluegrass from the intermountain western United States (United States)

    Richard C. Johnson; Matthew E. Horning; Erin Espeland; Ken Vance-Borland


    Genetic variation for potentially adaptive traits of the key restoration species Sandberg bluegrass (Poa secunda J. Presl) was assessed over the intermountain western United States in relation to source population climate. Common gardens were established at two intermountain west sites with progeny from two maternal parents from each of 130 wild populations. Data were...

  13. Changing State-University Relations: The Experiences of Japan and Lessons for Malaysia (United States)

    Sirat, Morshidi; Kaur, Sarjit


    This article investigates the changing state-university relations in Japan and Malaysia. Its main objective is to identify and examine possible lessons for Malaysia, based on the Japanese experience. Notably, since the late 1970s, Malaysia has been looking towards Japan as a model for socio-economic development (the "look-east" Policy)…

  14. The relation between resting state connectivity and creativity in adolescents before and after training

    NARCIS (Netherlands)

    Cousijn, Janna; Zanolie, Kiki; Munsters, Robbert J M; Kleibeuker, Sietske W; Crone, Eveline A


    An important component of creativity is divergent thinking, which involves the ability to generate novel and useful problem solutions. In this study, we tested the relation between resting-state functional connectivity of brain areas activated during a divergent thinking task (i.e., supramarginal

  15. Relative states and the existential interpretation: einselection, envariance and quantum Darwinism

    Energy Technology Data Exchange (ETDEWEB)

    Zurek, Wojciech H [Los Alamos National Laboratory


    This is a brief 'guide to ideas' aimed at illuminating various developments that are based on the recognition of the role of the environment in the transition from quantum to dassical, and that are relevant to Everett's 'Relative State Interpretation' .

  16. 45 CFR 205.45 - Federal financial participation in relation to State emergency welfare preparedness. (United States)


    ... with other government and voluntary welfare agencies, and welfare-related business and professional organizations and associations, in developing emergency operating plans and attaining operational readiness; (5..., as prescribed in “Guidelines for the Preparation of State Emergency Welfare Services Plan” issued by...

  17. Infinite Relational Modeling of Functional Connectivity in Resting State fMRI

    DEFF Research Database (Denmark)

    Mørup, Morten; Madsen, Kristoffer H.; Dogonowski, Anne Marie


    Functional magnetic resonance imaging (fMRI) can be applied to study the functional connectivity of the neural elements which form complex network at a whole brain level. Most analyses of functional resting state networks (RSN) have been based on the analysis of correlation between the temporal...... dynamics of various regions of the brain. While these models can identify coherently behaving groups in terms of correlation they give little insight into how these groups interact. In this paper we take a different view on the analysis of functional resting state networks. Starting from the definition...... of resting state as functional coherent groups we search for functional units of the brain that communicate with other parts of the brain in a coherent manner as measured by mutual information. We use the infinite relational model (IRM) to quantify functional coherent groups of resting state networks...

  18. The Golden Horde State in the System of International Relations »

    Directory of Open Access Journals (Sweden)

    I.М. Mirgaleev


    Full Text Available The present article examines the place of the Golden Horde in the system of international relations of the 13th–14th centuries as well as directions of its foreign policy. To determine the place of the ulus of Jochi in the international system the author suggests to disclose the subject through illumination of such important issues as: – the Mongol conquests and creation of the Chingisid state entities, the establishment of a new international order. – formation of the ulus of Jochi as an independent State and its role in the Chingisid States’ relations, the kurultai of 1269. – international activities of the Golden Horde State during the period of its might. – interstate coalitions in the global geopolitics and national interests of the ulus of Jochi in international systems. – The role and place of the Golden Horde in the international life of the second half of the 14th – early 15th centuries. The program activity of the Jochids in a new geopolitical situation of the late 14th – early 15th centuries. The author believes that the establishment of the Golden Horde State occurred in three phases (1207–1241, 1242–1259, 1260–1269. The Jochids’ policy towards their neighbors and other Chingisid states formed during this time. Both the Distemper of the 1360–70’s in the ulus of Jochi and destruction of all other Chingisid States resulted in the Golden Horde’s loss of its place in the system of international relations. Therefore, the program activity of the Jochids in a new geopolitical situation of the late 14th – early 15th centuries, was aimed at restoring the international authority of the State. The author considers the directions of the Golden Horde foreign policy, which were laid down during the reign of Berke khan and remained a priority until the end of the 14th century.

  19. Third Level of International Relations: Characteristics of Sub-State Actors

    Directory of Open Access Journals (Sweden)

    Sergey P. Arteev


    Full Text Available The article is in the genre of the review for textbook O. V. Plotnikova and O. Y. Dubrovina International relations of the regions States: characteristics and features (Moscow: Norma; INFRA-M, 2016. 192 p.. Textbook on international activities of sub-state/subnational actors in international relations. Under the sub-state/subnational actors refers to the regions of the States. The authors propose an along with interstate relations (first level and supranational organizations (second level to distinguish a third level of international relations - international relations of the regions in Federal and unitary States. The topic is very relevant due to the ongoing restructuring of the architecture of international relations and world politics. In addition, these processes lead to involvement in international relations new actors. The resulting configuration and the role of traditional players. In addition to long-term evolutionary processes, we should not forget about the position of Russia in the last few years. It is obvious that the current tensions around the Russian Federation may not be fully resolved with the old methods. At the same time, sub-state/ subnational actors as subjects of a combined nature, the role played by regions of the Russian Federation, able to combine harmoniously in its international activities as the techniques characteristic of the traditional actors - States and developments in the tools of non-traditional actors - international non-governmental and non-profit organizations etc. As a result of positive results can be achieved faster and at the interstate level. The review considers the subject and the relevance of the topic, presents the analysis of the content of the work. Marked strengths of the textbook, including those associated with the consideration of the diagonal ties and the political components in the international activities of the regions. In addition to the advantages, attention is paid to the analysis of

  20. A universal nonlinear relation among boundary states in closed string field theory

    International Nuclear Information System (INIS)

    Kishimoto, Isao; Matsuo, Yutaka; Watanabe, Eitoku


    We show that the boundary states satisfy a nonlinear relation (the idempotency equation) with respect to the star product of closed string field theory. This relation is universal in the sense that various D-branes, including the infinitesimally deformed ones, satisfy the same equation, including the coefficient. This paper generalizes our analysis [hep-th/0306189] in the following senses. (1) We present a background-independent formulation based on conformal field theory. It illuminates the geometric nature of the relation and allows us to more systematically analyze the variations around the D-brane background. (2) We show that the Witten-type star product satisfies a similar relation but with a more divergent coefficient. (3) We determine the coefficient of the relation analytically. The result shows that the α parameter can be formally factored out, and the relation becomes universal. We present a conjecture on vacuum theory based on this computation. (author)

  1. Chinese herbal medicine for cancer-related fatigue: a systematic review of randomized clinical trials. (United States)

    Su, Chun-Xiang; Wang, Li-Qiong; Grant, Suzanne J; Liu, Jian-Ping


    To assess the effectiveness and safety of Chinese herbal medicine for the treatment of cancer-related fatigue. We systematically searched seven electronic databases and two trial registries for randomized clinical trials of Chinese herbal medicine for cancer-related fatigue. Two authors independently extracted data and assessed the methodological quality of the included trials using the Cochrane risk of bias tool. Data were synthesized using RevMan 5.2 software. A total of 10 trials involving 751 participants with cancer-related fatigue were identified and the methodological quality of the included trials was generally poor. Chinese herbal medicine used alone or in combination with chemotherapy or supportive care showed significant relief in cancer-related fatigue compared to placebo, chemotherapy or supportive care based on single trials. Chinese herbal medicine plus chemotherapy or supportive care was superior to chemotherapy or supportive care in improving quality of life. Data from one trial demonstrated Chinese herbal medicine exerted a greater beneficial effect on relieving anxiety but no difference in alleviating depression. Seven trials reported adverse events and no severe adverse effects were found in Chinese herbal medicine groups. The findings from limited number of trials suggest that Chinese herbal medicine seems to be effective and safe in the treatment of cancer-related fatigue. However, the current evidence is insufficient to draw a confirmative conclusion due to the poor methodological quality of included trials. Thus, conducting rigorously designed trials on potential Chinese herbal medicine is warranted. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. PSA testing without clinical indication for prostate cancer in relation to socio-demographic and clinical characteristics in the Danish Diet, Cancer and Health Study

    DEFF Research Database (Denmark)

    Karlsen, Randi V; Larsen, Signe B; Christensen, Jane


    Background. Social differences in prostate cancer (PC) incidence and mortality might be related to testing for prostate-specific antigen (PSA). Although routine PSA screening is not recommended in Denmark, testing without clinical indication increased during the past decade. We evaluated...... associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Material and methods. In the Danish Diet, Cancer and Health Cohort, we identified 1051 men with PC diagnosed in 1993-2008. Diagnostic and clinical characteristics were obtained from medical records......, and socio-demographic information was retrieved from administrative registers. We used general logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Cox...

  3. Effect of gatifloxacin against Mycoplasma genitalium-related urethritis: an open clinical trial (United States)

    Takahashi, Satoshi; Kiyota, Hiroshi; Yasuda, Mitsuru; Hayami, Hiroshi; Arakawa, Soichi; Tomono, Kazunori; Matsumoto, Tetsuro


    Objectives Mycoplasma genitalium and Chlamydia trachomatis are the primary pathogens detected from non-gonococcal urethritis (NGU). In this study, the efficacy of gatifloxacin was examined against M genitalium-related urethritis. Methods The study was an open clinical trial evaluating the effectiveness of gatifloxacin with 200 mg doses twice a day for 7 days against male NGU. Results Between March and September 2008, 169 male patients were enrolled, and microbiological and clinical cure rates could be evaluated in 86 patients detected with C trachomatis or M genitalium and in 135 with NGU, respectively. Microbiological cure rates of gatifloxacin against C trachomatis and M genitalium were 100% and 83%, respectively, and the total clinical cure rate was 99%. Conclusion Analysis of in-vivo and in-vitro data from the literature of fluoroquinolone efficacies against M genitalium suggests that a MIC90 of 0.125 μg/ml or less may be useful for optimal activity against M genitalium infection. PMID:21531704

  4. Clinical characteristics of catamenial and non-catamenial thoracic endometriosis-related pneumothorax. (United States)

    Fukuoka, Mizuki; Kurihara, Masatoshi; Haga, Takahiro; Ebana, Hiroki; Kataoka, Hideyuki; Mizobuchi, Teruaki; Tatsumi, Koichiro


    A major pathogenic factor for catamenial pneumothorax is thoracic endometriosis. However, thoracic endometriosis-related pneumothorax (TERP) can develop as either catamenial or non-catamenial pneumothorax (CP). Therefore, the aim of this study was to elucidate the clinical differences between catamenial and non-catamenial TERP. The clinical and pathological data in female patients who underwent video-assisted thoracoscopic surgery at the Pneumothorax Research Center during an 8-year period were retrospectively reviewed. This study included 150 female patients with surgico-pathologically confirmed TERP. The subjects were divided into two groups, those having all of the pneumothorax episodes in the catamenial period (CP group) and those who did not (non-CP group). We compared the clinical characteristics and surgico-pathological findings between these two groups. Of the 150 TERP patients, 55 (36.7%) were classified in the CP group, and 95 (63.3%) in the non-CP group. In regard to the locations of endometriosis, all TERP patients had diaphragmatic endometriosis, while pleural implantation was recognized in 34 of the 55 (61.8%) patients in the CP group and 42 of the 95 (44.2%) patients in the non-CP group (P pneumothorax episodes. © 2015 Asian Pacific Society of Respirology.

  5. Quality management and job related factors predicting satisfaction of dental clinic staff in Estonia. (United States)

    Merisalu, Eda; Männik, Georg; Põlluste, Kaja


    The aim of the study was to explore the role of managerial style, work environment factors and burnout in determining job satisfaction during the implementation of quality improvement activities in a dental clinic. Quantitative research was carried out using a prestructured anonymous questionnaire to survey 302 respondents in Kaarli Dental Clinic, Estonia. Dental clinic staff assessed job satisfaction, managerial style, work stress and burnout levels through the implementation period of ISO 9000 quality management system in 2003 and annually during 2006-2009. Binary logistic regression was used to explain the impact of satisfaction with management and work organisation, knowledge about managerial activities, work environment and psychosocial stress and burnout on job satisfaction. The response rate limits were between 60% and 89.6%. Job satisfaction increased significantly from 2003 to 2006 and the percentage of very satisfied staff increased from 17 to 38 (pwork organisation and working environment, as well as factors related to career, security and planning. The average scores of emotional exhaustion showed significant decrease, correlating negatively with job satisfaction (pwork environment by decreasing burnout symptoms and increased job satisfaction in staff.

  6. The relation between serum vitamin D levels and clinical findings of fibromyalgia syndrome

    Directory of Open Access Journals (Sweden)

    Nurcan Kılıç Baygutalp


    Full Text Available Objective:This study was performed to identify serum 25-OH vitamin D levels and to investigate the relationship between 25-OH vitamin D and clinical findings on patients with fibromyalgia syndrome (FMS. Methods:Nineteen premenopausal women with FMS who were diagnosed according to ACR 1990 fibromyalgia diagnostic criteria and 24 premenopausal healthy women as control group were included in the study. Serum 25-OH vitamin D levels were determined in both patient and control groups. Widespread body pain, headache, fatigue, morning stiffness, sleep disorder, the number of tender points, Fibromyalgia Impact Questionnaire (FIQ scores and Beck depression scores were evaluated as clinical findings in patients with FMS. Results:Serum 25-OH vitamin D levels were significantly lower in patients with FMS than those in control group (p=0.01. There were significantly negative correlations between 25-OH vitamin D levels and widespread body pain (r=-0.731, Beck depression scores (r=-0.777, headache (r=-0.629, and sleep disorder (r=-0.767 in the FMS group (p<0.01. Conclusion: It was concluded that 25-OH vitamin D deficiency may be related to the clinical findings such as widespread body pain, depression, headache and sleep disorder in patients with FMS.

  7. Bone and fall-related fracture risks in women and men with a recent clinical fracture. (United States)

    van Helden, Svenhjalmar; van Geel, Antonia C M; Geusens, Piet P; Kessels, Alfons; Nieuwenhuijzen Kruseman, Arie C; Brink, Peter R G


    Worldwide fracture rates are increasing as a result of the aging population, and prevention, both primary and secondary, is an important public health goal. Therefore, we systematically analyzed risk factors in subjects with a recent clinical fracture. All men and women over fifty years of age who had been treated in the emergency department of, or hospitalized at, our institution because of a recent fracture during a one-year period were offered the opportunity to undergo an evidence-based bone and fall-related risk-factor assessment and bone densitometry. The women included in this study were also compared with a group of postmenopausal women without a fracture history who had been included in another cohort study. Of the 940 consecutive patients, 797 (85%) were eligible for this study and 568 (60%) agreed to participate. The prevalence of fall-related risk factors (75% [95% confidence interval = 71% to 78%]; n = 425) and the prevalence of bone-related risk factors (53% [95% confidence interval = 49% to 57%]; n = 299) at the time of fracture were higher than the prevalence of osteoporosis (35% [95% confidence interval = 31% to 39%]; n = 201) as defined by a dual x-ray absorptiometry T score of fall and bone-related risk factors were present irrespective of the fracture location, patient age, or gender. An overlap between bone and fall-related risk factors was found in 50% of the patients. After adjusting for age, weight, and height, we found that women with a fracture more frequently had a diagnosis of osteoporosis (odds ratio = 2.9; 95% confidence interval = 2.0 to 4.1) and had a more extensive history of falls (odds ratio = 4.0; 95% confidence interval = 2.7 to 5.9) than did the postmenopausal women without a fracture history. Men and women over fifty years of age who had recently sustained a clinical fracture had, at the time of that fracture, bone and fall-related risk factors that were greater than the risk predicted by the presence of osteoporosis. Risk

  8. Integrating query of relational and textual data in clinical databases: a case study. (United States)

    Fisk, John M; Mutalik, Pradeep; Levin, Forrest W; Erdos, Joseph; Taylor, Caroline; Nadkarni, Prakash


    The authors designed and implemented a clinical data mart composed of an integrated information retrieval (IR) and relational database management system (RDBMS). Using commodity software, which supports interactive, attribute-centric text and relational searches, the mart houses 2.8 million documents that span a five-year period and supports basic IR features such as Boolean searches, stemming, and proximity and fuzzy searching. Results are relevance-ranked using either "total documents per patient" or "report type weighting." Non-curated medical text has a significant degree of malformation with respect to spelling and punctuation, which creates difficulties for text indexing and searching. Presently, the IR facilities of RDBMS packages lack the features necessary to handle such malformed text adequately. A robust IR+RDBMS system can be developed, but it requires integrating RDBMSs with third-party IR software. RDBMS vendors need to make their IR offerings more accessible to non-programmers.

  9. The relational underpinnings of quality internal auditing in medical clinics in Israel. (United States)

    Carmeli, Abraham; Zisu, Malka


    Internal auditing is a key mechanism in enhancing organizational reliability. However, research on the ways quality internal auditing is enabled through learning, deterrence, motivation and process improvement is scant. In particular, the relational underpinnings of internal auditing have been understudied. This study attempts to address this need by examining how organizational trust, perceived organizational support and psychological safety enable internal auditing. Data collected from employees in medical clinics of one of the largest healthcare organizations in Israel at two points in time six months apart. Our results show that organizational trust and perceived organizational support are positively related to psychological safety (measured at time 1), which, in turn, is associated with internal auditing (measured at time 2).

  10. Unintended Transformations of Clinical Relations with a Computerized Physician Order Entry System

    DEFF Research Database (Denmark)

    Wentzer, Helle; Böttger, Ulrich; Boye, Niels


    A socio-technical approach was used to study the qualitative effects of deploying a medication CPOE (Computerized Physician Order Entry System with no decision support) at two internal medical wards in a hospital in Denmark. Our results show spatial and temporal transformations of core acts...... and relations in medication work, i.e. of the intended use of the system inscribed in hardware and software, in the relations of care between doctors and patients, of collaboration between doctors and nurses, and prospectively of the patients’ trajectories when readmitted to hospital or another health care...... or ‘doing medication’. The paper argues for the project organization to support the local collaboration and renegotiation of time and place of enacting medication with CPOE, as well as set up feedback for maturation of the software for future clinical use....

  11. Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management - United States, 2015. (United States)

    Barbour, Kamil E; Moss, Susan; Croft, Janet B; Helmick, Charles G; Theis, Kristina A; Brady, Teresa J; Murphy, Louise B; Hootman, Jennifer M; Greenlund, Kurt J; Lu, Hua; Wang, Yan


    Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity. 2015. The Behavioral Risk Factor Surveillance System is an annual, random-digit-dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method. In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%-33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%-42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%-19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%-61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%-53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain

  12. Using redescription mining to relate clinical and biological characteristics of cognitively impaired and Alzheimer's disease patients.

    Directory of Open Access Journals (Sweden)

    Matej Mihelčić

    Full Text Available Based on a set of subjects and a collection of attributes obtained from the Alzheimer's Disease Neuroimaging Initiative database, we used redescription mining to find interpretable rules revealing associations between those determinants that provide insights about the Alzheimer's disease (AD. We extended the CLUS-RM redescription mining algorithm to a constraint-based redescription mining (CBRM setting, which enables several modes of targeted exploration of specific, user-constrained associations. Redescription mining enabled finding specific constructs of clinical and biological attributes that describe many groups of subjects of different size, homogeneity and levels of cognitive impairment. We confirmed some previously known findings. However, in some instances, as with the attributes: testosterone, ciliary neurotrophic factor, brain natriuretic peptide, Fas ligand, the imaging attribute Spatial Pattern of Abnormalities for Recognition of Early AD, as well as the levels of leptin and angiopoietin-2 in plasma, we corroborated previously debatable findings or provided additional information about these variables and their association with AD pathogenesis. Moreover, applying redescription mining on ADNI data resulted with the discovery of one largely unknown attribute: the Pregnancy-Associated Protein-A (PAPP-A, which we found highly associated with cognitive impairment in AD. Statistically significant correlations (p ≤ 0.01 were found between PAPP-A and clinical tests: Alzheimer's Disease Assessment Scale, Clinical Dementia Rating Sum of Boxes, Mini Mental State Examination, etc. The high importance of this finding lies in the fact that PAPP-A is a metalloproteinase, known to cleave insulin-like growth factor binding proteins. Since it also shares similar substrates with A Disintegrin and the Metalloproteinase family of enzymes that act as α-secretase to physiologically cleave amyloid precursor protein (APP in the non-amyloidogenic pathway

  13. Using redescription mining to relate clinical and biological characteristics of cognitively impaired and Alzheimer's disease patients. (United States)

    Mihelčić, Matej; Šimić, Goran; Babić Leko, Mirjana; Lavrač, Nada; Džeroski, Sašo; Šmuc, Tomislav


    Based on a set of subjects and a collection of attributes obtained from the Alzheimer's Disease Neuroimaging Initiative database, we used redescription mining to find interpretable rules revealing associations between those determinants that provide insights about the Alzheimer's disease (AD). We extended the CLUS-RM redescription mining algorithm to a constraint-based redescription mining (CBRM) setting, which enables several modes of targeted exploration of specific, user-constrained associations. Redescription mining enabled finding specific constructs of clinical and biological attributes that describe many groups of subjects of different size, homogeneity and levels of cognitive impairment. We confirmed some previously known findings. However, in some instances, as with the attributes: testosterone, ciliary neurotrophic factor, brain natriuretic peptide, Fas ligand, the imaging attribute Spatial Pattern of Abnormalities for Recognition of Early AD, as well as the levels of leptin and angiopoietin-2 in plasma, we corroborated previously debatable findings or provided additional information about these variables and their association with AD pathogenesis. Moreover, applying redescription mining on ADNI data resulted with the discovery of one largely unknown attribute: the Pregnancy-Associated Protein-A (PAPP-A), which we found highly associated with cognitive impairment in AD. Statistically significant correlations (p ≤ 0.01) were found between PAPP-A and clinical tests: Alzheimer's Disease Assessment Scale, Clinical Dementia Rating Sum of Boxes, Mini Mental State Examination, etc. The high importance of this finding lies in the fact that PAPP-A is a metalloproteinase, known to cleave insulin-like growth factor binding proteins. Since it also shares similar substrates with A Disintegrin and the Metalloproteinase family of enzymes that act as α-secretase to physiologically cleave amyloid precursor protein (APP) in the non-amyloidogenic pathway, it could be

  14. Initial clinical experience with dedicated ultra fast solid state cardiac gamma camera

    International Nuclear Information System (INIS)

    Aland, Nusrat; Lele, V.


    detector reducing camera related motion artifacts. Diagnostic performance was comparable to that of standard dual detector gamma camera images. Mid septum invariably showed perfusion defects in QPS protocol, this probably was due to lack of normal database for solid state detector. Lung activity could not be visualized due to small field of view. Extra cardiac activity could be assessed. CONCLUSION: We preferred solid state cardiac gamma camera over conventional dual detector gamma camera for myocardial perfusion imaging. Advantages of solid state gamma camera over standard dual head gamma camera: 1. Faster acquisition time 2. Increased patient comfort 3. Less radiation dose to the patient 4. Brighter images 5. No motion artifact 6. Better right ventricular imaging Disadvantages 1. Extra cardiac activity cannot be assessed 2. Lung activity not seen due to small field of view 3. Invariably septal perfusion defects noted

  15. Psychological, Relational, and Biological Correlates of Ego-Dystonic Masturbation in a Clinical Setting. (United States)

    Castellini, Giovanni; Fanni, Egidia; Corona, Giovanni; Maseroli, Elisa; Ricca, Valdo; Maggi, Mario


    Attitudes toward masturbation are extremely varied, and this practice is often perceived with a sense of guilt. To evaluate the prevalence of ego-dystonic masturbation (EM), defined as masturbation activity followed by a sense of guilt, in a clinical setting of sexual medicine and the impact of EM on psychological and relational well-being. A series of 4,211 men attending an andrology and sexual medicine outpatient clinic was studied retrospectively. The presence and severity of EM were defined according to ANDROTEST items related to masturbation, determined by the mathematical product of the frequency of masturbation and the sense of guilt after masturbation. Clinical, biochemical, and psychological parameters were studied using the Structured Interview on Erectile Dysfunction, ANDROTEST, and modified Middlesex Hospital Questionnaire. Three hundred fifty-two subjects (8.4%) reported any sense of guilt after masturbation. Subjects with EM were younger than the remaining sample (mean age ± SD = 51.27 ± 13.43 vs 48.31 ± 12.04 years, P < .0001) and had more psychiatric comorbidities. EM severity was positively associated with higher free-floating (Wald = 35.94, P < .001) and depressive (Wald = 16.85, P < .001) symptoms, and subjects with a higher EM score reported less phobic anxiety (Wald = 4.02, P < .05) and obsessive-compulsive symptoms (Wald = 7.6, P < .01). A higher EM score was associated with a higher alcohol intake. Subjects with EM more often reported the partner's lower frequency of climax and more problems achieving an erection during sexual intercourse. EM severity was positively associated with worse relational and intrapsychic domain scores. Clinicians should consider that some subjects seeking treatment in a sexual medicine setting might report compulsive sexual behaviors. EM represents a clinically relevant cause of disability, given the high level of psychological distress reported by subjects with this condition, and the severe impact on

  16. Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling. (United States)

    Grant, Jon E; Chamberlain, Samuel R; Schreiber, Liana R N; Odlaug, Brian L


    Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for selecting appropriate prevention and treatment strategies. The aim of this study was to investigate clinical and cognitive differences in treatment-seeking people with pathological gambling as a function of gender. 501 adult subjects (n = 274 [54.7%] females) with DSM-IV pathological gambling presenting for various clinical research trials over a 9-year period were assessed in terms of sociodemographics and clinical characteristics. A subset (n = 77) had also undertaken neuropsychological assessment with the Stop-signal and set-shift tasks. PG in females was associated with significantly worse disease severity, elevated mood and anxiety scores, and history of affective disorders, later age of study presentation, later age of disease onset, and elevated risk of having a first-degree relative with gambling or alcohol problems. These findings were of small effect size (0.20-0.35). Additionally, PG in females was associated with proportionately more non-strategic gambling with medium effect size (0.61). In contrast, PG in males was associated with a significantly greater lifetime history of an alcohol use disorder and any substance use disorder (small effect sizes 0.22-0.38); and slower motoric reaction times (medium effect size, 0.50). Response inhibition and cognitive flexibility were similar between the groups. These data suggest that important differences exist in the features of pathological gambling in women and men. Findings are of considerable relevance to clinicians and in terms of targeted treatments. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Geographic Distribution of Trauma Centers and Injury Related Mortality in the United States (United States)

    Brown, Joshua B.; Rosengart, Matthew R.; Billiar, Timothy R.; Peitzman, Andrew B.; Sperry, Jason L.


    Background Regionalized trauma care improves outcomes; however access to care is not uniform across the US. The objective was to evaluate whether geographic distribution of trauma centers correlates with injury mortality across state trauma systems. Methods Level I/II trauma centers in the contiguous US were mapped. State-level age-adjusted injury fatality rates/100,000people were obtained and evaluated for spatial autocorrelation. Nearest neighbor ratios (NNR) were generated for each state. A NNR1 indicates dispersion. NNR were tested for difference from random geographic distribution. Fatality rates and NNR were examined for correlation. Fatality rates were compared between states with trauma center clustering versus dispersion. Trauma center distribution and population density were evaluated. Spatial-lag regression determined the association between fatality rate and NNR, controlling for state-level demographics, population density, injury severity, trauma system resources, and socioeconomic factors. Results Fatality rates were spatially autocorrelated (Moran's I=0.35, pcenter distribution. Fatality rate and NNR were correlated (ρ=0.34, p=0.03). Clustered states had a lower median injury fatality rate compared to dispersed states (56.9 [IQR 46.5–58.9] versus 64.9 [IQR 52.5–77.1], p=0.04). Dispersed compared to clustered states had more counties without a trauma center that had higher population density than counties with a trauma center (5.7% versus 1.2%, pdistribution of trauma centers correlates with injury mortality, with more clustered state trauma centers associated with lower fatality rates. This may be a result of access relative to population density. These results may have implications for trauma system planning and requires further study to investigate underlying mechanisms PMID:26517780

  18. Study of the Clinical Proton Beam Relative Biological Effectiveness at the JINR Phasotron, Dubna

    CERN Document Server

    Vitanova, A; Gaevskii, V N; Molokonov, A G; Spurny, F; Fadeeva, T A; Shmakova, N L


    Proton clinical beams contain particles with high linear energy transfer (LET). Secondary heavy charged particles produced from nuclear interactions and degraded protons at the Bragg peak region are particles with high LET. These particles could enhance the Relative Biological Effectiveness (RBE) of the proton beam. We have carried out two radiobiological experiments to investigate the RBE of 150 MeV clinical proton beam. The irradiation of the Chinese Hamster V79 cells were performed at two points of the depth-dose distribution - at the beam entrance and at the Bragg peak. The contribution of the high LET particles to dosimetric and microdosimetric characteristics in the various depth of proton beam was also experimentally studied using the CR-39 track etched detectors. The LET spectra between 10 and 700 keV/{\\mu}m were measured by means of track detectors and the automatic optical image analyzer LUCIA-II. The relative contribution of the high LET particles to ab! sorbed dose increases from several per cent ...

  19. Mentoring ethnic minority counseling and clinical psychology students: A multicultural, ecological, and relational model. (United States)

    Chan, Anne W; Yeh, Christine J; Krumboltz, John D


    The aim of the current study was to understand the role of race and culture in successful mentoring relationships in graduate school. We examined the practices of 9 faculty mentors working with 15 ethnic minority doctoral students in counseling and clinical psychology. Grounded theory was used to discern unifying patterns and to formulate a theory of multicultural mentoring. Five overall themes significant to multicultural mentoring emerged: (a) career support and guidance tailored for ethnic minorities, (b) relationality between mentors and protégés, (c) significance of contexts, (d) interconnections across contexts, and (e) multidirectionality of interactions between contexts. The 5 themes combined to form a multicultural, ecological, and relational model of mentoring. Our findings suggest that mentoring ethnic minority students can be successful, productive, and satisfying for both mentors and protégés when mentors possess the necessary skills, time, commitment, and multicultural competencies. Implications for doctoral programs in counseling and clinical psychology are discussed, along with recommendations for future research directions. (c) 2015 APA, all rights reserved).

  20. Dairy intake in relation to in vitro fertilization outcomes among women from a fertility clinic. (United States)

    Afeiche, M C; Chiu, Y-H; Gaskins, A J; Williams, P L; Souter, I; Wright, D L; Hauser, R; Chavarro, J E


    Is dairy food consumption associated with live birth among women undergoing infertility treatment? There was a positive association between total dairy food consumption and live birth among women ≥35 years of age. Dairy food intake has been previously related to infertility risk and measures of fertility potential but its relation to infertility treatment outcomes are unknown. Our study population comprised a total of 232 women undergoing 353 in vitro fertilization (IVF) treatment cycles between February 2007 and May 2013, from the Environment and Reproductive Health study, an ongoing prospective cohort. Diet was assessed before assisted reproductive technology (ART) treatment using a validated food frequency questionnaire. Study outcomes included ovarian stimulation outcomes (endometrial thickness, estradiol levels and oocyte yield), fertilization rates, embryo quality measures and clinical outcomes (implantation, clinical pregnancy and live birth rates). We used generalized linear mixed models with random intercepts to account for multiple ART cycles per woman while simultaneously adjusting for age, caloric intake, BMI, race, smoking status, infertility diagnosis, protocol type, alcohol intake and dietary patterns. The age- and calorie-adjusted difference in live birth between women in the highest (>3.0 servings/day) and lowest (Switzerland and completed this work while at the Harvard School of Public Health. The other authors declare no conflicts of interest. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email:

  1. [Atypical epithelial hyperplasia of the breast: current state of knowledge and clinical practice]. (United States)

    Lavoué, V; Bertel, C; Tas, P; Bendavid, C; Rouquette, S; Foucher, F; Audrain, O; Bouriel, C; Levêque, J


    The diagnosis of atypical epithelial hyperplasia (AEH) increases with breast cancer screening. AEH is divided in three groups: atypical ductal hyperplasia, columnar cell lesions with atypia, lobular neoplasia. The management of women with AEH is not consensual because of uncertainty about their diagnosis related to the type of the biopsy sampling (core needle biopsy or surgical excision) and their controversial clinical signification between risk marker and true precursor of breast cancer. A systematic review of published studies was performed. Medline baseline interrogation was performed with the following keywords: atypical ductal hyperplasia, columnar cell lesions with atypia, lobular neoplasia, core needle biopsy, breast cancer, precursor lesion, hormonal replacement therapy. For each breast lesion, identified publications (English or French) were assessed for clinical practise in epidemiology, diagnosis and patient management. With immunohistochemistry and molecular studies, AEH seems to be precursor of breast cancer. But, epidemiological studies show low rate of breast cancer in women with AEH. AEH were still classified as risk factor of breast cancer. Because of high rate of breast cancer underestimation, surgical excision is necessary after the diagnosis of AEH at core needle biopsy. Surgical oncology rules and collaboration with radiologist are required for this surgery. A second operation was not required due to involved margins by AEH (except with pleiomorphic lobular neoplasia) because local control of breast cancer seems to be unchanged. Besides, hormonal replacement therapy for patient with AEH is not recommended because of lack of studies about this subject. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  2. Gambling disorder in financial markets: Clinical and treatment-related features. (United States)

    Shin, Young-Chul; Choi, Sam-Wook; Ha, Juwon; Choi, Jung-Seok; Kim, Dai-Jin


    To date, few studies have examined the clinical manifestation of disordered gamblers in financial markets. This study examined the differences in the clinical and treatment-related features of gambling disorder between financial markets and horse races. Subjects who met the DSM-IV criteria for pathological gambling (PG) and who sought treatment were assessed by retrospective chart review. One hundred forty-four subjects were included in this sample, which consisted of the following groups: financial markets (n = 45; 28.6%) and horse races (n = 99; 71.4%). Multiple similar manifestations were found between the groups, including severity of PG, age of PG onset, amounts of gambling debts, drinking days per week, depressive mood, duration of seeking treatment after the onset of PG, and treatment follow-up duration. However, disordered gamblers who invested in the financial market were significantly more likely to be educated (p = 0.003), live with their spouses (p = 0.007), have full-time jobs (p = 0.006), and they were more likely to participate in the first type of gambling than the horse races group (pfinancial markets group received the anti-craving medication less often than the horse races group (p = 0.04). These findings suggest that disordered gamblers in financial markets show different socio-demographic, clinical and treatment-related features compared with the horse race gamblers, despite a similar severity of gambling disorder. Understanding these differential manifestations may provide insight into prevention and treatment development for specific types of gambling.

  3. Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference. (United States)

    Levy, David M; Kuhns, Benjamin D; Chahal, Jaskarndip; Philippon, Marc J; Kelly, Bryan T; Nho, Shane J


    To determine whether the hip arthroscopy literature to date has shown outcomes consistent with published patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) estimates. All clinical investigations of hip arthroscopy using modified Harris Hip Score (mHHS) and/or Hip Outcome Score (HOS) outcomes with at least 1 year of follow-up were reviewed. Ninety-one studies (9,746 hips) were included for review. Eighty-one studies (9,317 hips) contained only primary hip arthroscopies and were the primary focus of this review. The remaining studies (429 hips) did not exclude patients with prior surgical history and were thus considered separately. Mean mHHS, HOS-ADL (Activities of Daily Living) and HOS-SS (Sports-Specific) scores were compared with previously published PASS and MCID values. After 31 ± 20 months, 5.8% of study populations required revision arthroscopy and 5.5% total hip arthroplasty. A total of 88%, 25%, and 30% of study populations met PASS for mHHS, HOS-ADL, and HOS-SS, respectively, and 97%, 90%, and 93% met MCID. On bivariate analysis, increasing age was associated with significantly worse postoperative mHHS (P arthroscopy, we have found that more than 90% of study populations meet MCID standards for the most commonly used patient-reported outcomes measures in hip arthroscopy literature, mHHS and HOS. Eighty-eight percent meet PASS standards for the mHHS, but PASS standards are far more difficult to achieve for HOS-ADL (25%) and HOS-SS (30%) subscales. Differences in psychometric properties of the mHHS and HOS likely account for the discrepancies in PASS. Level IV, systematic review of Level I to IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. A description of the roles, activities, and skills of clinical nurse specialists in the United States. (United States)

    Scott, R A


    Clinical nurse specialists (CNSs) frequently adapt to meet the challenging and changing needs of patients, families, nurses, physicians, and institutions, thus creating an advance practice role that is problematic in definition and description. The two dilemmas associated with CNSs have been role confusion and ambiguity, and the inability to explicate CNSs' value in economic terms. The purpose of this study was to describe the roles, activities, skills, and the cost-saving and revenue-generating activities of Master's-prepared nurses who function in traditional CNS roles in the United States. A descriptive research design was employed, using Role Theory as a framework to guide the study. The tool used to measure CNS practice included a 68-item instrument. It was pretested and used in two pilot studies. Content validity was supported by three experienced CNSs who were, at the time, in a doctoral nursing program. Instrument reliability was 0.89. Surveys were mailed to all individuals who subscribed (n = 2379) to the Clinical Nurse Specialist Journal. From the convenience sample, 724 CNSs participated, providing a margin of error of +/- 4 percentage points with a 99% confidence level. Regarding the five role components, CNSs reported (listed from most frequently to least frequently) spending time in the role of expert practitioner, educator, consultant, administrator, and researcher. Most of the activities listed in each of the roles were typical of CNS practice. Of the advanced practice roles, the two with the most surprising results were the expert practitioner and administrator roles. The results indicated a trend toward performing advanced skills that have been in the past considered solely medical practice and toward increasing administrative responsibilities. A small number of CNSs were able to identify cost-saving and revenue-generating activities, including the monetary value of the activity.

  5. A survey of current clinical practice of permanent prostate brachytherapy in the United States

    International Nuclear Information System (INIS)

    Prestidge, Bradley R.; Prete, James J.; Buchholz, Thomas A.; Friedland, Jay L.; Stock, Richard G.; Grimm, Peter D.; Bice, William S.


    Purpose: To help establish standards of care for transperineal interstitial permanent prostate brachytherapy (TIPPB) by obtaining data regarding current clinical practice among the most experienced TIPPB brachytherapists in the United States. Methods and Materials: The 70 brachytherapists who performed the greatest number of TIPPB cases in 1995 in the U.S. were surveyed. Each received a comprehensive four page questionnaire that included sections on training and experience, patient and isotope selection criteria, manpower, technique, and follow-up. Thirty-five (50%) surveys were ultimately returned after three mailings and follow-up phone calls. The cumulative experience of the 35 respondents represented approximately 45% of the total TIPPB volume in the U.S. for 1995. Respondents included 29 from the private sector and six from academic programs. Results: The median physician experience with TIPPB was reported as 4.9 years. Each performed an average of 73 TIPPB procedures in 1995 (range 40-300). This represented an increase in volume for most (74%) of the respondents. Sixty-three percent of the respondents attended a formal training course, 54% had TIPPB-specific residency training, and 31% had been proctored (16 had received two or more types of training experience). The most commonly reported selection criteria for implant alone was on Gleason score ≤7, PSA 125 I prescribed to 120 Gy (75%) or 103 Pd to 90 Gy (50%). Sixty percent reported using a Mick applicator, 46% prefer using preloaded needles, and (11%) use both techniques. Real-time imaging was usually performed with ultrasound (94%); most included fluoroscopy (60%). Definitions of PSA control varied widely. Conclusions: TIPPB clinical practice in the U.S. demonstrates similarities in technique, but differences in patient selection and definitions of biochemical control. It is, therefore, incumbent on those beginning TIPPB programs to carefully review the specific practice details of those institutions

  6. Antimicrobial Susceptibility and Clonality of Clinical Ureaplasma Isolates in the United States. (United States)

    Fernández, Javier; Karau, Melissa J; Cunningham, Scott A; Greenwood-Quaintance, Kerryl E; Patel, Robin


    Ureaplasma urealyticum and Ureaplasma parvum are pathogens involved in urogenital tract and intrauterine infections and also in systemic diseases in newborns and immunosuppressed patients. There is limited information on the antimicrobial susceptibility and clonality of these species. In this study, we report the susceptibility of 250 contemporary isolates of Ureaplasma (202 U. parvum and 48 U. urealyticum isolates) recovered at Mayo Clinic, Rochester, MN. MICs of doxycycline, azithromycin, ciprofloxacin, tetracycline, erythromycin, and levofloxacin were determined by broth microdilution, with MICS of the last three interpreted according to CLSI guidelines. Levofloxacin resistance was found in 6.4% and 5.2% of U. parvum and U. urealyticum isolates, respectively, while 27.2% and 68.8% of isolates, respectively, showed ciprofloxacin MICs of ≥4 μg/ml. The resistance mechanism of levofloxacin-resistant isolates was due to mutations in parC, with the Ser83Leu substitution being most frequent, followed by Glu87Lys. No macrolide resistance was found among the 250 isolates studied; a single U. parvum isolate was tetracycline resistant. tet(M) was found in 10 U. parvum isolates, including the single tetracycline-resistant isolate, as well as in 9 isolates which had low tetracycline and doxycycline MICs. Multilocus sequence typing (MLST) performed on a selection of 46 isolates showed high diversity within the clinical Ureaplasma isolates studied, regardless of antimicrobial susceptibility. The present work extends previous knowledge regarding susceptibility to antimicrobial agents, resistance mechanisms, and clonality of Ureaplasma species in the United States. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  7. Factors relating to transmission of viral hepatitis in a United States military population stationed in Thailand. (United States)

    Scott, R M; Schneider, R J; Snitbhan, R; Karwacki, J J


    To determine the incidence of clinical and inapparent hepatitis in a US military population stationed in Thailand, the authors prospectively studied a cohort of 326 men during one year. Clinical hepatitis A occurred in one man (clinical attack rate = 3.1/1000 men/year), and clinical hepatitis B was found in four men (clinical attack rate = 12.3/1000 men/year). No non-A, non-B hepatitis was identified. There was no serologically identified inapparent hepatitis A but inapparent hepatitis B occurred in 17 men. The apparent/inapparent ratio for hepatitis B was 1:4.25. Serotype analysis suggested that hepatitis B virus largely originated from Thai contacts, although 23% of cases were derived from western sources. To determine the relative contribution of 16 statistically significant (out of 67 studied) behavioral variables to the transmission of HBV, a factor analysis and a multivariate correlation analysis were employed. Factor analysis indicated that social and sexual contact with the indigenous population, including prostitutes, residence within the Thai community and marijuana use were behavioral areas that were associated with the acquisition of hepatitis B. Residence in the Thai community during the first four-month period in Thailand, sexual contact with a prostitute during the third four-month period, and ever having maintained a Thai mistress were found to be significant and independent risk factors by multiple regression analysis.

  8. Quantum steering of multimode Gaussian states by Gaussian measurements: monogamy relations and the Peres conjecture

    International Nuclear Information System (INIS)

    Ji, Se-Wan; Nha, Hyunchul; Kim, M S


    It is a topic of fundamental and practical importance how a quantum correlated state can be reliably distributed through a noisy channel for quantum information processing. The concept of quantum steering recently defined in a rigorous manner is relevant to study it under certain circumstances and here we address quantum steerability of Gaussian states to this aim. In particular, we attempt to reformulate the criterion for Gaussian steering in terms of local and global purities and show that it is sufficient and necessary for the case of steering a 1-mode system by an N-mode system. It subsequently enables us to reinforce a strong monogamy relation under which only one party can steer a local system of 1-mode. Moreover, we show that only a negative partial-transpose state can manifest quantum steerability by Gaussian measurements in relation to the Peres conjecture. We also discuss our formulation for the case of distributing a two-mode squeezed state via one-way quantum channels making dissipation and amplification effects, respectively. Finally, we extend our approach to include non-Gaussian measurements, more precisely, all orders of higher-order squeezing measurements, and find that this broad set of non-Gaussian measurements is not useful to demonstrate steering for Gaussian states beyond Gaussian measurements. (paper)

  9. EPA guidance on the early detection of clinical high risk states of psychoses

    DEFF Research Database (Denmark)

    Schultze-Lutter, F; Michel, C; Schmidt, S J


    The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates...... to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates...... in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow...

  10. Research related to boron neutron capture therapy at The Ohio State University

    International Nuclear Information System (INIS)

    Barth, R.F.; Soloway, A.H.; Alam, F.


    Research in the area of boron neutron capture therapy (BNCT) at The Ohio State University is a highly multidisciplinary effort involving approximately twenty investigators in nine different departments. Major areas of interest include: (1) Boronation of monoclonal antibodies directed against tumor-associated antigens for the delivery of 10 B; (2) Synthesis of 10 B-containing derivatives of promazines and porphyrins that possess tumor-localizing properties; (3) Development of a rat model for the treatment of glioblastoma by BNCT; (4) Quantitation and microdistribution of 10 B in tissues by means of a solid state nuclear track detector. The ultimate goal of this research is to carry out the extensive preclinical studies that are required to bring BNCT to the point of a clinical trial. 13 references

  11. The clinical expression of hereditary protein C and protein S deficiency: : a relation to clinical thrombotic risk-factors and to levels of protein C and protein S

    NARCIS (Netherlands)

    Henkens, C. M. A.; van der Meer, J.; Hillege, J. L.; Bom, V. J. J.; Halie, M. R.; van der Schaaf, W.

    We investigated 103 first-degree relatives of 13 unrelated protein C or protein S deficient patients to assess the role of additional thrombotic risk factors and of protein C and protein S levels in the clinical expression of hereditary protein C and protein S deficiency. Fifty-seven relatives were

  12. Clinical and pathogenic features of ETV6-related thrombocytopenia with predisposition to acute lymphoblastic leukemia (United States)

    Melazzini, Federica; Palombo, Flavia; Balduini, Alessandra; De Rocco, Daniela; Marconi, Caterina; Noris, Patrizia; Gnan, Chiara; Pippucci, Tommaso; Bozzi, Valeria; Faleschini, Michela; Barozzi, Serena; Doubek, Michael; Di Buduo, Christian A.; Kozubik, Katerina Stano; Radova, Lenka; Loffredo, Giuseppe; Pospisilova, Sarka; Alfano, Caterina; Seri, Marco; Balduini, Carlo L.; Pecci, Alessandro; Savoia, Anna


    ETV6-related thrombocytopenia is an autosomal dominant thrombocytopenia that has been recently identified in a few families and has been suspected to predispose to hematologic malignancies. To gain further information on this disorder, we searched for ETV6 mutations in the 130 families with inherited thrombocytopenia of unknown origin from our cohort of 274 consecutive pedigrees with familial thrombocytopenia. We identified 20 patients with ETV6-related thrombocytopenia from seven pedigrees. They have five different ETV6 variants, including three novel mutations affecting the highly conserved E26 transformation-specific domain. The relative frequency of ETV6-related thrombocytopenia was 2.6% in the whole case series and 4.6% among the families with known forms of inherited thrombocytopenia. The degree of thrombocytopenia and bleeding tendency of the patients with ETV6-related thrombocytopenia were mild, but four subjects developed B-cell acute lymphoblastic leukemia during childhood, resulting in a significantly higher incidence of this condition compared to that in the general population. Clinical and laboratory findings did not identify any particular defects that could lead to the suspicion of this disorder from the routine diagnostic workup. However, at variance with most inherited thrombocytopenias, platelets were not enlarged. In vitro studies revealed that the maturation of the patients’ megakaryocytes was defective and that the patients have impaired proplatelet formation. Moreover, platelets from patients with ETV6-related thrombocytopenia have reduced ability to spread on fibrinogen. Since the dominant thrombocytopenias due to mutations in RUNX1 and ANKRD26 are also characterized by normal platelet size and predispose to hematologic malignancies, we suggest that screening for ETV6, RUNX1 and ANKRD26 mutations should be performed in all subjects with autosomal dominant thrombocytopenia and normal platelet size. PMID:27365488

  13. Classification of the European Union member states according to the relative level of sustainable development. (United States)

    Anna, Bluszcz

    Nowadays methods of measurement and assessment of the level of sustained development at the international, national and regional level are a current research problem, which requires multi-dimensional analysis. The relative assessment of the sustainability level of the European Union member states and the comparative analysis of the position of Poland relative to other countries was the aim of the conducted studies in the article. EU member states were treated as objects in the multi-dimensional space. Dimensions of space were specified by ten diagnostic variables describing the sustainability level of UE countries in three dimensions, i.e., social, economic and environmental. Because the compiled statistical data were expressed in different units of measure, taxonomic methods were used for building an aggregated measure to assess the level of sustainable development of EU member states, which through normalisation of variables enabled the comparative analysis between countries. Methodology of studies consisted of eight stages, which included, among others: defining data matrices, calculating the variability coefficient for all variables, which variability coefficient was under 10 %, division of variables into stimulants and destimulants, selection of the method of variable normalisation, developing matrices of normalised data, selection of the formula and calculating the aggregated indicator of the relative level of sustainable development of the EU countries, calculating partial development indicators for three studies dimensions: social, economic and environmental and the classification of the EU countries according to the relative level of sustainable development. Statistical date were collected based on the Polish Central Statistical Office publication.

  14. Medical encounters for opioid-related intoxications in Southern Nevada: sociodemographic and clinical correlates. (United States)

    Feng, Jing; Iser, Joseph P; Yang, Wei


    Despite today's heightened concern over opioid overdose, the lack of population-based data examining clinical and contextual factors associated with opioid use represents a knowledge gap with relevance to prevention and treatment interventions. We sought to quantify rates of emergency department (ED) visits and inpatient hospitalizations for harmful opioid effects and their sociodemographic differentials as well as clinical correlates in Southern Nevada, using ED visit and hospital inpatient discharge records from 2011 to 2013. Cases were identified by ICD-9-CM diagnosis codes for opioid poisoning and opioid-type drug dependence and abuse as well as poisoning and adverse effect E-codes. Comorbid conditions, including pain-related diagnoses, major chronic diseases, affective disorders, sleep disorders, sexually transmitted infections and viral hepatitis were assessed from all available diagnosis fields. Counts by age-race per zip code were modeled by negative binomial regression. Opioid injuries were further examined as a function both of neighborhood income and individual characteristics, with mixed-effects logistic regression to estimate the likelihood for an adverse outcome. Opioid intoxications and comorbidities were more common in low-income communities. The multivariable-adjusted rate for opioid-related healthcare utilization was 42 % higher in the poorest vs. richest quartile during the study period. The inter-quartile (quartile 1 vs. 4) rate increases for chronic bodily pains (44 %), hypertension (89 %), renal failure/diabetes (2.6 times), chronic lower respiratory disease (2.2 times), and affective disorders (57 %) were statistically significant. Chronic disease comorbidity was greater among non-Hispanic blacks, whereas abuse/dependence related disorders, alcohol or benzodiazepine co-use, chronic bodily pains, and affective disorders were more prevalent among non-Hispanic whites than nonwhites. There were consistent patterns of disparities in healthcare

  15. Prevalence and clinical features of sports-related lumbosacral stress injuries in the young. (United States)

    Kaneko, Hideto; Murakami, Mototsune; Nishizawa, Kazuya


    Stress injuries (stress fractures and stress reactions) of the lumbosacral region are one of the causes of sports-related lower back pain in young individuals. These injuries can be detected by bone marrow edema lesion on MRI. However, little is known about the prevalence and clinical features of early stage lumbosacral stress injuries. This study aimed to evaluate the epidemiology of lumbosacral stress injuries. A total of 312 patients (under 18 years of age) who complained of sports-related lower back pain that had lasted for ≥7 days underwent magnetic resonance imaging (MRI) scans. We reviewed patients' records retrospectively. MRI showed that 33.0% of the patients had lumbar stress injuries and 1.6% had sacral stress injuries. Lumbar stress injuries were more common in males than in females and were found in 30% of 13- to 18-year-old patients. About 50% of the patients that participated in soccer or track and field were diagnosed with lumbar stress injuries. No clinical patterns in the frequencies of sacral stress injuries were detected due to the low number of patients that suffered this type of injury. Plain radiography is rarely able to detect the early stage lesions associated with lumbosacral stress injuries, but such lesions can be detected in the caudal-ventral region of the pars interarticularis on sagittal computed tomography scans. Thirty-three percent of young patients that complained of sports-related lower back pain for ≥7 days had lumbar stress injuries, while 1.6% of them had sacral stress injuries. Clinicians should be aware of the existence of these injuries. MRI is useful for diagnosing lumbosacral stress injuries.

  16. Clinical spectrum and diagnostic value of antibodies against the potassium channel-related protein complex☆ (United States)

    Montojo, M.T.; Petit-Pedrol, M.; Graus, F.; Dalmau, J.


    Introduction Antibodies against a protein complex that includes voltage-gated potassium channels (VGKC) have been reported in patients with limbic encephalitis, peripheral nerve hyperexcitability, Morvan's syndrome, and a large variety of neurological syndromes. Review summary In this article, a review is presented of the syndromes associated with antibodies against VGKC-related proteins and the main antigens of this protein complex, the proteins LGI1 (leucine rich glioma inactivated protein 1) and Caspr2 (contactin-associated protein-like 2). The conceptual problems and clinical implications of the description of antibodies against VGKC-related proteins other than LGI1 and Caspr2 are also discussed. Although initial studies indicated the occurrence of antibodies against VGKC, recent investigations have shown that the main antigens are a neuronal secreted protein known as LGI1 which modulates synaptic excitability, and a protein called Caspr2 located on the cell surface and processes of neurons of different brain regions, and at the juxtaparanodal region of myelinated axons. While antibodies against LGI1 preferentially associate with classical limbic encephalitis, antibodies against Caspr2 associate with a wider spectrum of symptoms, including Morvan's syndrome, peripheral nerve hyperexcitability or neuromyotonia, and limbic or more extensive encephalitis. In addition there are reports of patients with antibodies against VGKC-related proteins that are different from LGI1 or Caspr2. In these cases, the identity and location of the antigens are unknown, the syndrome association is not specific, and the response to treatment uncertain. Conclusions The discovery of antigens such as LGI1 and Caspr2 has resulted in a clinical and molecular definition of the broad group of diseases previously attributed to antibodies against VGKC. Considering the literature that describes the presence of antibodies against VGKC other than LGI1 and Caspr2 proteins, we propose a practical

  17. A mixed state core for melancholia: an exploration in history, art and clinical science. (United States)

    Akiskal, H S; Akiskal, K K


    We argue for a mixed state core for melancholia comparing concepts of melancholia across centuries using examples from art, history and scientific literature. Literature reviews focusing on studies from Kraepelin onward, DSM-IV classification and view-points from clinical experience highlighting phenomenologic and biologic features as predictors of bipolar outcome in prospective studies of depression. Despite the implied chemical pathology in the term endogenous/melancholic depression, frequently reported glucocortical and sleep neurophysiologic abnormalities, there is little evidence that melancholia is inherited independently from more broadly defined depressions. Prospective follow-up of 'neurotic' depressions have shown melancholic outcomes in as many as a third; hypomania has also been observed in such follow-up. These findings and considerations overall do suggest that melancholia as defined today is more closely aligned with the depressive and/or mixed phase of bipolar disorder. Given the high suicidality from many of these patients the practice of treating them with antidepressant monotherapy needs re-evaluation.

  18. Early Period Results and Clinical Characteristics of Upper Gastrointestinal Endoscopy in Sivrihisar State Hospital

    Directory of Open Access Journals (Sweden)

    Ozgur Turk


    Full Text Available Aim: Our aim was to identify the characteristics of the patient that performed upper gastrointestinal endoscopy in a new established endoscopy unit of a state hospital. We want to present the spectrum of gastrointestinal diseases in our hospitals region. Material and Method: We analyzed patients upper endoscopy results according to age, sex, complaints, clinical characteristics, type of anesthesia, and the necessity of biopsy. We reviewed 256 patients data between 2013 December-2014 July. All endoscopies were performed by same surgeon. Results: The highest complaint was epigastric pain (n=112, 43, 8%. Other complaints were followed as dyspepsia (n=84, 32.8%, heartburn (n=42, 16.4%, nausea (n=4, 1.6%, vomiting (n=2, 0.8%, dysphagia (n=6, 2.3%. We determined 218 gastritis (85.2%, 64 hiatal hernia (25%, 120 esophagitis (46.9%, 76 duodenitis (29.7%, 4 gastric ulcer (1.6%, 18 duodenal ulcers (7%, 20 bile reflux (7.8%, 26 Gastro esophageal reflux disease (GERD in patients (10.2%. 10 patients reported as normal (3.9%. Biopsy was performed in 186 of the patients. Discussion: Endoscopy can become an early diagnostic examination by increasing the availability of endoscopy. Also alarm symptoms should not be ignored and endoscopy should perform immediately in symptomatic patients. As an early result of upper gastrointestinal endoscopies that performed in this study; gastritis, esophagitis, duodenitis and hiatal hernia are common gastrointestinal diseases in our region.

  19. Reference bias: presentation of extreme health states prior to eq-vas improves health-related quality of life scores. a randomised cross-over trial

    Directory of Open Access Journals (Sweden)

    McPhail Steven


    Full Text Available Abstract Background Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as health-related quality of life. However, unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs, longitudinal comparison of these measures may be invalid. This study aimed to investigate whether patients give consideration to a standard health state rating scale (EQ-VAS and whether consideration of good and poor health state descriptors immediately changes their self-report. Methods A randomised crossover trial was implemented amongst hospitalised older adults (n = 151. Patients were asked to consider descriptions of extremely good (Description-A and poor (Description-B health states. The EQ-VAS was administered as a self-report at baseline, after the first descriptors (A or B, then again after the remaining descriptors (B or A respectively. At baseline patients were also asked if they had considered either EQ-VAS anchors. Results Overall 106/151 (70% participants changed their self-evaluation by ≥5 points on the 100 point VAS, with a mean (SD change of +4.5 (12 points (p Conclusions Health state self-reports may not be well considered. An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring. Caution should be exercised in research and clinical settings when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning. Trial Registration Australian and New Zealand Clinical Trials Registry (#ACTRN12607000606482

  20. Clinical utilisation of the "G.T. MSRS", the rating scale for mixed states: 35 cases report. (United States)

    Tavormina, Giuseppe


    The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders. The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of both psychiatrists and GPs by enabling them to make an early "general" diagnosis of mixed states. This study presents some cases in which the "G.T. MSRS" scale has been used, in order to demonstrate its usefullness.

  1. Reversal Strategies for NOACs: State of Development, Possible Clinical Applications and Future Perspectives. (United States)

    Husted, Steen; Verheugt, Freek W A; Comuth, Willemijn J


    The non-vitamin K antagonist oral anticoagulants (NOACs) are used for thromboembolic prophylaxis of patients with atrial fibrillation and in the treatment as well as secondary prophylaxis of patients with venous thromboembolism. Even though NOACs have a better safety profile than vitamin K antagonists (VKAs), there will still be bleeding complications on NOAC treatment. In some cases, stopping the NOAC and non-drug-related management such as manual compression and interventional endoscopy will be sufficient to stop the bleeding. In more serious bleeding events and before acute surgery, coagulation factor concentrates or NOAC-specific antidotes could be used. Coagulation factor concentrates can be used in patients with haemophilia and to reverse the effect of VKAs but, in NOAC-treated patients, results are inconsistent and these agents could potentially have pro-thrombotic effects. Specific antidotes for NOACs are expected to be on the market soon. Phase III clinical trials with a humanized antibody fragment directed against dabigatran (idarucizumab) and recombinant, modified factor Xa (andexanet alfa) are ongoing. A molecule (aripazine) with broad activity against various anticoagulants including NOACs is currently undergoing phase II trials. For use of these specific antidotes, it is desirable that measurements for coagulation activity with a short response delay are widely available for the different NOACs and further research in this field is needed. Furthermore, guidelines for antidote use, including general measures for the treatment of NOAC-related bleeding, should be available.

  2. The Aging Lung: Clinical and Imaging Findings and the Fringe of Physiological State. (United States)

    Schröder, T H; Storbeck, B; Rabe, K F; Weber, C


    Since aspects of demographic transition have become an essential part of socioeconomic, medical and health-care research in the last decades, it is vital for the radiologist to discriminate between normal ageing related effects and abnormal imaging findings in the elderly. This article reviews functional and structural aspects of the ageing lung and focuses on typical ageing related radiological patterns. • The physiological aging process of the thoracic organs shows typical structural and functional aspects.• Mild interstitial fibrosis and focal parenchymal abnormalities like septal thickening can be diagnosed frequently - whereas a clinical correlate is often lacking.• With increasing patient age, the influence by various intrinsic and extrinsic factors (including comorbidities of the patient, and drug inhalation toxicants) also increases.• A growing spectrum of imaging techniques (including functional cardiopulmonary MRI, MRI spectroscopy, hybrid-techniques) is confronted by rare empiric data in the very old people (aging 80 years and older). © Georg Thieme Verlag KG Stuttgart · New York.

  3. Optimal replacement policy for safety-related multi-component multi-state systems

    International Nuclear Information System (INIS)

    Xu Ming; Chen Tao; Yang Xianhui


    This paper investigates replacement scheduling for non-repairable safety-related systems (SRS) with multiple components and states. The aim is to determine the cost-minimizing time for replacing SRS while meeting the required safety. Traditionally, such scheduling decisions are made without considering the interaction between the SRS and the production system under protection, the interaction being essential to formulate the expected cost to be minimized. In this paper, the SRS is represented by a non-homogeneous continuous time Markov model, and its state distribution is evaluated with the aid of the universal generating function. Moreover, a structure function of SRS with recursive property is developed to evaluate the state distribution efficiently. These methods form the basis to derive an explicit expression of the expected system cost per unit time, and to determine the optimal time to replace the SRS. The proposed methodology is demonstrated through an illustrative example.

  4. Overview of potential procedural and participant-related confounds for neuroimaging of the resting state (United States)

    Duncan, Niall W.; Northoff, Georg


    Studies of intrinsic brain activity in the resting state have become increasingly common. A productive discussion of what analysis methods are appropriate, of the importance of physiologic correction and of the potential interpretations of results has been ongoing. However, less attention has been paid to factors other than physiologic noise that may confound resting-state experiments. These range from straightforward factors, such as ensuring that participants are all instructed in the same manner, to more obscure participant-related factors, such as body weight. We provide an overview of such potentially confounding factors, along with some suggested approaches for minimizing their impact. A particular theme that emerges from the overview is the range of systematic differences between types of study groups (e.g., between patients and controls) that may influence resting-state study results. PMID:22964258

  5. Aberrant development of functional connectivity among resting state-related functional networks in medication-naïve ADHD children.

    Directory of Open Access Journals (Sweden)

    Jeewook Choi

    Full Text Available OBJECTIVE: The aim of this study was to investigate the compromised developmental trajectory of the functional connectivity among resting-state-related functional networks (RSFNs in medication-naïve children with attention-deficit/hyperactivity disorder (ADHD. SUBJECTS AND METHODS: Using both independent component analysis and dual regression, subject-specific time courses of 12 RSFNs were extracted from both 20 medication-naïve children with ADHD, and 20 age and gender-matched control children showing typical development (TDC. Both partial correlation coefficients among the 12 RSFNs and a resting-state resource allocation index (rsRAI of the salience network (SN were entered into multiple linear regression analysis to investigate the compromised, age-related change in medication-naïve ADHD children. Finally, correlation analyses were performed between the compromised RSFN connections showing significant group-by-age interaction and rsRAI of SN or clinical variables. RESULTS: Medication-naïve ADHD subjects failed to show age-related increment of functional connectivity in both rsRAI of SN and two RSFN connections, SN-Sensory/motor and posterior default mode/precuneus network (pDMN/prec--anterior DMN. Lower SN-Sensory/motor connectivity was related with higher scores on the ADHD Rating Scale, and with poor scores on the continuous performance test. The pDMN/prec-aDMN connectivity was positively related with rsRAI of SN. CONCLUSIONS: Our results suggest that medication-naïve ADHD subjects may have delayed maturation of the two functional connections, SN-Sensory/Motor and aDMN-pDMN/prec. Interventions that enhance the functional connectivity of these two connections may merit attention as potential therapeutic or preventive options in both ADHD and TDC.

  6. An analysis of redactions in Canada's Common Drug Review Clinical Review Reports and how they relate to the patients' voice. (United States)

    Soprovich, Allison; El Kurdi, Sylvia; Eurich, Dean T


    , harms, HRQL) matters to patients and should be publicly available within the CDR-CRR. Canada trails Europe and the USA regarding the transparency of clinical study data. This lack of transparency relates to the patient voice, and limits movement towards patient-centred care and patient-engaged research, restricting real-world value measurement. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Six-year clinical study of firework-related eye injuries in North China. (United States)

    Kong, Yichun; Tang, Xin; Kong, Baohuan; Jiang, Hao; Chen, Ying


    To analyse the demographic data, clinical characteristics, management and prognosis of patients with firework-related eye injuries. A retrospective review was performed of patients with eye injuries related to fireworks referred to TianJin Eye Hospital in North China from 2008 to 2013. Demographic information, clinical features, management and visual outcome were analysed and prognosis factors were evaluated. Ninety-nine patients (86 men) with 118 eye injuries were enrolled in the study. The average age of the patients was 32.0±20.5 years; 70/99 (70.7%) were aged >20 years. Eighty-one of the patients had been lighting the fireworks while the rest were bystanders. The main ophthalmic manifestations were hyphaema, vitreous haemorrhage, corneal/sclera/corneoscleral open globe injury, eyelid laceration, traumatic cataract, retinal/choroid detachment, endophthalmitis and intraocular foreign body (IOFB). Ninety patients required surgical intervention including repair of open globe injury, vitrectomy, cataract extraction and enucleation. 56/118 eyes (47.5%) received multiple operations. After treatment, final best-corrected visual acuity (BCVA) significantly improved (p=0.015). Some factors were significantly correlated with better final BCVA, including initial BCVA (p=0.036), closed globe injury (p=0.031), absence of endophthalmitis (p=0.014), absence of IOFB (p=0.024) and absence of retinal detachment (p=0.046). Firework-related eye injuries mainly occur in adult men and result in severe visual damage. The most common clinical manifestations are hyphaema and vitreous haemorrhage. Better initial BCVA and closed globe injury have a better visual result while endophthalmitis, IOFB and retinal detachment have a negative visual outcome. Improved eye protection, along with enhanced public education and legal ban on fireworks, could reduce the incidence of eye injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  8. [Current status of job burnout in clinical nurses in a grade A tertiary hospital and related influencing factors]. (United States)

    Ye, L Y; Fan, C L; Wang, L G; Tao, T; Gao, W B; Li, Y H


    Objective: To investigate the current status of job burnout in clinical nurses in a grade A tertiary hospitalin Shaoxing,China and related influencing factors. Methods: In October 2016, the Nursing Burnout Scale (NBS)was used for the investigation of 304 clinical nurses in a grade A tertiary hospital.The contents of the investigation included general data(including age,education background,working years,marital status, frequency of night shifts,professional title, and way of employment), characteristics of working environment,burnout, personality characteristics,coping strategy,and psychosomatic symptoms.SPSS 18.0 was used to conduct Pearson correlation analysis of the scores of each dimension of NBS. A multivariate regression analysis was performed with the demographic features of clinical nurses as the independent variable and the scores of each dimension of NBS as the dependent variable. Results: Among the clinical nurses in this grade A tertiary hospital, the incidence rate of severe burnout was 74%.The Pearson correlation analysis showed that burnout,pessimistic personality,negative coping,and psychosomatic symptoms were positively correlated with working environment( r =0.530,0.316,0.116,and 0.502); pessimistic personality and psychosomatic symptoms were positively correlated with burnout( r =0.618 and 0.675); psychosomatic symptoms were positively correlated withpessimistic personality( r =0.540); negative coping was negatively correlated with pessimistic personality( r =-0.145).The multivariate linear regression analysis showed that department(Department of Internal Medicine or Department of Surgery, B =-0.364 and -0.428)and frequency of night shifts(burnout; 1 - 3 working years( B =-0.238)was an influencing factor for the score of pessimistic personality; married state,1 - 3 working years,and department (Department of Internal Medicine or Department of Surgery)were influencing factors for the score of psychosomatic symptoms( B =0.263,-0.301,-0.322,and -0

  9. Differential structural and resting state connectivity between insular subdivisions and other pain-related brain regions. (United States)

    Wiech, K; Jbabdi, S; Lin, C S; Andersson, J; Tracey, I


    Functional neuroimaging studies suggest that the anterior, mid, and posterior division of the insula subserve different functions in the perception of pain. The anterior insula (AI) has predominantly been associated with cognitive-affective aspects of pain, while the mid and posterior divisions have been implicated in sensory-discriminative processing. We examined whether this functional segregation is paralleled by differences in (1) structural and (2) resting state connectivity and (3) in correlations with pain-relevant psychological traits. Analyses were restricted to the 3 insular subdivisions and other pain-related brain regions. Both type of analyses revealed largely overlapping results. The AI division was predominantly connected to the ventrolateral prefrontal cortex (structural and resting state connectivity) and orbitofrontal cortex (structural connectivity). In contrast, the posterior insula showed strong connections to the primary somatosensory cortex (SI; structural connectivity) and secondary somatosensory cortex (SII; structural and resting state connectivity). The mid insula displayed a hybrid connectivity pattern with strong connections with the ventrolateral prefrontal cortex, SII (structural and resting state connectivity) and SI (structural connectivity). Moreover, resting state connectivity revealed strong connectivity of all 3 subdivisions with the thalamus. On the behavioural level, AI structural connectivity was related to the individual degree of pain vigilance and awareness that showed a positive correlation with AI-amygdala connectivity and a negative correlation with AI-rostral anterior cingulate cortex connectivity. In sum, our findings show a differential structural and resting state connectivity for the anterior, mid, and posterior insula with other pain-relevant brain regions, which might at least partly explain their different functional profiles in pain processing. Copyright © 2014 The Authors. Published by Elsevier B.V. All

  10. Profile of mood states and stress-related biochemical indices in long-term yoga practitioners

    Directory of Open Access Journals (Sweden)

    Sudo Nobuyuki


    Full Text Available Abstract Background Previous studies have shown the short-term or intermediate-term practice of yoga to be useful for ameliorating several mental disorders and psychosomatic disorders. However, little is known about the long-term influences of yoga on the mental state or stress-related biochemical indices. If yoga training has a stress-reduction effect and also improves an individual's mental states for a long time, long-term yoga practitioners may have a better mental state and lower stress-related biochemical indices in comparison to non-experienced participants. This study simultaneously examined the differences in mental states and urinary stress-related biochemical indices between long-term yoga practitioners and non-experienced participants. Methods The participants were 38 healthy females with more than 2 years of experience with yoga (long-term yoga group and 37 age-matched healthy females who had not participated in yoga (control group. Their mental states were assessed using the Profile of Mood States (POMS questionnaire. The level of cortisol, 8-hydroxydeoxyguanosine (8-OHdG and biopyrrin in urine were used as stress-related biochemical indices. Results The average self-rated mental disturbance, tension-anxiety, anger-hostility, and fatigue scores of the long-term yoga group were lower than those of the control group. There was a trend toward a higher vigor score in the long-term yoga group than that in the control group. There were no significant differences in the scores for depression and confusion in the POMS between the two groups. The urine 8-OHdG concentration showed a trend toward to being lower in the long-term yoga group in comparison to the control group. There were no significant differences in the levels of urine biopyrrin or cortisol. Conclusions The present findings suggest that long-term yoga training can reduce the scores related to mental health indicators such as self-rated anxiety, anger, and fatigue.

  11. Patterns in deer-related traffic injuries over a decade: the Mayo clinic experience

    Directory of Open Access Journals (Sweden)

    Smoot Dustin L


    Full Text Available Abstract Background Our American College of Surgeons Level 1 Trauma Center serves a rural population. As a result, there is a unique set of accidents that are not present in an urban environment such as deer related motor vehicle crashes (dMVC. We characterized injury patterns between motorcycle/all-terrain vehicles (MCC and automobile (MVC crashes related to dMVC (deer motor vehicle crash with the hypotheses that MCC will present with higher Injury Severity Score (ISS and that it would be related to whether the driver struck the deer or swerved. Methods The records of 157 consecutive patients evaluated at our institution for injury related to dMVC from January 1st, 1997 to December 31st, 2006 were reviewed from our prospectively collected trauma database. Demographic, clinical, and crash specific parameters were abstracted. Injury severity was analyzed by the Abbreviated Injury Scale score for each body region as well as the overall Injury Severity Score (ISS. Results Motorcycle crashes presented with a higher median ISS than MVCs (14 vs 5, p Within the MVC group, there was no difference between swerving and hitting the deer in any AIS group. Forty-seven percent of drivers were not wearing seat belts which resulted in similar median ISS (6 vs 5 and AIS of all body regions. Conclusions Motorcycle operators suffered higher ISS. There were no significant differences in median ISS if a driver involved in a deer-related motor vehicle crash swerved rather than collided, was helmeted, or restrained.

  12. The position of IAEA safeguards relative to nuclear material control accountancy by States

    International Nuclear Information System (INIS)

    Rometsch, R.; Hough, G.


    IAEA Safeguards, which are always implemented on the basis of agreements which are concluded between one or more Governments and the IAEA, lay down the rights and obligations of the parties; and the more modern types of agreement, in particular those in connection with the Treaty on the Non-Proliferation of Nuclear Weapons, do this in quite some detail. Several articles, for instance, regulate the working relations between the States and the IAEA inspectorate. These are based on two basic obligations - that of the State to establish and maintain a ''System of Accountancy for and Control of Nuclear Material'' and that of the IAEA to ascertain the absence of diversion of nuclear material by verifying the findings of the States' systems, inter alia through independent measurements and observations. Other articles dealing also with the working relations between States and the IAEA rule that the IAEA should take due account of the technical effectiveness of the States' systems and mention among the criteria for determining the inspection effort, the extent of functional dependence of the State's accountancy on that of the facility operator. However, quantitative relationships in this respect are left to be worked out in practice. With the help of consultants and expert advisory groups a rationale has been developed and possible practical arrangements discussed with several States concerned. The rationale for co-ordinating the work of the States' inspectorate with that of the IAEA was to use a factor by which the significant quantity used for calculating verification sampling plans would be adjusted so as to reduce to a certain extent the IAEA's independent verification work in case the States would themselves do extensive verifications in a manner transparent to the IAEA. However, in practice it proved that there are a number of points in the fuel cycle where such adaptations would have little or no effect on the inspection effort necessary to achieve the safeguards

  13. The position of IAEA safeguards relative to nuclear material control accountancy by states

    International Nuclear Information System (INIS)

    Rometsch, R.; Hough, G.


    IAEA Safeguards are always implemented on the basis of agreements which are concluded between one or more Governments and the Agency. They lay down the rights and obligations of the parties; the more modern types of agreements, in particular those in connection with the Treaty on the Non-Proliferation of Nuclear Weapons, do that in quite some details. Several articles, for instance, regulate the working relations between the States and the IAEA inspectorate. Those are based on two basic obligations: that of the State to establish and maintain a ''System of Accountancy for and Control of Nuclear Material'' and that of the Agency to ascertain the absence of diversion of nuclear material by verifying the findings of the States' system, inter alia through independent measurements and observations. Other articles dealing also with the working relations States - IAEA rule that the Agency should take due account of the technical effectiveness of the States' system and mention among the criteria for determining the inspection effort, the extent of functional dependence of the State's accountancy from that of the facility operator. However, quantitative relationships in that respect are left to be worked out in practice. With the help of consultants and expert advisory groups a rational has been developed and possible practical arrangements discussed with several States concerned. The rational for coordinating the work of the States' inspectorate with IAEA's inspectorate was to use a factor by which the significant quantity used for calculating verification sampling plans would be adjusted in order to reduce to a certain extent the Agency's independent verification work in case the States would do extensive verifications themselves in a manner transparent to IAEA. However, in practice it proved that there are quite a number of points in the fuel cycle where such adaptations would have little or no effect on the inspection effort necessary to achieve the safeguards objective

  14. Different glassy states, as indicated by a violation of the generalized Cauchy relation

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, J K [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Britz, T [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Coutre, A le [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Baller, J [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Possart, W [Universitaet des Saarlandes, Fakultaet fuer Chemie, Pharmazie und Werkstoffwissenschaften 8.15, Gebaeude 22, D-66041 Saarbruecken (Germany); Alnot, P [Laboratoire Europeen de Recherche Universitaire Saarland-Lorraine (LERUSL), Universitaet des Saarlandes, Fakultaet fuer Physik und Elektrotechnik 7.2, Gebaeude 38, D-66041 Saarbruecken (Germany); Sanctuary, R [Centre Universitaire de Luxembourg, Departement des Sciences, Laboratoire 1.19, 162a Avenue de la Faiencerie, L-1511, Luxembourg (Luxembourg)


    Using Brillouin spectroscopy as a probe for high-frequency clamped acoustic properties, a shear modulus c{sub 44}{sup {infinity}} can be measured in addition to the longitudinal modulus c{sub 11}{sup {infinity}} already well above the thermal glass transition. On slow cooling of the liquid through the thermal glass transition temperature T{sub g}, both moduli show a kink-like behaviour and the function c{sub 11}{sup {infinity}} = c{sub 11}{sup {infinity}}(c{sub 44}{sup {infinity}}) follows a generalized Cauchy relation (gCR) defined by the linear relation c{sub 11}{sup {infinity}} = 3c{sub 44}{sup {infinity}} + constant, which completely hides the glass transition. In this work we show experimentally that on fast cooling this linear transformation becomes violated within the glassy state, but that thermal ageing drives the elastic coefficients towards the gCR, i.e. towards a unique glassy state.

  15. Firm-level perspectives on State-Business Relations in Africa

    DEFF Research Database (Denmark)

    Charles, Goodluck; Jeppesen, Søren; Kamau, Paul


    Experiences from developed and emerging economies inform us that close state–business relations (SBRs) are crucial for economic development and structural transformation. Based on the positive experiences from other parts of the world, most African governments have begun processes to establish...... collaborative SBRs. Amongst other initiatives, these processes include amendments to existing laws to facilitate public–private interaction, direct support to existing business associations (BAs). This article draws on an analysis of survey data from 210 local firms, complemented with qualitative data from...... and requirements of local businesses and that BAs in these countries are poorly organised. In spite of initiatives taken by the states and other actors, including an increase in the number of formal relations between state and businesses, it is difficult to conclude whether SBRs are collaborative or collusive...

  16. Comparison of clinical features between primary and drug-induced sleep-related eating disorder

    Directory of Open Access Journals (Sweden)

    Komada Y


    Full Text Available Yoko Komada,1 Yoshikazu Takaesu,2 Kentaro Matsui,3 Masaki Nakamura,3 Shingo Nishida,3 Meri Kanno,3,† Akira Usui,3 Yuichi Inoue1,3 1Department of Somnology, 2Department of Psychiatry, Tokyo Medical University, 3Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan †Meri Kanno passed away on March 1, 2016 Purpose: The aim of this study was to ascertain the clinical characteristics of drug-induced sleep-related eating disorder (SRED. Patients and methods: We retrospectively reviewed the medical records of 30 patients with primary SRED (without any comorbid sleep disorders and who were not taking any possible causative medications, and ten patients with drug-induced SRED (occurrence of SRED episodes after starting nightly medication of sedative drugs, which completely resolved after dose reduction or discontinuation of the sedatives. Results: All patients with drug-induced SRED took multiple types of sedatives, such as benzodiazepines or benzodiazepine receptor agonists. Clinical features of drug-induced SRED compared with primary SRED were as follows: higher mean age of onset (40 years old in drug-induced SRED vs 26 years old in primary SRED, significantly higher rate of patients who had total amnesia during most of their SRED episodes (75.0% vs 31.8%, significantly lower rate of comorbidity of night eating syndrome (0% vs 63.3%, and significantly lower rate of history of sleepwalking (10.0% vs 46.7%. Increased doses of benzodiazepine receptor agonists may be responsible for drug-induced SRED. Conclusion: The clinical features of drug-induced SRED were different from those of primary SRED, possibly reflecting differences in the underlying mechanisms between these two categories of SREDs. Keywords: nocturnal eating syndrome, night eating, eating disorder, hypnotics, amnesia, sleepwalking, benzodiazepine

  17. Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study. (United States)

    Gomes de Alvarenga, Pedro; de Mathis, Maria Alice; Dominguez Alves, Anna Claudia; do Rosário, Maria Conceição; Fossaluza, Victor; Hounie, Ana Gabriela; Miguel, Euripedes Constantino; Rodrigues Torres, Albina


    To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample. A cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. The sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). The general lifetime prevalence of TD was 29.0% (n = 236), with 8.9% (n = 72) presenting Tourette syndrome, 17.3% (n = 141) chronic motor tic disorder, and 2.8% (n = 23) chronic vocal tic disorder. The mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD + TD group. Compared to OCD patients without comorbid TD, those with TD (OCD + TD group, n = 236) were more likely to be males (49.2% vs. 38.5%, p disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the "aggressive," "sexual/religious," and "hoarding" symptom dimensions were more severe in the OCD + TD group. Tic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.

  18. Clinical pathology observation on orbit IgG4 related disease

    Directory of Open Access Journals (Sweden)

    Ji-Hua Guo


    Full Text Available AIM:To discuss clinical pathological features of orbit IgG4 related disease(IgG4-RD. METHODS: The clinical pathological materials of 23 patients(35 eyeswith orbit IgG4-RD were collected. They were observed in terms of histology and immunohistochemistry, and its clinical and pathologic characteristics were summarized. RESULTS: There were 23 patients(35 eyeswith orbit IgG4-RD(8 male patients, 9 eyes; 15 female patients, 26 eyes, with an average age of 52.1 year-old(from age 28 to 72. 19 patients(30 eyesoccured in lacrimal gland and 4 cases(5 eyesin other places, and they went to hospital for lacrimal gland cyst or exophthalmos. There were 11 cases in one side and 12 cases in both sides. The disease lasted from 1mo to 10a, averaging 27mo. It recureded in one patient(1 eyeafter 1mo. In general inspection: Gray nodular goiter, thin fibrous coat wrapping around the lacrimal gland could be observed. Histologic characteristics: lacrimal gland bubble and catheter group shrinked or even disappeared, substituted by lymphocyte, plasma cells and lymphoid follicle and accompanied with fibrosis. Immunohistochemical staining: IgG4 positive plasma cells of 23 cases(35 eyeswas >50/HPF, and IgG4/IgG ratio of positive plasma cells was >40%. CONCLUSION: Orbit IgG4-RD mainly occures in lacrimal gland tissue, and expression of IgG4 can be detected through histologic characteristics and immunohistochemical staining. IgG4-RD should be screened, prevented and treated in the early phase.

  19. Relating UMLS semantic types and task-based ontology to computer-interpretable clinical practice guidelines. (United States)

    Kumar, Anand; Ciccarese, Paolo; Quaglini, Silvana; Stefanelli, Mario; Caffi, Ezio; Boiocchi, Lorenzo


    Medical knowledge in clinical practice guideline (GL) texts is the source of task-based computer-interpretable clinical guideline models (CIGMs). We have used Unified Medical Language System (UMLS) semantic types (STs) to understand the percentage of GL text which belongs to a particular ST. We also use UMLS semantic network together with the CIGM-specific ontology to derive a semantic meaning behind the GL text. In order to achieve this objective, we took nine GL texts from the National Guideline Clearinghouse (NGC) and marked up the text dealing with a particular ST. The STs we took into consideration were restricted taking into account the requirements of a task-based CIGM. We used DARPA Agent Markup Language and Ontology Inference Layer (DAML + OIL) to create the UMLS and CIGM specific semantic network. For the latter, as a bench test, we used the 1999 WHO-International Society of Hypertension Guidelines for the Management of Hypertension. We took into consideration the UMLS STs closest to the clinical tasks. The percentage of the GL text dealing with the ST "Health Care Activity" and subtypes "Laboratory Procedure", "Diagnostic Procedure" and "Therapeutic or Preventive Procedure" were measured. The parts of text belonging to other STs or comments were separated. A mapping of terms belonging to other STs was done to the STs under "HCA" for representation in DAML + OIL. As a result, we found that the three STs under "HCA" were the predominant STs present in the GL text. In cases where the terms of related STs existed, they were mapped into one of the three STs. The DAML + OIL representation was able to describe the hierarchy in task-based CIGMs. To conclude, we understood that the three STs could be used to represent the semantic network of the task-bases CIGMs. We identified some mapping operators which could be used for the mapping of other STs into these.

  20. Clinical Features and Outcomes of 666 Cases with Therapy-Related Myelodysplastic Syndrome (t-MDS). (United States)

    El-Fattah, Mohamed Abd


    Therapy-related myelodysplastic syndrome (t-MDS) is a serious complication of chemoradiotherapy for primary diseases. This cohort was aimed to determine the clinical features and outcomes of t-MDS in comparison with de novo MDS. I retrieved data of 666 cases with t-MDS, and 29,703 cases with de novo MDS diagnosed between 2001 and 2012 from the database of U.S. National Cancer Institute. Survival curves were estimated, and Cox proportional hazards model was constructed. Compared with patients with de novo MDS, patients with t-MDS tended to be young (median age; 65 vs. 76 years, p  MDS than de novo MDS (17.2 months and 22% vs. 31 months and 32%, respectively, p  MDS cases, with a median follow-up of 16 months (range 1-143 months), 521 cases (78.2%) had died. Of which, 78 (15%) cases had died from acute myeloid leukemia, and 66 (12.7%) cases had died from solid cancers. Of the total 66 cases died from solid cancers; 19 cases (28.8%) died from cancer of lung/bronchus, 11 cases (16.7%) breast cancers, and 10 cases (15.2%) ovarian cancer. In a multivariate analysis adjusted for clinical features, calendar period and radiotherapy, the hazard of mortality was significantly low in de novo MDS compared with t-MDS (hazard ratio 0.59; p  MDS is a distinct entity of MDS in terms of clinical characteristics and prognosis.

  1. Querying clinical data in HL7 RIM based relational model with morph-RDB. (United States)

    Priyatna, Freddy; Alonso-Calvo, Raul; Paraiso-Medina, Sergio; Corcho, Oscar


    Semantic interoperability is essential when carrying out post-genomic clinical trials where several institutions collaborate, since researchers and developers need to have an integrated view and access to heterogeneous data sources. One possible approach to accommodate this need is to use RDB2RDF systems that provide RDF datasets as the unified view. These RDF datasets may be materialized and stored in a triple store, or transformed into RDF in real time, as virtual RDF data sources. Our previous efforts involved materialized RDF datasets, hence losing data freshness. In this paper we present a solution that uses an ontology based on the HL7 v3 Reference Information Model and a set of R2RML mappings that relate this ontology to an underlying relational database implementation, and where morph-RDB is used to expose a virtual, non-materialized SPARQL endpoint over the data. By applying a set of optimization techniques on the SPARQL-to-SQL query translation algorithm, we can now issue SPARQL queries to the underlying relational data with generally acceptable performance.

  2. Therapeutic Change in Group Therapy For Interpersonal Trauma: A Relational Framework for Research and Clinical Practice. (United States)

    Chouliara, Zoë; Karatzias, Thanos; Gullone, Angela; Ferguson, Sandra; Cosgrove, Katie; Burke Draucker, Claire


    Our understanding of therapeutic change processes in group therapy for complex interpersonal trauma has been limited. The present study aimed at addressing this gap by developing a framework of therapeutic change in this field from a survivor and therapist perspective. This is a qualitative study, which utilized semistructured individual interviews. Transcripts were analyzed using interpretative phenomenological analysis (IPA) to identify recurrent themes. A final sample of n = 16 patients and n = 5 facilitators completed the interview. Main change processes identified by survivors were as follows: self versus others, trust versus threat, confrontation versus avoidance, and "patching up" versus true healing. Therapeutic processes identified by therapist facilitators included managing group dynamics, unpredictability and uncertainty, and process versus content. The proposed framework explains therapeutic change in group therapy in relational terms, that is, therapeutic dissonance, the dynamic interaction of self and experience as well as building empathic trusting relations. The importance of managing dissonance to aid personally meaningful recovery was highlighted. These findings have implications for the usefulness of relational and person-centered approaches to clinical practice in the area of interpersonal and complex trauma, especially in the early identification, prevention, and management of dropouts.

  3. Clinical study of Conbercept intravitreal injection for the treatment of wet age-related macular degeneration

    Directory of Open Access Journals (Sweden)

    Xu-Ting He


    Full Text Available AIM: To observe the clinical curative effect of conbercept intravitreal injection for the treatment of wet age-related macular degeneration.METHODS: Sixty patients with wet age related macular degeneration were randomly divided into treatment group 30 cases and control group 30 cases according to the random number table. The treatment group was injected with Conbercept 0.05mL, the control group was injected with triamcinolone acetonide 0.1mL. The best corrected visual acuity(BCVAwas performed before and after 1d, 1 and 3mo after treatment, and the thickness of macular was detected by optical coherence tomography(OCT. The complications of patients were observed after 1d, 1 and 3mo,including inflammatory reaction, corneal edema, anterior chamber, high intraocular pressure, etc.RESULTS:In treatment group 1d, 1 and 3mo after treatment, eyesight was improved significantly better than the control group(PPCONCLUSION: Intravitreal injection of Conbercept in the treatment of wet age-related macular degeneration can improve the curative effect.

  4. Relation between 'no broadcasting' for noncommuting states and 'no local broadcasting' for quantum correlations

    International Nuclear Information System (INIS)

    Luo Shunlong; Li Nan; Cao Xuelian


    The no-broadcasting theorem, first established by Barnum et al. [Phys. Rev. Lett. 76, 2818 (1996)], states that a set of quantum states can be broadcast if and only if it constitutes a commuting family. Quite recently, Piani et al. [Phys. Rev. Lett. 100, 090502 (2008)] showed, by using an ingenious and sophisticated method, that the correlations in a single bipartite state can be locally broadcast if and only if the state is effectively a classical one (i.e., the correlations therein are classical). In this Brief Report, under the condition of nondegenerate spectrum, we provide an alternative and significantly simpler proof of the latter result based on the original no-broadcasting theorem and the monotonicity of the quantum relative entropy. This derivation motivates us to conjecture the equivalence between these two elegant yet formally different no-broadcasting theorems and indicates a subtle and fundamental issue concerning spectral degeneracy which also lies at the heart of the conflict between the von Neumann projection postulate and the Lueders ansatz for quantum measurements. This relation not only offers operational interpretations for commutativity and classicality but also illustrates the basic significance of noncommutativity in characterizing quantumness from the informational perspective.

  5. Professionalism in Public Relations Pedagogy: A Comparative Analysis of Public Relations Curricula among the United States, the United Kingdom, and South Korea (United States)

    Chung, Wonjun; Choi, Jinbong


    Based on a concept of professionalism, this study analyzed and compared current public relations curricula of higher education among the United States, the United Kingdom, and South Korea. In terms of three educational orientations, results indicated that public relations education in the United States is the most balanced among theoretical,…

  6. Clinical Relation Extraction Toward Drug Safety Surveillance Using Electronic Health Record Narratives: Classical Learning Versus Deep Learning. (United States)

    Munkhdalai, Tsendsuren; Liu, Feifan; Yu, Hong


    Medication and adverse drug event (ADE) information extracted from electronic health record (EHR) notes can be a rich resource for drug safety surveillance. Existing observational studies have mainly relied on structured EHR data to obtain ADE information; however, ADEs are often buried in the EHR narratives and not recorded in structured data. To unlock ADE-related information from EHR narratives, there is a need to extract relevant entities and identify relations among them. In this study, we focus on relation identification. This study aimed to evaluate natural language processing and machine learning approaches using the expert-annotated medical entities and relations in the context of drug safety surveillance, and investigate how different learning approaches perform under different configurations. We have manually annotated 791 EHR notes with 9 named entities (eg, medication, indication, severity, and ADEs) and 7 different types of relations (eg, medication-dosage, medication-ADE, and severity-ADE). Then, we explored 3 supervised machine learning systems for relation identification: (1) a support vector machines (SVM) system, (2) an end-to-end deep neural network system, and (3) a supervised descriptive rule induction baseline system. For the neural network system, we exploited the state-of-the-art recurrent neural network (RNN) and attention models. We report the performance by macro-averaged precision, recall, and F1-score across the relation types. Our results show that the SVM model achieved the best average F1-score of 89.1% on test data, outperforming the long short-term memory (LSTM) model with attention (F1-score of 65.72%) as well as the rule induction baseline system (F1-score of 7.47%) by a large margin. The bidirectional LSTM model with attention achieved the best performance among different RNN models. With the inclusion of additional features in the LSTM model, its performance can be boosted to an average F1-score of 77.35%. It shows that

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

    Czech Academy of Sciences Publication Activity Database

    Zvolský, Miroslav


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

  8. Time-dependent inelastic analysis of metallic media using constitutive relations with state variables

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, V; Mukherjee, S [Cornell Univ., Ithaca, N.Y. (USA)


    A computational technique in terms of stress, strain and displacement rates is presented for the solution of boundary value problems for metallic structural elements at uniform elevated temperatures subjected to time varying loads. This method can accommodate any number of constitutive relations with state variables recently proposed by other researchers to model the inelastic deformation of metallic media at elevated temperatures. Numerical solutions are obtained for several structural elements subjected to steady loads. The constitutive relations used for these numerical solutions are due to Hart. The solutions are discussed in the context of the computational scheme and Hart's theory.

  9. A coarse grained description of time evolution: Irreversible state reduction and time-energy relation

    International Nuclear Information System (INIS)

    Bonifacio, R.; Milan Univ.


    We show that a proper coarse-grained description of time evolution leads to a finite difference equation with step tau for the density operator. This implies state reduction to the diagonal form in the energy representation and a quasi ergodic behaviour of quantum mechanical ensemble averages. An intrinsic time-energy relation tauΔE>=(h/2π)/2 is proposed, and its equivalence to a time quantization is discussed. (author)

  10. Halitosis and related factors in patient referred to the Clinic of Dentistry, Zahedan

    Directory of Open Access Journals (Sweden)

    Tahereh Nosratzehi


    Full Text Available Background: Halitosis is defined as unpleasant odor from the mouth .In %87 of cases the cause of halitosis are located in the oral cavity. It is a medico-social problem that affect a many number of people. purpose of this study was to determine factors involved in halitosis patients were referred to the dental clinic Zahedan. Materials and Methods : 320 people were attending the halitosis or halitophobia for this survey were selected . Selected individuals from eating, drinking, smoking, chewing gum, about 24 hours before sampling was forbidden , and also noted that on examination of brushing, flossing and mouthwash brands do not use . Regarding gingival index periodontal used, in terms of smoking were divided into two groups, consumer and non- consumer - reviews decay and bad restorations through clinical examination and bitewing radiography was performed and the diagnosis of patients with the prosthesis or any the corresponding table were recorded . Crowding teeth were considered . Organoleptic method was used to check for bad breath . Results: The findings of factors such as tooth decay (72%, periodontal disease (47.5%, tounge  coating (17.5% are artificial teeth (13.75% and food impaction, were signficantly  related with halitosis. Conclusion: diagnosis and treatment of halitosis are pramily the responsibility of dentists. It is important for the dentist to have a proper understanding of halitosis and provide correct treatment.

  11. Crouch gait patterns defined using k-means cluster analysis are related to underlying clinical pathology. (United States)

    Rozumalski, Adam; Schwartz, Michael H


    In this study a gait classification method was developed and applied to subjects with Cerebral palsy who walk with excessive knee flexion at initial contact. Sagittal plane gait data, simplified using the gait features method, is used as input into a k-means cluster analysis to determine homogeneous groups. Several clinical domains were explored to determine if the clusters are related to underlying pathology. These domains included age, joint range-of-motion, strength, selective motor control, and spasticity. Principal component analysis is used to determine one overall score for each of the multi-joint domains (strength, selective motor control, and spasticity). The current study shows that there are five clusters among children with excessive knee flexion at initial contact. These clusters were labeled, in order of increasing gait pathology: (1) mild crouch with mild equinus, (2) moderate crouch, (3) moderate crouch with anterior pelvic tilt, (4) moderate crouch with equinus, and (5) severe crouch. Further analysis showed that age, range-of-motion, strength, selective motor control, and spasticity were significantly different between the clusters (p<0.001). The general tendency was for the clinical domains to worsen as gait pathology increased. This new classification tool can be used to define homogeneous groups of subjects in crouch gait, which can help guide treatment decisions and outcomes assessment.

  12. Clinical and radiological characteristics of hemiplegic arm raising related to yawning in stroke patient

    Directory of Open Access Journals (Sweden)

    Jian-yong LI


    Full Text Available Objective To investigate the clinical and radiological characteristics of parakinesia brachialis oscitans (PBD related to yawning in stroke patient and its mechanism. Methods We reported 4 patients with involuntary raising of the paralyzed limbs when yawning in neurological unit of Hainan Branch of Chinese PLA General Hospital, and analyzed their clinical characteristics together with published cases in literatures. Results In this group of stroke patients, when they yawned, their paralyzed upper limb could lift upward involuntarily. Totally 22 patients with ischemic (n=20 and hemorrhagic (n=2 stroke were enrolled. Brain imaging showed infarcts in the middle cerebral artery (MCA in 17 patients and in the brain stem in 5 patients. This phenomenon occurred 4 hours to 4 months (14.57±31.66d after stroke onset, and lasted from 1 week to 3 years (6.70±11.66 months. Corticobulbar tract and pyramidal tract were both damaged in these 22 patients. The mechanism might be that after corticobulbar tract and pyramidal tract damaged, their dominant role in the cranial nerve nuclei of the brainstem and the anterior horn cells of the spinal cord disappeared, and the projection of oxytocinergic neurons from paraventricular nucleus functions, thus causing yawning and muscle contraction. Conclusion PBO may be a rare phenomenon of abnormal movement after stroke. This phenomenon indicates damaging of pyramidal tract, and PBO disappears gradually with the recovery of pyramidal tract function. DOI: 10.11855/j.issn.0577-7402.2018.03.09

  13. Fluctuation relations for equilibrium states with broken discrete or continuous symmetries

    International Nuclear Information System (INIS)

    Lacoste, D; Gaspard, P


    Isometric fluctuation relations are deduced for the fluctuations of the order parameter in equilibrium systems of condensed-matter physics with broken discrete or continuous symmetries. These relations are similar to their analogues obtained for non-equilibrium systems where the broken symmetry is time reversal. At equilibrium, these relations show that the ratio of the probabilities of opposite fluctuations goes exponentially with the symmetry-breaking external field and the magnitude of the fluctuations. These relations are applied to the Curie–Weiss, Heisenberg, and XY models of magnetism where the continuous rotational symmetry is broken, as well as to the q-state Potts model and the p-state clock model where discrete symmetries are broken. Broken symmetries are also considered in the anisotropic Curie–Weiss model. For infinite systems, the results are calculated using large-deviation theory. The relations are also applied to mean-field models of nematic liquid crystals where the order parameter is tensorial. Moreover, their extension to quantum systems is also deduced. (paper)

  14. Injuries to children in the United States related to trampolines, 1990-1995: a national epidemic. (United States)

    Smith, G A


    To describe the epidemiology of trampoline-related injuries among children in the United States. A retrospective analysis of data for children 18 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990 through 1995. There were an estimated 249 400 trampoline-related injuries [95% confidence interval (CI), 166 300-332 500] to children 18 years old and younger treated in hospital emergency departments in the United States during the 6-year study period. The number of injuries increased by 98% from 29 600 in 1990 to 58 400 in 1995, with an average of 41 600 (95% CI, 27 700-55 500) injuries per year, or 59.4 injuries per 100 000 United States children per year (95% CI, 39.6-79.3). The median age of injured children was 10 years, and 50% were males. Ninety-three percent of injuries occurred at home. Injuries to the extremities predominated among children of all ages and accounted for more than 70% of all injuries. This study identified several age-specific injury patterns. There was an inverse relationship between age versus the relative frequency of upper extremity injuries, and fractures and dislocations; and there was a direct relationship between age versus lower extremity injuries and soft tissue injury. There was also an inverse relationship between age versus facial injuries, head and neck injuries, and lacerations. Annually, an estimated 1400 children (95% CI, 800-2000), or 2.0 per 100 000 United States children (95% CI, 1. 1-2.9), required hospital admission or interhospital transfer because of a trampoline-related injury. This represented 3.3% of all children with a trampoline-associated injury. Fractures or dislocations accounted for 83% of injuries among admitted or transferred children, and children with a fracture or dislocation were more likely to be admitted or transferred to another hospital (8.4%) than children with other types of injury (relative risk, 10.80; 95% CI

  15. Segmentation of age-related white matter changes in a clinical multi-center study

    DEFF Research Database (Denmark)

    Dyrby, Tim B.; Rostrup, E.; Baare, W.F.C.


    Age-related white matter changes (WMC) are thought to be a marker of vascular pathology, and have been associated with motor and cognitive deficits. In the present study, an optimized artificial neural network was used as an automatic segmentation method to produce probabilistic maps of WMC...... in a clinical multi-center study. The neural network uses information from T1- and T2-weighted and fluid attenuation inversion recovery (FLAIR) magnetic resonance (MR) scans, neighboring voxels and spatial location. Generalizability of the neural network was optimized by including the Optimal Brain Damage (OBD......) pruning method in the training stage. Six optimized neural networks were produced to investigate the impact of different input information on WMC segmentation. The automatic segmentation method was applied to MR scans of 362 non-demented elderly subjects from 11 centers in the European multi-center study...

  16. Clinical management of HPV-related disease of the lower genital tract. (United States)

    Kyrgiou, M; Valasoulis, G; Founta, C; Koliopoulos, G; Karakitsos, P; Nasioutziki, M; Navrozoglou, I; Dalkalitsis, N; Paraskevaidis, E


    Cytology remains the mainstay for cervical screening. The need to achieve effective management, limit complications, and preserve reproductive function led to the popularity of local treatment. Although the cure rates for ablative and excisional methods are similar, the excisional method provides a more reliable histopathological diagnosis. Recent evidence revealed increased perinatal morbidity after treatment that appears to be related to the proportion of cervix removed. The human papillomavirus (HPV) DNA test appears to enhance the detection of disease in primary screening, in the triage of minor cytological abnormalities, and in follow-up. Further research on the clinical application of a scoring system is ongoing. The vaccines are now available and appear to be safe, well tolerated, and highly efficacious in HPV naive women. A synergy of vaccination and screening will be required. Treatment for early cervical cancer is increasingly shifting toward more fertility-sparing surgical techniques. Careful selection of patients is essential. © 2010 New York Academy of Sciences.

  17. Stress responses during aerobic exercise in relation to motivational dominance and state. (United States)

    Thatcher, Joanne; Kuroda, Yusuke; Legrand, Fabien D; Thatcher, Rhys


    We examined the hypothesis that congruence between motivational dominance and state results in optimal psychological responses and performance during exercise. Twenty participants (10 telic dominant and 10 paratelic dominant) rated their stress at 5 min intervals as they cycled on an ergometer at gas exchange threshold for 30 min in both telic and paratelic state manipulated conditions. Participants then performed a test to exhaustion at a resistance equivalent to 110% of VO(2max). The hypothesized interaction between condition and dominance was significant for internal tension stress, as paratelic dominants were more stressed than telic dominants when exercising in the telic state and telic dominants were more stressed than paratelic dominants when exercising in the paratelic state. Similarly, the condition × dominance interaction for internal stress discrepancy was significant, as paratelic dominants reported greater internal stress discrepancy exercising in the telic compared with the paratelic state. Findings are discussed in relation to the application of reversal theory for understanding stress responses during aerobic exercise.

  18. Health related vulnerability due to chronic diseases: Impact on clinical services across emergency shelters in mass disasters (United States)

    Koleva, Yordanka Nikolova

    Chronic diseases are increasingly recognized as major contributors to the global burden of disease. Individuals with chronic disease are particularly vulnerable during mass emergencies as they may suffer an interruption in their therapeutic programs, leading to life-threatening conditions and complications. Based on the individual and community risk factors framework, three categories are defined as the most vulnerable to extreme natural events: physically, psychologically, and socially vulnerable. Complex emergencies that occurred in the recent decade have provided evidence that these groups suffer more pronounced effects than others. Individuals seeking community support during emergencies have been predominantly medically dependent, elderly, children, people with chronic health conditions, and lower socioeconomic status. The purpose of this study was to investigate the effect of health-related vulnerability on shelter operations, and to estimate the burden of chronic disease on community resources following catastrophic events. A comprehensive survey data collection conducted by the United States Public Health Service in 2005 was used to evaluate clinical services for populations with health conditions accommodated by Louisiana temporary disaster shelters. Correlation and multiple regression analyses determined the relationship between shelter characteristics and the factors predicting shelters' needs for short-term assistance. Significant predictors were identified in all three explored domains: structural shelter characteristics (sponsor, interpreter needed); clinical characteristics (access to health providers, clinic on site, staff had no days off); population characteristics (census, compromised mental health alone, or in combination with chronic conditions and diseases with epidemic potential). Shelters sponsored by faith-based organizations were less likely to be in risk of rapid resource depletion. Shelters with large census demonstrated association with

  19. Student Perceptions of Effective Clinical Teaching Characteristics in Dental Hygiene Programs in Northeastern States (United States)

    Bearor, Dawn E.


    The clinical education component provided to dental hygiene students is an essential part of their development as competent practitioners. Instructor approaches to clinical teaching are therefore critical in providing quality clinical learning experiences. This study sought to identify dental hygiene students' perceptions of "best" and…

  20. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. (United States)

    Carmina, E; Rosato, F; Jannì, A; Rizzo, M; Longo, R A


    We undertook this study to estimate the prevalence of the various androgen excess disorders using the new criteria suggested for the diagnosis of polycystic ovary syndrome (PCOS). The study was performed at two endocrine departments at the University of Palermo (Palermo, Italy). The records of all patients referred between 1980 and 2004 for evaluation of clinical hyperandrogenism were reevaluated. All past diagnoses were reviewed using the actual diagnostic criteria. To be included in this study, the records of the patients had to present the following available data: clinical evaluation of hyperandrogenism, body weight and height, testosterone (T), free T, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, progesterone, and pelvic sonography. A total of 1226 consecutive patients were seen during the study period, but only the scores of 950 patients satisfied all criteria and were reassessed for the diagnosis. The prevalence of androgen excess disorders was: PCOS, 72.1% (classic anovulatory patients, 56.6%; mild ovulatory patients, 15.5%), idiopathic hyperandrogenism, 15.8%; idiopathic hirsutism, 7.6%; 21-hydroxylase-deficient nonclassic adrenal hyperplasia, 4.3%; and androgen-secreting tumors, 0.2%. Compared with other androgen excess disorders, patients with PCOS had increased body weight whereas nonclassic adrenal hyperplasia patients were younger and more hirsute and had higher serum levels of T, free T, and 17-hydroxyprogesterone. Classic PCOS is the most common androgen excess disorder. However, mild androgen excess disorders (ovulatory PCOS and idiopathic hyperandrogenism) are also common and, in an endocrine setting, include about 30% of patients with clinical hyperandrogenism.

  1. Acute carbon monoxide intoxication : the relation between MR findings and clinical outcome

    International Nuclear Information System (INIS)

    Chang, Jin Bae; Jeong, Hae Woong; Kim, Ki Nam; Kim, Dong Wook; Kim, Chang Soo


    To analyse MR findings of various involving sites and the relation between such findings and clinical outcome, the authors retrospectively reviewed MR images of acute carbon monoxide intoxication. In 12 patients, MR images obtained from several hours to 12 days after acute carbon monoxide intoxication were reviewed. The images were analysed with regard to involved sites, symmetricity, signal intensity, and the presence or absence of hemorrhage, and the relationship between MR findings and clinical outcome; the presence of delayed encephalopathy was then determined. The globus pallidus(n=9), white matter(n=3), [centrum semiovale(n=2), periventricular white matter(n=1)] and gyrus(n=6) [inferior temporal gyrus(n=2), cingulate gyrus(n=1), precentral gyrus(n=1), hippocampal gyrus(n=1), parahippocampal gyrus(n=1)] were typically involved, and there was also involvenent of the corpus callosum(n=3), thalamus(n=2) and midbrain(n=2). All lesions of the globus pallidus, thalamus, midbrain and temporal lobe were bilaterally symmetric. In all these cases, subtle or prominent low signal intensity was seen on spin-echo T1WI, and high signal intensity on PDWI and T2WI. Some lesions of the globus pallidus(n=1), thalamus(n=1) and midbrain(n=1) were associated with hemorrhage, which occurred during the early subacute stage and was seen on high/low signal intensity T1/T2WI images. Acute cerebral(n=1) and cerebellar(n=1) infarctions were also seen. Cerebral white matter involvement correlated with poor clinical outcome, and in two cases, delayed encephalopathy developed. In these cases of acute carbon monoxide intoxication, the globus pallidus, white matter, cortex and hippocampus were frequently involved, and there was also involvement of various sites such as the corpus callosum, thalamus and midbrain. Lesions of the temporal lobe, thalamus and midbrain were bilaterally symmetric. The involvement of cerebral white matter and the presence of delayed encephalopathy can influence

  2. Exploring correlates of diabetes-related stress among adults with Type 1 diabetes in the T1D exchange clinic registry. (United States)

    Boden, Matthew Tyler; Gala, Sasha


    To explore relations between diabetes-related stress and multiple sociodemographic, diabetes health, other health, and treatment-related variables among a large sample of adults with Type 1 Diabetes (T1D). The sample consisted of 10,821 adults (over 18 years old) enrolled in the T1D Exchange Clinic Registry. The T1D Exchange clinic network consists of 67 diabetes clinical centers throughout the United States selected to broadly represent pediatric and adult patients with T1D. Variables were assessed through participant self-report and extraction of clinic chart data. Univariate and multiple linear regression (with simultaneous entry of all predictors) analyses were conducted. Robustly associated with increased diabetes-related stress across analyses were multiple sociodemographic (female [vs. male], native Hawaiian/other Pacific islander [vs. white/Caucasian], decreased age and diabetes duration), diabetes health (higher HbA1c), other health (lower general health, presence of major life stress and depression, less physical activity), and treatment related variables (use of injections/pen or combination injection/pen/pump [vs. pump], use of CGM, increased frequency of missing insulin doses and BG checking, decreased frequency of BG checking prior to bolus, receipt of mental health treatment). We replicated and extended research demonstrating that diabetes-related stress among people with T1D occurs at higher levels among those with particular sociodemographic characteristics and is associated with a range poorer diabetes health and other health variables, and multiple treatment-related variables. The strong incremental prediction of diabetes-related stress by multiple variables in our study suggests that a multi-variable, personalized approach may increase the effectiveness of treatments for diabetes-related stress. Published by Elsevier B.V.

  3. Increased power spectral density in resting-state pain-related brain networks in fibromyalgia. (United States)

    Kim, Ji-Young; Kim, Seong-Ho; Seo, Jeehye; Kim, Sang-Hyon; Han, Seung Woo; Nam, Eon Jeong; Kim, Seong-Kyu; Lee, Hui Joong; Lee, Seung-Jae; Kim, Yang-Tae; Chang, Yongmin


    Fibromyalgia (FM), characterized by chronic widespread pain, is known to be associated with heightened responses to painful stimuli and atypical resting-state functional connectivity among pain-related regions of the brain. Previous studies of FM using resting-state functional magnetic resonance imaging (rs-fMRI) have focused on intrinsic functional connectivity, which maps the spatial distribution of temporal correlations among spontaneous low-frequency fluctuation in functional MRI (fMRI) resting-state data. In the current study, using rs-fMRI data in the frequency domain, we investigated the possible alteration of power spectral density (PSD) of low-frequency fluctuation in brain regions associated with central pain processing in patients with FM. rsfMRI data were obtained from 19 patients with FM and 20 age-matched healthy female control subjects. For each subject, the PSDs for each brain region identified from functional connectivity maps were computed for the frequency band of 0.01 to 0.25 Hz. For each group, the average PSD was determined for each brain region and a 2-sample t test was performed to determine the difference in power between the 2 groups. According to the results, patients with FM exhibited significantly increased frequency power in the primary somatosensory cortex (S1), supplementary motor area (SMA), dorsolateral prefrontal cortex, and amygdala. In patients with FM, the increase in PSD did not show an association with depression or anxiety. Therefore, our findings of atypical increased frequency power during the resting state in pain-related brain regions may implicate the enhanced resting-state baseline neural activity in several brain regions associated with pain processing in FM. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  4. Relation of visual creative imagery manipulation to resting-state brain oscillations. (United States)

    Cai, Yuxuan; Zhang, Delong; Liang, Bishan; Wang, Zengjian; Li, Junchao; Gao, Zhenni; Gao, Mengxia; Chang, Song; Jiao, Bingqing; Huang, Ruiwang; Liu, Ming


    Visual creative imagery (VCI) manipulation is the key component of visual creativity; however, it remains largely unclear how it occurs in the brain. The present study investigated the brain neural response to VCI manipulation and its relation to intrinsic brain activity. We collected functional magnetic resonance imaging (fMRI) datasets related to a VCI task and a control task as well as pre- and post-task resting states in sequential sessions. A general linear model (GLM) was subsequently used to assess the specific activation of the VCI task compared with the control task. The changes in brain oscillation amplitudes across the pre-, on-, and post-task states were measured to investigate the modulation of the VCI task. Furthermore, we applied a Granger causal analysis (GCA) to demonstrate the dynamic neural interactions that underlie the modulation effect. We determined that the VCI task specifically activated the left inferior frontal gyrus pars triangularis (IFGtriang) and the right superior frontal gyrus (SFG), as well as the temporoparietal areas, including the left inferior temporal gyrus, right precuneus, and bilateral superior parietal gyrus. Furthermore, the VCI task modulated the intrinsic brain activity of the right IFGtriang (0.01-0.08 Hz) and the left caudate nucleus (0.2-0.25 Hz). Importantly, an inhibitory effect (negative) may exist from the left SFG to the right IFGtriang in the on-VCI task state, in the frequency of 0.01-0.08 Hz, whereas this effect shifted to an excitatory effect (positive) in the subsequent post-task resting state. Taken together, the present findings provide experimental evidence for the existence of a common mechanism that governs the brain activity of many regions at resting state and whose neural activity may engage during the VCI manipulation task, which may facilitate an understanding of the neural substrate of visual creativity.

  5. Establishing a clinical pharmacy technician at a United States Army military treatment facility. (United States)

    Evans, Jennifer L; Gladd, Ellen M; Gonzalez, Alicia C; Tranam, Salman; Larrabee, Joni M; Lipphardt, Sarah E; Chen, Tina T; Ronn, Michael D; Spain, John


    To describe the creation of a clinical pharmacy technician position within the U.S. Army and to identify the personal skills and characteristics required to meet the demands of this role. An outpatient military treatment facility located in Maryland. The clinical pharmacy technician position was designed to support clinical pharmacy services within a patient-centered medical home. Funding and a position description were established to hire a clinical pharmacy technician. Expected duties included administrative (45%), patient education (30%), and dispensing (25%). Local policy, in accordance with federal law and U.S. Army regulations, was developed to define the expanded technician responsibility to deliver patient medication education. In the initial 3 months, the clinical pharmacy technician spent 24 hours per week on clinical activities, affording an additional 10-15 hours per week for clinical pharmacists to provide patient care. Completed consults increased from 41% to 56%, and patient-pharmacist encounters increased from 240 to 290 per month. The technician, acting as a clinical pharmacist extender, also completed an average of 90 patient encounters independently each month. As a result of these improvements, the decision was made to hire a second technician. Currently, the technicians spend 28-40 hours per week on clinical activities, offsetting an average of 26 hours per week for the clinical pharmacists. A patient-centered medical home clinical pharmacy technician can reduce the administrative workload for clinical pharmacists, improve their efficiency, and enhance the use of clinical pharmacy services. Several characteristics, particularly medication knowledge, make pharmacy technicians particularly suited for this role. The results from the implementation of a clinical pharmacy technician at this military treatment facility resulted in an Army-wide expansion of the position and suggested applicability in other practice sites, particularly in federal

  6. Epidemiology, trends, assessment and management of sport-related concussion in United States high schools. (United States)

    Guerriero, Réjean M; Proctor, Mark R; Mannix, Rebekah; Meehan, William P


    Sport-related concussion affects athletes at every level of participation. The short and long-term effects of concussions that occur during childhood and adolescence are not fully understood. The purpose of this review is to describe the current burden of disease, current practice patterns and current recommendations for the assessment and management of sport-related concussions sustained by United States high school athletes. Millions of high school students participate in organized sports in the United States. Current estimates suggest that, across all sports, approximately 2.5 concussions occur for every 10 000 athletic exposures, in which an athletic exposure is defined as one athlete participating in one game or practice. At schools that employ at least one athletic trainer, most high school athletes who sustain sport-related concussions will be cared for by athletic trainers and primary care physicians. Approximately 40% will undergo computerized neurocognitive assessment. The number of high school athletes being diagnosed with sport-related concussions is rising. American football has the highest number of concussions in high school with girls' soccer having the second highest total number. Fortunately, coaches are becoming increasingly aware of these injuries and return-to-play guidelines are being implemented.

  7. Using Mobile Sensing to Test Clinical Models of Depression, Social Anxiety, State Affect, and Social Isolation Among College Students. (United States)

    Chow, Philip I; Fua, Karl; Huang, Yu; Bonelli, Wesley; Xiong, Haoyi; Barnes, Laura E; Teachman, Bethany A


    likelihood of spending time at home, and more negative or less positive affect was linked to longer homestay. Interactions indicated that, among individuals higher in social anxiety, higher negative affect and lower positive affect within a day was associated with greater likelihood of spending time at home the following day. Results demonstrate the feasibility and utility of modeling the relationship between affect and homestay using fine-grained GPS data. Although these findings must be replicated in a larger study and with clinical samples, they suggest that integrating repeated state affect assessments in situ with continuous GPS data can increase understanding of how actual homestay is related to affect in everyday life and to symptoms of anxiety and depression. ©Philip I Chow, Karl Fua, Yu Huang, Wesley Bonelli, Haoyi Xiong, Laura E Barnes, Bethany A Teachman. Originally published in the Journal of Medical Internet Research (, 03.03.2017.

  8. Correlation and clinical significance between glomerular filtration rate and age in living-related kidney donors

    International Nuclear Information System (INIS)

    Zhao Xiuyi; Shao Yahui; Wang Yanming; Zhang Aimin; Hao Junwen; Tian Jun; Sun Ben; Han Jiankui


    Objective: To quantitatively investigate the effect of age on the glomerular filtration rate (GFR) in living-related kidney donors. to analyze the clinical value and the dependence of GFR on age and to provide an objective basis for the selection of the living kidney donor. Methods: One hundred and sixty-one living-related kidney donors were divided into four age groups, namely 20-29 years (n=52), 30-39 years (n=44), 40-49 years (n=38) and ≥50 years (n=27). On the other hand, the total donors were divided into the groups older than 55 years (n=24) and younger than 55 years (n=137). To quantify GFR in all the subjects using the 99 Tc m -diethylenetriamine pentaacetic acid ( 99 Tc m -DTPA) renography according to standard procedure and to evaluate the effects of age on renal function. Results: The total GFR in living-related kidney donors was calculated as (89.55±12.87) ml·min -1 ·(1.73 m 2 ) -1 . The GFR in the first to the four age groups were (88.27±12.29) ml·min -1 ·(1.73 m 2 ) -1 , (91.85±14.51) ml·min -1 ·(1.73 m 2 ) -1 , (98.25±11.26) ml·min -1 ·(1.73 m 2 ) -1 and (88.24±13.20) ml·min -1 ·(1.73 m 2 ) -1 . The difference of GFR were not significant between the four age groups (F=2.09, P=0.10). The GFR in the donors older than 55 years and younger than 55 years were (88.57±13.14) ml·min -1 ·(1.73 m 2 ) -1 and (89.44±10.34) ml·min -1 ·(1.73 m 2 ) -1 , there no significant difference in GFR between the two groups (F=1.31, P=0.25). When relating GFR to age in all the living-related kidney donors, there was no significant correlation (r=-0.033, P=0.69). No serious complications occurred after living kidney transplantation, serum creatinine values and blood urea nitrogen recovered to the normal levels in a short period, hepatic and renal functions were normal. Conclusion: This study indicated that the GFR values were not correlated with the change of age in living-related kidney donors, and the results were helpful for the selection of living

  9. Myoglobin plasma level related to muscle mass and fiber composition: a clinical marker of muscle wasting? (United States)

    Weber, Marc-André; Kinscherf, Ralf; Krakowski-Roosen, Holger; Aulmann, Michael; Renk, Hanna; Künkele, Annette; Edler, Lutz; Kauczor, Hans-Ulrich; Hildebrandt, Wulf


    Progressive muscle wasting is a central feature of cancer-related cachexia and has been recognized as a determinant of poor prognosis and quality of life. However, until now, no easily assessable clinical marker exists that allows to predict or to track muscle wasting. The present study evaluated the potential of myoglobin (MG) plasma levels to indicate wasting of large locomotor muscles and, moreover, to reflect the loss of MG-rich fiber types, which are most relevant for daily performance. In 17 cancer-cachectic patients (weight loss 22%) and 27 age- and gender-matched healthy controls, we determined plasma levels of MG and creatine kinase (CK), maximal quadriceps muscle cross-sectional area (CSA) by magnetic resonance imaging, muscle morphology and fiber composition in biopsies from the vastus lateralis muscle, body cell mass (BCM) by impedance technique as well as maximal oxygen uptake (VO(2)max). In cachectic patients, plasma MG, muscle CSA, BCM, and VO(2)max were 30-35% below control levels. MG showed a significant positive correlation to total muscle CSA (r = 0.65, p max as an important functional readout. CK plasma levels appear to be less reliable because prolonged increases are observed in even subclinical myopathies or after exercise. Notably, cancer-related muscle wasting was not associated with increases in plasma MG or CK in this study.

  10. Metaphor-related figurative language comprehension in clinical populations: a critical review

    Directory of Open Access Journals (Sweden)

    Maity Siqueira


    Full Text Available This paper aims to critically review current studies with respect to definitions,methods, and results on the comprehension of metaphor, metonymy,idioms, and proverbs under the following clinical conditions: aphasia,Alzheimer’s disease, autism, brain injuries, specific language impairment,and Williams Syndrome. A comprehensive search of experimentalpsycholinguistic research was conducted using EBSCOhost, PsychInfo,PUBMED, and Web of Science databases. Thirty-eight studies met thereview inclusion criteria. Results point to deficits in figurative languagecomprehension in all conditions considered, lack of clear definitions ofthe phenomena investigated, and varied methods throughout the sample.Patients’ difficulties are attributed to multiple factors, such as a lack ofTheory of Mind, executive dysfunctions, and poor semantic knowledge.The study of nonliteral aspects of language comprehension in clinicalpopulations reveals a range of disparate impairments. There was no specificfeature about metaphor-related phenomena identified that could, on its own,account for the difficulty some populations have to understand figurativelanguage. Rather, metaphor-related language comprehension difficultiesare often part of pragmatic, linguistic, and/or cognitive impairments.Keywords: Figurative language. Metaphor. Metonymy. Proverb. Clinicalpopulations

  11. Family functioning in bipolar disorder: Characteristics, congruity between patients and relatives, and clinical correlates. (United States)

    Reinares, María; Bonnín, C Mar; Hidalgo-Mazzei, Diego; Colom, Francesc; Solé, Brisa; Jiménez, Esther; Torrent, Carla; Comes, Mercè; Martínez-Arán, Anabel; Sánchez-Moreno, José; Vieta, Eduard


    Functional improvement has become one of the aims of the treatment of bipolar disorder. However, scant attention has been given to family functioning, even though it has a role in the illness outcome and is affected by the disorder. The aims of this study were to compare family functioning reported by euthymic patients with bipolar disorder and healthy controls; explore the level of congruence in the perception of family environment between patients with bipolar disorder and their relatives; and analyse the relationship between clinical variables and family functioning. The sample comprised 82 adult euthymic subjects with bipolar disorder, 82 family caregivers of these patients and 47 healthy controls. Participants completed the Family Environment Scale. Results showed moderate correlations and a mean pattern almost identical between relatives' and patients' reported scores in family functioning subscales. There were significant differences between patients and controls, favourable for the latter, in the subscales cohesion (pbipolar disorder and highlight the importance of family work. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Distinct characteristics of mandibular bone collagen relative to long bone collagen: relevance to clinical dentistry. (United States)

    Matsuura, Takashi; Tokutomi, Kentaro; Sasaki, Michiko; Katafuchi, Michitsuna; Mizumachi, Emiri; Sato, Hironobu


    Bone undergoes constant remodeling throughout life. The cellular and biochemical mechanisms of bone remodeling vary in a region-specific manner. There are a number of notable differences between the mandible and long bones, including developmental origin, osteogenic potential of mesenchymal stem cells, and the rate of bone turnover. Collagen, the most abundant matrix protein in bone, is responsible for determining the relative strength of particular bones. Posttranslational modifications of collagen, such as intermolecular crosslinking and lysine hydroxylation, are the most essential determinants of bone strength, although the amount of collagen is also important. In comparison to long bones, the mandible has greater collagen content, a lower amount of mature crosslinks, and a lower extent of lysine hydroxylation. The great abundance of immature crosslinks in mandibular collagen suggests that there is a lower rate of cross-link maturation. This means that mandibular collagen is relatively immature and thus more readily undergoes degradation and turnover. The greater rate of remodeling in mandibular collagen likely renders more flexibility to the bone and leaves it more suited to constant exercise. As reviewed here, it is important in clinical dentistry to understand the distinctive features of the bones of the jaw.

  13. Distinct Characteristics of Mandibular Bone Collagen Relative to Long Bone Collagen: Relevance to Clinical Dentistry

    Directory of Open Access Journals (Sweden)

    Takashi Matsuura


    Full Text Available Bone undergoes constant remodeling throughout life. The cellular and biochemical mechanisms of bone remodeling vary in a region-specific manner. There are a number of notable differences between the mandible and long bones, including developmental origin, osteogenic potential of mesenchymal stem cells, and the rate of bone turnover. Collagen, the most abundant matrix protein in bone, is responsible for determining the relative strength of particular bones. Posttranslational modifications of collagen, such as intermolecular crosslinking and lysine hydroxylation, are the most essential determinants of bone strength, although the amount of collagen is also important. In comparison to long bones, the mandible has greater collagen content, a lower amount of mature crosslinks, and a lower extent of lysine hydroxylation. The great abundance of immature crosslinks in mandibular collagen suggests that there is a lower rate of cross-link maturation. This means that mandibular collagen is relatively immature and thus more readily undergoes degradation and turnover. The greater rate of remodeling in mandibular collagen likely renders more flexibility to the bone and leaves it more suited to constant exercise. As reviewed here, it is important in clinical dentistry to understand the distinctive features of the bones of the jaw.

  14. Accessing the public MIMIC-II intensive care relational database for clinical research. (United States)

    Scott, Daniel J; Lee, Joon; Silva, Ikaro; Park, Shinhyuk; Moody, George B; Celi, Leo A; Mark, Roger G


    The Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database is a free, public resource for intensive care research. The database was officially released in 2006, and has attracted a growing number of researchers in academia and industry. We present the two major software tools that facilitate accessing the relational database: the web-based QueryBuilder and a downloadable virtual machine (VM) image. QueryBuilder and the MIMIC-II VM have been developed successfully and are freely available to MIMIC-II users. Simple example SQL queries and the resulting data are presented. Clinical studies pertaining to acute kidney injury and prediction of fluid requirements in the intensive care unit are shown as typical examples of research performed with MIMIC-II. In addition, MIMIC-II has also provided data for annual PhysioNet/Computing in Cardiology Challenges, including the 2012 Challenge "Predicting mortality of ICU Patients". QueryBuilder is a web-based tool that provides easy access to MIMIC-II. For more computationally intensive queries, one can locally install a complete copy of MIMIC-II in a VM. Both publicly available tools provide the MIMIC-II research community with convenient querying interfaces and complement the value of the MIMIC-II relational database.

  15. Clinical spectrum and diagnostic value of antibodies against the potassium channel related protein complex. (United States)

    Montojo, M T; Petit-Pedrol, M; Graus, F; Dalmau, J


    Antibodies against a protein complex that includes voltage-gated potassium channels (VGKC) have been reported in patients with limbic encephalitis, peripheral nerve hyperexcitability, Morvan's syndrome, and a large variety of neurological syndromes. In this article, a review is presented of the syndromes associated with antibodies against VGKC-related proteins and the main antigens of this protein complex, the proteins LGI1 (leucine rich glioma inactivated protein 1) and Caspr2 (contactin-associated protein-like 2). The conceptual problems and clinical implications of the description of antibodies against VGKC-related proteins other than LGI1 and Caspr2 are also discussed. Although initial studies indicated the occurrence of antibodies against VGKC, recent investigations have shown that the main antigens are a neuronal secreted protein known as LGI1 which modulates synaptic excitability, and a protein called Caspr2 located on the cell surface and processes of neurons of different brain regions, and at the juxtaparanodal region of myelinated axons. While antibodies against LGI1 preferentially associate with classical limbic encephalitis, antibodies against Caspr2 associate with a wider spectrum of symptoms, including Morvan's syndrome, peripheral nerve hyperexcitability or neuromyotonia, and limbic or more extensive encephalitis. In addition there are reports of patients with antibodies against VGKC-related proteins that are different from LGI1 or Caspr2. In these cases, the identity and location of the antigens are unknown, the syndrome association is not specific, and the response to treatment uncertain. The discovery of antigens such as LGI1 and Caspr2 has resulted in a clinical and molecular definition of the broad group of diseases previously attributed to antibodies against VGKC. Considering the literature that describes the presence of antibodies against VGKC other than LGI1 and Caspr2 proteins, we propose a practical algorithm for the diagnosis and treatment


    Fleseriu, Maria; Hamrahian, Amir H; Hoffman, Andrew R; Kelly, Daniel F; Katznelson, Laurence


    Recurrence of hypercortisolemia after initial treatment of Cushing disease (CD) is more common than previously thought, with a third of patients suffering a recurrence over their lifetime. Awareness of this high rate and delayed timeline (sometimes decades) of potential recurrence is critical and patients with CD should be monitored at regular intervals throughout their lives. In this manuscript, we review the complex evaluation needed for defining CD remission versus persistent disease after surgery, and focus on challenges in diagnosing early recurrent hypercortisolemia. Late night salivary cortisol appears to be an earlier predictor of recurrence when compared with urinary free cortisol (UFC) excretion. We also review the criteria suggested to define recurrence of hypercortisolemia in patients treated with medical therapy. Further research is needed to determine the optimal way to evaluate a patient with CD recurrence as well as the riskbenefit ratio of treatment in early, mild recurrent disease. ACTH = adrenocorticotropic hormone AI = adrenal insufficiency CD = Cushing disease CDDT = coupled dexamethasone desmopressin test CR = circadian rhythm CRH = corticotropin-releasing hormone GC = glucocorticoid GCR = global clinical response HPA = hypothalamic-pituitary-adrenal LDDST = low-dose dexamethasone suppression test LNSC = late-night salivary cortisol ODST = overnight dexamethasone suppression test TSS = trans-sphenoidal surgery.

  17. Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review

    Directory of Open Access Journals (Sweden)

    Solmi M


    Full Text Available Marco Solmi,1,2 Andrea Murru,3 Isabella Pacchiarotti,3 Juan Undurraga,4,5 Nicola Veronese,2,6 Michele Fornaro,7,8 Brendon Stubbs,2,9–11 Francesco Monaco,2 Eduard Vieta,3 Mary V Seeman,12 Christoph U Correll,13,14 André F Carvalho2,15 1Neuroscience Department, University of Padua, 2Institute for Clinical Research and Education in Medicine, Padua, Italy; 3Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; 4Department of Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, 5Early Intervention Program, J. Horwitz Psychiatric Institute, Santiago, Chile; 6National Research Council, Ageing Section, Padua, 7Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, School of Medicine, University “Federico II”, Naples, Italy; 8New York State Psychiatric Institute, Columbia University, New York, NY, USA; 9Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 10Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, 11Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK; 12Institute of Medical Science, Toronto, ON, Canada; 13Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, 14Department of Psychiatry and Molecular Medicine Hempstead, Hofstra Northwell School of Medicine, Hempstead, NY, USA; 15Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil Abstract: Since the discovery of chlorpromazine (CPZ in 1952, first-generation antipsychotics (FGAs have revolutionized psychiatric care in terms of facilitating discharge from hospital and enabling large numbers of patients with severe mental illness (SMI to be treated in the community. Second

  18. The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes. (United States)

    Karlsen, Bjørg; Oftedal, Bjørg; Bru, Edvin


    This article is a report of a cross-sectional study examining the degree to which clinical indicators, coping styles and perceived support from healthcare professionals and family are related to diabetes-related distress. Many people with type 2 diabetes experience high levels of distress stemming from concerns and worries associated with their disease. Diabetes-related distress has predominantly been studied in relation to diabetes management and metabolic control, and to some extent in relation to coping styles and perceived social support. To date, little is known about the relative contribution of clinical indicators, coping styles and perceptions of social support to perceived distress among people with type 2 diabetes. A sample comprising 425 Norwegian adults, aged 30-70, with type 2 diabetes, completed questionnaires assessing coping styles, perceived social support from health professionals and family and diabetes-related distress assessed by the Problem Areas in Diabetes Scale. Demographical and clinical data were collected by self-report. Data were collected in October 2008.   Results from the regression analyses showed a greater variance in emotional distress accounted for by coping styles (21·3%) and perceived support (19·7%) than by clinical indicators (5·8%). FINDINGS may indicate that healthcare providers should pay more attention to non-clinical factors such as coping styles and social support, when addressing diabetes-related distress. They should also be aware that interventions based on psychosocial approaches may primarily influence distress, and not necessarily metabolic control. © 2011 Blackwell Publishing Ltd.

  19. Analysis of iron acquisition and storage-related genes in clinical and non-clinical strains of Yersinia enterocolitica biovar 1A. (United States)

    Kanaujia, Pawan Kumar; Bajaj, Priyanka; Virdi, Jugsharan Singh


    Possession of mechanisms for iron acquisition and its storage enhances the ability of the bacteria to survive in the iron-limiting environment of the host. In this study, 81 strains of Yersinia enterocolitica biovar 1A isolated from various clinical (n = 51) and non-clinical (n = 30) sources were investigated for the presence of the genes related to iron acquisition and storage. Important genes which were present in more than 85% of the strains included hasA, foxA, bfr, bfd, ftnA, and hmsT as well as the fhuCDB, fepBDGCfesfepA, feoAB, yfuABCD, hemPRSTUV, and hmsHFRS gene clusters. Majority of these genes is being reported for the first time in biovar 1A strains and showed significant homology with genes present in the known pathogenic biovars of Y. enterocolitica. However, no significant difference was observed in the distribution of iron acquisition and storage-related genes among clinical and non-clinical biovar 1A strains. Thus, it may be suggested that the presence of iron acquisition and storage-related genes per se might not be responsible for the supposedly better ability of clinical biovar 1A strains to cause infections in humans. However, in the backdrop of this data, the need to undertake functional studies are highly recommended. © 2015 APMIS. Published by John Wiley & Sons Ltd.

  20. Physical state condition in quantum general relativity as a consequence of BRST symmetry

    International Nuclear Information System (INIS)

    Castellana, Michele; Montani, Giovanni


    Quantization of systems with constraints can be carried out with several methods. In the Dirac formulation the classical generators of gauge transformations are required to annihilate physical quantum states to ensure their gauge invariance. Carrying on BRST symmetry it is possible to get a condition on physical states which, different from the Dirac method, requires them to be invariant under the BRST transformation. Employing this method for the action of general relativity expressed in terms of the spin connection and tetrad fields with path integral methods, we construct the generator of the BRST transformation associated with the underlying local Lorentz symmetry of the theory and write a physical state condition following from BRST invariance. This derivation is based on the general results on the dependence of the effective action used in path integrals and consequently of Green's functions on the gauge-fixing functionals used in the DeWitt-Faddeev-Popov method. The condition we gain differs from the one obtained within Ashtekar's canonical formulation, showing how we recover the latter only by a suitable choice of the gauge-fixing functionals. Finally we discuss how it should be possible to obtain all of the requested physical state conditions associated with all the underlying gauge symmetries of the classical theory using our approach

  1. Understanding and retention of trial-related information among participants in a clinical trial after completing the informed consent process. (United States)

    Mexas, Fernanda; Efron, Anne; Luiz, Ronir Raggio; Cailleaux-Cezar, Michelle; Chaisson, Richard E; Conde, Marcus B


    for assessing the level of understanding of trial-related information during the informed consent (IC) process in developing countries are lacking. To assess the understanding and retention of trial-related information presented in the IC process by administering an informed consent assessment instrument (ICAI) to participants in a clinical trial for a new tuberculosis (TB) regimen being conducted in Rio de Janeiro (Brazil). Methods The format of the ICAI was based on the language and structure of the United States National Cancer Institute's IC comprehension checklist. The ICAI was designed to assess points of the RioMAR study IC process that addressed the principles of research ethics requested by Brazilian Regulatory Authority: autonomy, beneficence, non-maleficence, and justice. Briefly, (1) Is the respondent participating in a clinical trial? (2) Are two different treatments being evaluated? (3) Is the treatment arm chosen by chance? (4) Is an HIV test required? (5) Are liver function tests required? (6) Can participants leave the study at any time? (7) Are the risks and benefits of taking part in the study clear? (8) May pregnant women participate in the study? (9) Can one of the study drugs reduce the effectiveness of contraceptives? (10) Are patients paid to participate in the study? The ICAI was applied at two time points: immediately after enrollment in the clinical trial and 2 months later. A total of 61 patients who enrolled in the RioMAR study participated in this study. The percentage of correct answers to all questions was 82% at the time of the first ICAI; 31 participants (51%) did not recall that an HIV test was required (question 4) and 43 (70%) did not know that they could leave the study (question 6). Other individual questions were answered correctly by at least 76% of participants. There was no association between incorrect answers and age, gender, monthly family income, neighborhood, or level of education (p > 0.07). When the responses to the

  2. Maxillary Distraction Osteogenesis Using a Rigid External Distractor: Which Clinical Factors Are Related With Relapse? (United States)

    Kim, Jeenam; Uhm, Ki-Il; Shin, Donghyeok; Lee, Jina; Choi, Hyungon


    Maxillary distraction osteogenesis is a reliable treatment for cleft lip and palate with midfacial retrusion. The purpose of this study was to evaluate the results of long-term follow-up in patients with cleft lip and palate after maxillary distraction osteogenesis and to find clinical factors related to relapse. From February 2002 to June 2008, 21 patients with severe class III malocclusion were treated at our hospital. We performed distraction osteotomy with a rigid external distractor device. The distraction length was more than 15 mm in all patients. Preoperative and postoperative lateral cephalometric radiographs were used for analysis. The sella-nasion-subnasale, sella-nasion-supramentale, and point-A-point-B-nasion (sella-nasion-subnasale-sella-nasion-supramentale) angles were recorded. The timelines for follow-up were preoperatively, after distraction, after consolidation, at 3 years, and once fully grown (5- to 8-year follow-ups). A comparative analysis of clinical factors was performed for the relapsing and nonrelapsing groups. Of the 21 patients, 14 had relapsed. The mean age in the relapsing group was 9.1 years (7 boys and 7 girls) with 9 patients with unilateral cleft palate and 5 c bilateral cleft palate. The mean age in the nonrelapsing group was 11.7 years (4 boys and 3 girls) with 5 patients with unilateral cleft palate and 2 patients with bilateral cleft palate. Despite greater anterior overcorrection, relapse occurred owing to scar tissue retraction and mandibular compensatory hypertrophy. The results suggest that the younger the patient, the more likely relapse will occur.

  3. The Relation between Diverse Phenotypes of PCOS with Clinical Manifestations, Anthropometric Indices and Metabolic Characteristics. (United States)

    Shahrami, Seyedeh Hajar; Abbasi Ranjbar, Zahra; Milani, Forozan; Kezem-Nejad, Ehsan; Hassanzadeh Rad, Afagh; Dalil Heirat, Seyedeh Fatemeh


    Critical issue regarding to variation of findings based on different phenotypes led investigators to define whether they are distinct features or overlapping ones. Therefore, we aimed to investigate the association between diverse phenotypes of PCOS (Poly Cystic Ovary Syndrome) with clinical manifestations, anthropometric indices, and metabolic characteristics. This was a descriptive cross-sectional study conducted in 15-39 years old women with PCOS referred to infertility clinics in the north part of Iran, Rasht during 2010-2011. Data were gathered through an interview by a form consisted of demographic characteristics, laboratory findings, ovarian volume and anthropometric indices. A total of 214 patients consisted of 161 PCOS (cases) and 53 normal women (controls) participated in this study. The most prevalent phenotype in PCOS population was IM/PCO/HA (54%), followed by IM/HA (28%) and IM/PCO (13%). PCO/HA was present only in 6 PCOS patients (5%). PCOS patients were significantly younger than controls (P=0.07). Results showed that increased ovarian volume were higher in PCOS group in comparison with controls and IM/PCO/HA, and IM/PCO had respectively the largest ovarian volumes. Also, a significant relation was observed based on Cholesterol, 17OHP, LH, TG, 2hpp, and LH/FSH between patients with PCOS and control groups. There were significant differences in demographic, anthropometric, hormonal and ultrasound findings between PCOS and controls. Therefore, it seems that classification of the characteristics of each phenotype could offer an appropriate guide for screening risks of PCOS and may facilitate performing most favorable treatment for these complications.

  4. Health related quality of life in pregeriatric patients with chronic diseases at urban, public supported clinics

    Directory of Open Access Journals (Sweden)

    Nguyen Kim M


    Full Text Available Abstract Background Understanding health-related quality of life (HRQOL leads to more effective and focused healthcare. America's growing health disparities makes it is increasingly necessary to understand the HRQOL of pregeriatric individuals who are now 55–64 years old, i.e. before they are eligible for federally mandated health care at age 65. Our study measured the self-perceived HRQOL of pregeriatric, poor patients with multiple chronic diseases treated at 2 public clinics. Methods Consecutive patients aged 55–64 years, many with multiple chronic diseases, responded in an interview to the 36-Item Short-Form Health Survey (SF–36 as a general measure of HRQOL during a regular visit to one of two university-staffed urban public clinics. Results The perceived physical and mental functioning of 316 pregeriatric patients was tabulated from SF–36 scores to yield their HRQOL. Their scores were statistically significantly lower than those of the general US pregeriatric population and lower than averages for US patients with multiple chronic diseases. All eight subscale scores of SF–36 were 16% to 36% lower compared with the averages of the general US pregeriatric population. Further, as the number of chronic diseases increased, the lower was the HRQOL. Lower physical and mental scores were associated with a lower income, unemployment, and higher numbers of multiple chronic diseases. Conclusion Chronic diseases have a powerful negative impact on perceived mental and physical functioning in pregeriatric patients. HRQOL information can assist health care providers to gain a more complete picture of their pregeriatric patients' health.

  5. Cancer-related Fatigue and its Relationship with Demographic and Clinical Characteristics

    Directory of Open Access Journals (Sweden)

    Maryam Chehrehgosha


    Full Text Available Background and objectives: Fatigue experience is a psychological experience therefore, the relevant caregivers’ acquaintance with this issueis the most important step in offering optimal care for the patients. Accordingly, this study was conductedto determine Cancer-related Fatigue and its Relationship with Demographic and Clinical Characteristics inCancer Patients.A cancer diagnosis is a highly undesirable event for anyone.Methods: characteristics form and the Multidimensional Fatigue Inventory. The data were analyzed with the SPSS-18 software and t-test and ANOVA and tukey post hoc test were used.In this analytical study, 150 cancer patients visiting the oncology unit, the Shafa Radiotherapy Center,and Gorgan’s 5th Azar Teaching Hospital in 2012, who were selected with a purposive sampling method,participated in the study for 4 months. The required information was collected using a demographic and clinicalResults: of treatment, 51.3% used chemotherapy-surgery-radiotherapy regimen, 24.7% surgery-chemotherapy regimen,14% used chemotherapy, 7.3% used radiotherapy, and 2.7% used surgery. The overall mean scoreof fatigue was 54.65±8.78 from 100. The variables of residence (P=0. 018, the duration of marriage(P=0.018, the treatment regimen type (P<0.001, and the family’s economic status (P<0.000 were found toThe patients’ mean age was 48.39±1.5 Of the patients, 55.3% had undergone less than 12 monthshave a significant relationship with fatigue.Conclusion: Psychological interventions, besides physical caring and nursing interventions play a significantrole in the all-inclusive management of cancer patients’ problems, in particular, their fatigue.

  6. Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures (United States)

    Journy, N; Sinno-Tellier, S; Maccia, C; Le Tertre, A; Pirard, P; Pagès, P; Eilstein, D; Donadieu, J; Bar, O


    Objective The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results The mean MSD and DAP were respectively 389 mGy and 65 Gy cm−2 for CAs, and 916 mGy and 69 Gy cm−2 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. PMID:22457404

  7. Carcinogenic Air Toxics Exposure and Their Cancer-Related Health Impacts in the United States.

    Directory of Open Access Journals (Sweden)

    Ying Zhou

    Full Text Available Public health protection from air pollution can be achieved more effectively by shifting from a single-pollutant approach to a multi-pollutant approach. To develop such multi-pollutant approaches, identifying which air pollutants are present most frequently is essential. This study aims to determine the frequently found carcinogenic air toxics or hazardous air pollutants (HAPs combinations across the United States as well as to analyze the health impacts of developing cancer due to exposure to these HAPs. To identify the most commonly found carcinogenic air toxics combinations, we first identified HAPs with cancer risk greater than one in a million in more than 5% of the census tracts across the United States, based on the National-Scale Air Toxics Assessment (NATA by the U.S. EPA for year 2005. We then calculated the frequencies of their two-component (binary, and three-component (ternary combinations. To quantify the cancer-related health impacts, we focused on the 10 most frequently found HAPs with national average cancer risk greater than one in a million. Their cancer-related health impacts were calculated by converting lifetime cancer risk reported in NATA 2005 to years of healthy life lost or Disability-Adjusted Life Years (DALYs. We found that the most frequently found air toxics with cancer risk greater than one in a million are formaldehyde, carbon tetrachloride, acetaldehyde, and benzene. The most frequently occurring binary pairs and ternary mixtures are the various combinations of these four air toxics. Analysis of urban and rural HAPs did not reveal significant differences in the top combinations of these chemicals. The cumulative annual cancer-related health impacts of inhaling the top 10 carcinogenic air toxics included was about 1,600 DALYs in the United States or 0.6 DALYs per 100,000 people. Formaldehyde and benzene together contribute nearly 60 percent of the total cancer-related health impacts. Our study shows that although

  8. Carcinogenic Air Toxics Exposure and Their Cancer-Related Health Impacts in the United States. (United States)

    Zhou, Ying; Li, Chaoyang; Huijbregts, Mark A J; Mumtaz, M Moiz


    Public health protection from air pollution can be achieved more effectively by shifting from a single-pollutant approach to a multi-pollutant approach. To develop such multi-pollutant approaches, identifying which air pollutants are present most frequently is essential. This study aims to determine the frequently found carcinogenic air toxics or hazardous air pollutants (HAPs) combinations across the United States as well as to analyze the health impacts of developing cancer due to exposure to these HAPs. To identify the most commonly found carcinogenic air toxics combinations, we first identified HAPs with cancer risk greater than one in a million in more than 5% of the census tracts across the United States, based on the National-Scale Air Toxics Assessment (NATA) by the U.S. EPA for year 2005. We then calculated the frequencies of their two-component (binary), and three-component (ternary) combinations. To quantify the cancer-related health impacts, we focused on the 10 most frequently found HAPs with national average cancer risk greater than one in a million. Their cancer-related health impacts were calculated by converting lifetime cancer risk reported in NATA 2005 to years of healthy life lost or Disability-Adjusted Life Years (DALYs). We found that the most frequently found air toxics with cancer risk greater than one in a million are formaldehyde, carbon tetrachloride, acetaldehyde, and benzene. The most frequently occurring binary pairs and ternary mixtures are the various combinations of these four air toxics. Analysis of urban and rural HAPs did not reveal significant differences in the top combinations of these chemicals. The cumulative annual cancer-related health impacts of inhaling the top 10 carcinogenic air toxics included was about 1,600 DALYs in the United States or 0.6 DALYs per 100,000 people. Formaldehyde and benzene together contribute nearly 60 percent of the total cancer-related health impacts. Our study shows that although there are many

  9. Latent Classes of Symptoms related to Clinically Depressed Mood in Adolescents. (United States)

    Blom, Eva Henje; Forsman, Mats; Yang, Tony T; Serlachius, Eva; Larsson, Jan-Olov


    The diagnosis of major depressive disorder (MDD), according to the Diagnostic and Statistical Manual of Mental Disorders , is based only on adult symptomatology of depression and not adapted for age and gender. This may contribute to the low diagnostic specificity and validity of adolescent MDD. In this study, we investigated whether latent classes based on symptoms associated with depressed mood could be identified in a sample of adolescents seeking psychiatric care, regardless of traditionally defined diagnostic categories. Self-reports of the Strengths and Difficulties Questionnaire and the Development and Well-Being Assessment were collected consecutively from all new patients between the ages of 13 and 17 years at two psychiatric outpatient clinics in Stockholm, Sweden. Those who reported depressed mood at intake yielded a sample of 21 boys and 156 girls. Latent class analyses were performed for all screening items and for the depression-specific items of the Development and Well-Being Assessment. The symptoms that were reported in association with depressed mood differentiated the adolescents into two classes. One class had moderate emotional severity scores on the Strengths and Difficulties Questionnaire and mainly symptoms that were congruent with the Diagnostic and Statistical Manual of Mental Disorders criteria for MDD. The other class had higher emotional severity scores and similar symptoms to those reported in the first class. However, in addition, this group demonstrated more diverse symptomatology, including vegetative symptoms, suicidal ideation, anxiety, conduct problems, body dysmorphic symptoms, and deliberate vomiting. The classes predicted functional impairment in that the members of the second class showed more functional impairment. The relatively small sample size limited the generalizability of the results of this study, and the amount of items included in the analysis was restricted by the rules of latent class analysis. No conclusions