Treatment Options by Stage (Pancreatic Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Esophageal Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Vulvar Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Penile Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Non-Hodgkin Lymphoma

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... lymphoma may come back as indolent lymphoma. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Prostate Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Adrenocortical Carcinoma)

Science.gov (United States)

... affect the prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Childhood Hodgkin Lymphoma

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... the lungs , liver , bones, or bone marrow . Treatment Option Overview Key Points There are different types of ...

Treatment Options for Adult Hodgkin Lymphoma

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Small Intestine Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Hodgkin Lymphoma)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Merkel Cell Carcinoma)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... common for Merkel cell carcinoma to recur. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Childhood Hodgkin Lymphoma)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... the lungs , liver , bones, or bone marrow . Treatment Option Overview Key Points There are different types of ...

Treatment Options for AIDS-Related Lymphoma

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... nervous system is not primary CNS lymphoma. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Renal Cell Cancer

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Gastric Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... such as the liver or lymph nodes . Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Thyroid Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Chronic Myelogenous Leukemia

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... of blast cells increases after a remission . Treatment Option Overview Key Points There are different types of ...

Treatment Options for Actinic Keratosis

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends mostly on ... helped by lip balm or petroleum jelly . Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Vaginal Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Anal Cancer)

Science.gov (United States)

... affect the prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Chronic Lymphocytic Leukemia)

Science.gov (United States)

... examination under a microscope. Certain factors affect treatment options and prognosis (chance of recovery). Treatment options depend ... that does not get better with treatment. Treatment Option Overview Key Points There are different types of ...

Traditional preventive treatment options

DEFF Research Database (Denmark)

Longbottom, C; Ekstrand, K; Zero, D

2009-01-01

Preventive treatment options can be divided into primary, secondary and tertiary prevention techniques, which can involve patient- or professionally applied methods. These include: oral hygiene (instruction), pit and fissure sealants ('temporary' or 'permanent'), fluoride applications (patient...... options....

Treatment Options for Adult Soft Tissue Sarcoma

Science.gov (United States)

... reacts to the light. Certain factors affect treatment options and prognosis (chance of recovery). The treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Merkel Cell Carcinoma)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... common for Merkel cell carcinoma to recur. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Hodgkin Lymphoma during Pregnancy

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Soft Tissue Sarcoma)

Science.gov (United States)

... reacts to the light. Certain factors affect treatment options and prognosis (chance of recovery). The treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Non-Hodgkin Lymphoma)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... lymphoma may come back as indolent lymphoma. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Small Cell Lung Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Acute Lymphoblastic Leukemia)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... marrow , or other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Adult Acute Lymphoblastic Leukemia

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... marrow , or other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Adult Acute Myeloid Leukemia

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... back in the blood or bone marrow . Treatment Option Overview Key Points There are different types of ...

Novel preventive treatment options

DEFF Research Database (Denmark)

Longbottom, C; Ekstrand, K; Zero, D

2009-01-01

A number of novel preventive treatment options which, as with traditional methods, can be differentiated into 3 categories of prevention (primary, secondary and tertiary), have been and are being currently investigated. Those reviewed are either commercially available or appear relatively close...... of these techniques show considerable promise and dentists should be aware of these developments and follow their progress, the evidence for each of these novel preventive treatment options is currently insufficient to make widespread recommendations. Changes in dental practice should be explored to see how oral...

Treatment Options by Stage (Vaginal Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Chronic Myeloproliferative Neoplasms

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options for primary myelofibrosis. Prognosis (chance of recovery ) depends ... factors affect prognosis (chance of recovery) and treatment options for essential thrombocythemia. Prognosis (chance of recovery ) and ...

Treatment Options for Nonmelanoma Skin Cancer

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends mostly on ... helped by lip balm or petroleum jelly . Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Chronic Myeloproliferative Neoplasms)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options for primary myelofibrosis. Prognosis (chance of recovery ) depends ... factors affect prognosis (chance of recovery) and treatment options for essential thrombocythemia. Prognosis (chance of recovery ) and ...

Novel treatment options for portal hypertension

Science.gov (United States)

Laleman, Wim

2017-01-01

Abstract Portal hypertension is most frequently associated with cirrhosis and is a major driver for associated complications, such as variceal bleeding, ascites or hepatic encephalopathy. As such, clinically significant portal hypertension forms the prelude to decompensation and impacts significantly on the prognosis of patients with liver cirrhosis. At present, non-selective β-blockers, vasopressin analogues and somatostatin analogues are the mainstay of treatment but these strategies are far from satisfactory and only target splanchnic hyperemia. In contrast, safe and reliable strategies to reduce the increased intrahepatic resistance in cirrhotic patients still represent a pending issue. In recent years, several preclinical and clinical trials have focused on this latter component and other therapeutic avenues. In this review, we highlight novel data in this context and address potentially interesting therapeutic options for the future. PMID:28533907

Treatment Option Overview (Kaposi Sarcoma)

Science.gov (United States)

... Treatment Childhood Vascular Tumors Treatment Research Kaposi Sarcoma Treatment (PDQ®)–Patient Version General Information About Kaposi Sarcoma ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

Treatment Options by Stage (Small Cell Lung Cancer)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Childhood Acute Lymphoblastic Leukemia)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on: How ... cancer that does not respond to treatment. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Ewing Sarcoma)

Science.gov (United States)

... Ewing Sarcoma Treatment Osteosarcoma Treatment Research Ewing Sarcoma Treatment (PDQ®)–Patient Version General Information About Ewing Sarcoma ... started or in another part of the body. Treatment Option Overview Key Points There are different types ...

Treatment Option Overview (Ovarian Germ Cell Tumors)

Science.gov (United States)

... Germ Cell Tumors Treatment (PDQ®)–Patient Version Treatment Option Overview Go to Health Professional Version Key Points ... and restore) the body’s blood cells. New treatment options Combination chemotherapy (the use of more than one ...

Treatment options for Primary CNS Lymphoma.

Science.gov (United States)

Laghari, Altaf Ali; Ahmed, Syed Ijlal; Jabbar, Adnan; Shamim, Muhammad Shahzad

2018-03-01

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Treatment Option Overview (Mycosis Fungoides and the Sezary Syndrome)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options By Stage (Ovarian Germ Cell Tumors)

Science.gov (United States)

... Germ Cell Tumors Treatment (PDQ®)–Patient Version Treatment Option Overview Go to Health Professional Version Key Points ... and restore) the body’s blood cells. New treatment options Combination chemotherapy (the use of more than one ...

Treatment Option Overview (Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... the cancer does not respond to treatment. Treatment Option Overview Key Points There are different types of ...

Comparative availability and reliability assessment of design options for the secondary sodium loops of the EFR

International Nuclear Information System (INIS)

Pamme, H.

1989-01-01

The EFR (European Fast Reactor) project has entered a conceptual study period where different design alternatives are compared concerning feasibility, safety and economic aspects. This paper describes a comparative probabilistic availability and reliability assessment of alternative design options for the secondary sodium loops. These loops will provide heat transfer from the reactor pool to the water-steam (power generating) side. So a high operational availability of the secondary loops during plant lifetime is essential for economic power generation. Additionally a high reliability is required to fulfill the operational decay heat removal function in case of a reactor trip. Availabilities and reliabilities of the different options were assessed using failure mode and effect analysis and the fault tree method. (orig.)

Treatment Option Overview (Wilms Tumor and Other Childhood Kidney Tumors)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... come back) after it has been treated. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Plasma Cell Neoplasms Including Multiple Myeloma)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... going up even though treatment is given. Treatment Option Overview Key Points There are different types of ...

Distribution planning with reliability options for distributed generation

International Nuclear Information System (INIS)

Trebolle, David; Gomez, Tomas; Cossent, Rafael; Frias, Pablo

2010-01-01

The promotion of electricity generation from renewable energy sources (RES) and combined heat and power (CHP) has resulted in increasing penetration levels of distributed generation (DG). However, large-scale connection of DG involves profound changes in the operation and planning of electricity distribution networks. Distribution System Operators (DSOs) play a key role since these agents have to provide flexibility to their networks in order to integrate DG. Article 14.7 of EU Electricity Directive states that DSOs should consider DG as an alternative to new network investments. This is a challenging task, particularly under the current regulatory framework where DSOs must be legally and functionally unbundled from other activities in the electricity sector. This paper proposes a market mechanism, referred to as reliability options for distributed generation (RODG), which provides DSOs with an alternative to the investment in new distribution facilities. The mechanism proposed allocates the firm capacity required to DG embedded in the distribution network through a competitive auction. Additionally, RODG make DG partly responsible for reliability and provide DG with incentives for a more efficient operation taking into account the network conditions. (author)

Distribution planning with reliability options for distributed generation

Energy Technology Data Exchange (ETDEWEB)

Trebolle, David [Union Fenosa Distribucion, C/Antonio Lopez, 19, 28026 Madrid (Spain); Gomez, Tomas; Cossent, Rafael; Frias, Pablo [Instituto de Investigacion Tecnologica, Escuela Tecnica Superior de Ingenieria, Universidad Pontificia Comillas, C/Quintana 21, 28008 Madrid (Spain)

2010-02-15

The promotion of electricity generation from renewable energy sources (RES) and combined heat and power (CHP) has resulted in increasing penetration levels of distributed generation (DG). However, large-scale connection of DG involves profound changes in the operation and planning of electricity distribution networks. Distribution System Operators (DSOs) play a key role since these agents have to provide flexibility to their networks in order to integrate DG. Article 14.7 of EU Electricity Directive states that DSOs should consider DG as an alternative to new network investments. This is a challenging task, particularly under the current regulatory framework where DSOs must be legally and functionally unbundled from other activities in the electricity sector. This paper proposes a market mechanism, referred to as reliability options for distributed generation (RODG), which provides DSOs with an alternative to the investment in new distribution facilities. The mechanism proposed allocates the firm capacity required to DG embedded in the distribution network through a competitive auction. Additionally, RODG make DG partly responsible for reliability and provide DG with incentives for a more efficient operation taking into account the network conditions. (author)

Fibromyalgia Pathogenesis and Treatment Options Update.

Science.gov (United States)

Chinn, Steven; Caldwell, William; Gritsenko, Karina

2016-04-01

This review article presents and summarizes up-to-date literature on the clinical manifestations, diagnosis, pathophysiological mechanisms, and treatment options for fibromyalgia patients. First, the most recent diagnostic criteria for fibromyalgia, as put forth by the American College of Rheumatology will be summarized. Clinical features, including chronic widespread pain, hyperalgesia, mood disorders, anxiety, and disturbed sleep patterns will be explored in-depth. The pathogenesis and pathophysiology of fibromyalgia involves alterations in multiple ascending and descending central nervous system pathways, as well as peripheral pathways, leading to heightened pain sensitivity. Risk factors have been studied extensively, and the most recent research focuses on various genetic influences and the contributions of stress and poor sleep. Lastly, the discussion in this article focuses on treatment options for fibromyalgia; some have been mainstay options for many years. Pharmacological agents include tricyclic antidepressants, anti-epileptic drugs, selective serotonin reuptake inhibitors, norepinephrine/serotonin reuptake inhibitors, as well as some investigational agents. The evidence behind non-pharmacologic treatments, including massage therapy, exercise, and acupuncture, are discussed.

Current options for the treatment of pathological scarring.

Science.gov (United States)

Poetschke, Julian; Gauglitz, Gerd G

2016-05-01

Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Microwave treatment of BPH: still an option?

NARCIS (Netherlands)

de la Rosette, J. J.

1994-01-01

Surgery, the gold standard in the treatment of benign prostatic hyperplasia (BPH), is presently performed in the majority of patients who receive treatment. An increasing number of alternative options recently became available for treatment of BPH and especially minimal invasive treatment

Alternative Cancer Treatments: 10 Options to Consider

Science.gov (United States)

Alternative cancer treatments: 10 options to consider Alternative cancer treatments can't cure your cancer, but they may provide some ... that may help them, including complementary and alternative cancer treatments. If cancer makes you feel as if you ...

Review of Saccharomyces boulardii as a treatment option in IBD

DEFF Research Database (Denmark)

Sivananthan, Kavitha; Petersen, Andreas Munk

2018-01-01

CONTEXT: Review of the yeast Saccharomyces boulardii as a treatment option for the inflammatory bowel diseases (IBD) ulcerative colitis and Crohn's disease. OBJECTIVE: IBD is caused by an inappropriate immune response to gut microbiota. Treatment options could therefore be prebiotics, probiotics......, antibiotics and/or fecal transplant. In this review, we have looked at the evidence for the yeast S. boulardii as a treatment option. MATERIAL AND METHODS: Searches in PubMed and the Cochrane Library with the MeSH words 'Saccharomyces boulardii AND IBD', 'Saccharomyces boulardii AND Inflammatory Bowel Disease....... Saccharomyces boulardii is, however, a plausible treatment option in the future, but more placebo-controlled clinical studies on both patients with ulcerative colitis and Crohn's disease are needed....

Achalasia: Treatment Options Revisited

Directory of Open Access Journals (Sweden)

Willemijntje A Hoogerwerf

2000-01-01

Full Text Available The aim of all current forms of treatment of achalasia is to enable the patient to eat without disabling symptoms such as dysphagia, regurgitation, coughing or choking. Historically, this has been accomplished by mechanical disruption of the lower esophageal sphincter fibres, either by means of pneumatic dilation (PD or by open surgical myotomy. The addition of laparoscopic myotomy and botulinum toxin (BTX injection to the therapeutic armamentarium has triggered a recent series of reviews to determine the optimal therapeutic approach. Both PD and BTX have excellent short term (less than three months efficacy in the majority of patients. New data have been published that suggest that PD and BTX (with repeat injections can potentially obtain long term efficacy. PD is still considered the first-line treatment by most physicians; its main disadvantage is risk of perforation. BTX injection is evolving as an excellent, safe option for patients who are considered high risk for more invasive procedures. Laparoscopic myotomy with combined antireflux surgery is an increasingly attractive option in younger patients with achalasia, but long term follow-up studies are required to establish its efficacy and the potential for reflux-related sequelae.

Treatment options for hepatocellular carcinoma.

Science.gov (United States)

Sandhu, Dalbir S; Tharayil, Vivek S; Lai, Jin-Ping; Roberts, Lewis R

2008-02-01

Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages and has a high mortality rate. With improved survival of patients with cirrhotic liver disease and increased prevalence of chronic hepatitis C viral infections, a rise in the number of HCC cases is being reported worldwide. Early diagnosis and treatment can significantly improve the prognosis of patients with HCC. Although surgical resection is an important potentially curative therapy for liver tumors, in appropriately selected patients, liver transplantation has been shown to achieve excellent survival rates for a solid tumor. Locally ablative and locoregional therapies in the form of percutaneous ethanol injection, radiofrequency ablation, transcatheter arterial chemoembolization and transcatheter arterial radioembolization (TheraSphere) are viable options in patients with unresectable HCC. Unfortunately, the role of systemic therapy has been very limited in the treatment of these patients. Novel treatment options based on an improved understanding of the molecular pathogenesis of HCC are being explored. These targeted molecular therapies are aimed at growth factors and their receptors, intracellular signal transduction and cell cycle control. A substantial improvement in outcomes of intermediate and advanced stage HCC is expected with the advent of these targeted therapies, used in combination with surgical or locoregional therapies. Recent positive results from a large Phase III study of the receptor tyrosine kinase inhibitor, sorafenib, hold great promise in the treatment of HCC.

Patient knowledge on stroke risk factors, symptoms and treatment options.

Science.gov (United States)

Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente; Rønning, Ole Morten

2018-01-01

Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: "Do you believe that stroke is a serious disorder?" and "Do you believe that time is of importance for stroke treatment?". In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger ( p options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

Treatment Option Overview (AIDS Related-Lymphoma)

Science.gov (United States)

... and treatment options. AIDS-related lymphoma is a disease in which malignant (cancer) cells form in the ... cord. The sample may also be checked for Epstein-Barr virus . This procedure is also called an LP ...

Novel treatment options in depression and psychosis

Directory of Open Access Journals (Sweden)

Ceskova E

2018-03-01

Full Text Available Eva Ceskova, Petr Silhan Department of Psychiatry, University Hospital Ostrava, Ostrava, Czech Republic Abstract: In spite of tremendous development in central nervous system research, current treatment is suboptimal, especially in severe mental disorders. In medicine, there are two main methods of improving the health care provided: seeking new treatment procedures and perfecting (optimizing the existing ones. Optimization of treatment includes not only practical tools such as therapeutic drug monitoring but also implementation of general trends in the clinical practice. New pharmacological options include new more sophisticated forms of monoaminergic drugs, old drugs rediscovered on the base of a better understanding of pathophysiology of mental illnesses, and drugs aimed at new treatment targets. In depression, treatment resistance to antidepressive pharmacotherapy represents one of the most important clinical challenges. Switching to monotherapy with new multimodal/multifunctional antidepressants and augmentation with new atypical antipsychotics (aripiprazole and brexpiprazole may be promising options. Further, current evidence supports utility and safety of adjunctive treatment of nutraceuticals. Novel approaches being studied include ketamine and opioids. Recent advances in technology and emerging knowledge about dysfunctional brain circuits and neuroplasticity have led to the development of different new neuromodulation techniques usually used as add-on therapy. Antipsychotics are still the cornerstone of the current treatment of schizophrenia. Two new partial dopamine agonists, brexpiprazole and cariprazine, are now available in addition to aripiprazole. Although the mechanisms of action are similar, the two agents differ in terms of their pharmacodynamic profiles. Further, two new formulations of long-acting injections of second-generation antipsychotics (aripiprazole lauroxil and 3-month paliperidone palmitate were introduced into

Cyanobacterial Treatment Options: Permanganate and ...

Science.gov (United States)

This presentation will begin with a brief overview of drinking water treatment options for cyanobacteria and their toxins. The treatment discussion will focus on the impacts of permanganate addition to suspensions of toxin-producing Microcystis aeruginosa, followed by powdered activated carbon (PAC) addition. Results will be presented that show changes in toxin concentrations, chlorophyll-a concentrations and cell membrane integrity. The EPA Small Systems Webinar Presentations allow the dissemination of the latest Agency guidance and research to a large geographically dispersed audience while minimizing taxpayer expense

Treatment options for carcinoma in situ testis

DEFF Research Database (Denmark)

Mortensen, M S; Gundgaard, M.G.; Daugaard, G

2011-01-01

countries only offer this to high-risk patients. The treatment options range from orchidectomy and chemotherapy to radiotherapy and in rare cases surveillance. Results of the different treatment strategies are presented in this review. The optimal radiation dose is still not clarified. Most patients have...

Cachexia and pancreatic cancer: Are there treatment options?

Science.gov (United States)

Mueller, Tara C; Burmeister, Marc A; Bachmann, Jeannine; Martignoni, Marc E

2014-01-01

Cachexia is frequently described in patients with pancreatic ductal adenocarcinoma (PDAC) and is associated with reduced survival and quality of life. Unfortunately, the therapeutic options of this multi-factorial and complex syndrome are limited. This is due to the fact that, despite extensive preclinical and clinical research, the underlying pathological mechanisms leading to PDAC-associated cachexia are still not fully understood. Furthermore, there is still a lack of consensus on the definition of cachexia, which complicates the standardization of diagnosis and treatment as well as the analysis of the current literature. In order to provide an efficient therapy for cachexia, an early and reliable diagnosis and consistent monitoring is required, which can be challenging especially in obese patients. Although many substances have been tested in clinical and preclinical settings, so far none of them have been proven to have a long-term effect in ameliorating cancer-associated cachexia. However, recent studies have demonstrated that multidimensional therapeutic modalities are able to alleviate pancreatic cancer-associated cachexia and ultimately improve patients’ outcome. In this current review, we propose a stepwise and pragmatic approach to facilitate and standardize the treatment of cachexia in pancreatic cancer patients. This strategy consists of nutritional, dietary, pharmacological, physical and psychological methods. PMID:25071331

[Necessary and unnecessary treatment options for hemorrhoids].

Science.gov (United States)

Zindel, Joel; Inglin, Roman; Brügger, Lukas

2014-12-01

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

Treatment options in otitis media with effusion.

Science.gov (United States)

Upadhya, Ila; Datar, J

2014-01-01

Secretary Otitis media with effusion (OME) is the accumulation of mucus in the middle ear and sometimes in the mastoid air cell system. The main etiological factor is alteration in mucociliary system of middle ear secondary to ET malfunction which may be primary or secondary. OME is the cause of concern due to its occurance in paediatric age group, highest at 2 years of age, presenting as impairment of hearing leading to delayed speech and language development, poor academic performance and behavioral problems. In spite of this there are no confirmed guidelines of treatment to overcome. Many treatment options are available medical as well as surgical. Prospective study conducted to evaluate various treatment options revealed that auto inflation of ET is the main stay of treatment. If the ET malfunction is due to any reasons like adenoids, deviated nasal septum, hypertrophied turbinates or any other cause surgical intervention of the same gives 100% results. Medical management gives good results but recurrence is equally common.

[Treatment options for patellar tendinopathy].

Science.gov (United States)

Duthon, V B; Borloz, S; Ziltener, J-L

2012-07-25

Patellar tendinopathy is also called jumper's knee because of its high incidence in athletes with jumping or cutting activities as soccer, basketball, volleyball. Many different treatment methods have been described. However, no consensus exists regarding the optimal treatment for this condition. According to the literature, eccentric exercise-based physical therapy should be proposed first because of its strong scientific evidence. Shockwave therapy and injections may be useful but their real efficacy still has to be proven by randomized controlled study. For patients recalcitrant to more conservative options, operative management may be indicated.

Comparison between three option, four option and five option multiple choice question tests for quality parameters: A randomized study.

Science.gov (United States)

Vegada, Bhavisha; Shukla, Apexa; Khilnani, Ajeetkumar; Charan, Jaykaran; Desai, Chetna

2016-01-01

Most of the academic teachers use four or five options per item of multiple choice question (MCQ) test as formative and summative assessment. Optimal number of options in MCQ item is a matter of considerable debate among academic teachers of various educational fields. There is a scarcity of the published literature regarding the optimum number of option in each item of MCQ in the field of medical education. To compare three options, four options, and five options MCQs test for the quality parameters - reliability, validity, item analysis, distracter analysis, and time analysis. Participants were 3 rd semester M.B.B.S. students. Students were divided randomly into three groups. Each group was given one set of MCQ test out of three options, four options, and five option randomly. Following the marking of the multiple choice tests, the participants' option selections were analyzed and comparisons were conducted of the mean marks, mean time, validity, reliability and facility value, discrimination index, point biserial value, distracter analysis of three different option formats. Students score more ( P = 0.000) and took less time ( P = 0.009) for the completion of three options as compared to four options and five options groups. Facility value was more ( P = 0.004) in three options group as compared to four and five options groups. There was no significant difference between three groups for the validity, reliability, and item discrimination. Nonfunctioning distracters were more in the four and five options group as compared to three option group. Assessment based on three option MCQs is can be preferred over four option and five option MCQs.

Availability, reliability and logistic support studies of the RF power system design options for the IFMIF accelerator

Energy Technology Data Exchange (ETDEWEB)

Bargallo, E., E-mail: enric.bargallo-font@upc.edu [Fusion Energy Engineering Laboratory (FEEL), Technical University of Catalonia (UPC) Barcelona-Tech, Barcelona (Spain); Giralt, A.; Martinez, G. [Fusion Energy Engineering Laboratory (FEEL), Technical University of Catalonia (UPC) Barcelona-Tech, Barcelona (Spain); Weber, M.; Regidor, D.; Arroyo, J.M. [Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid (Spain); Abal, J.; Dies, J.; Tapia, C.; De Blas, A. [Fusion Energy Engineering Laboratory (FEEL), Technical University of Catalonia (UPC) Barcelona-Tech, Barcelona (Spain); Mendez, P.; Ibarra, A.; Molla, J. [Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid (Spain)

2013-10-15

Highlights: ► Current RF system design based on tetrodes chains is evaluated. ► Alternative solid state power amplifiers RF system design is analyzed. ► Both designs are compared in terms of availability, logistics and cost. ► It is concluded that solid state option presents relevant improvements. -- Abstract: The current design of the radio frequency (RF) power system for the International Fusion Materials Irradiation Facility (IFMIF) is based upon tetrodes technology. Due to the improvement in the solid state amplifiers technology, the possibility of using this option for IFMIF RF system is becoming a very competitive alternative presenting from the beginning several advantages in terms of availability, reliability and logistics. The current design based on RF tetrodes chains leads no room for substantial improvements in terms of availability being the requirement for the RF system hard to achieve. The principal goals of this paper are to use RAMI (Reliability, Availability, Maintainability and Inspectionability) analysis in the solid state amplifier design, and to compare the availability, reliability and logistic performances for both alternatives.

Availability, reliability and logistic support studies of the RF power system design options for the IFMIF accelerator

International Nuclear Information System (INIS)

Bargallo, E.; Giralt, A.; Martinez, G.; Weber, M.; Regidor, D.; Arroyo, J.M.; Abal, J.; Dies, J.; Tapia, C.; De Blas, A.; Mendez, P.; Ibarra, A.; Molla, J.

2013-01-01

Highlights: ► Current RF system design based on tetrodes chains is evaluated. ► Alternative solid state power amplifiers RF system design is analyzed. ► Both designs are compared in terms of availability, logistics and cost. ► It is concluded that solid state option presents relevant improvements. -- Abstract: The current design of the radio frequency (RF) power system for the International Fusion Materials Irradiation Facility (IFMIF) is based upon tetrodes technology. Due to the improvement in the solid state amplifiers technology, the possibility of using this option for IFMIF RF system is becoming a very competitive alternative presenting from the beginning several advantages in terms of availability, reliability and logistics. The current design based on RF tetrodes chains leads no room for substantial improvements in terms of availability being the requirement for the RF system hard to achieve. The principal goals of this paper are to use RAMI (Reliability, Availability, Maintainability and Inspectionability) analysis in the solid state amplifier design, and to compare the availability, reliability and logistic performances for both alternatives

An update on adjunctive treatment options for bipolar disorder.

Science.gov (United States)

Dean, Olivia M; Gliddon, Emma; Van Rheenen, Tamsyn E; Giorlando, Francesco; Davidson, Sandra K; Kaur, Manreena; Ngo, Trung T; Williams, Lana J

2018-03-01

Bipolar disorder is a complex illness often requiring combinations of therapies to successfully treat symptoms. In recent years, there have been significant advancements in a number of therapies for bipolar disorder. It is therefore timely to provide an overview of current adjunctive therapeutic options to help treating clinicians to inform their patients and work towards optimal outcomes. Publications were identified from PubMed searches on bipolar disorder and pharmacotherapy, nutraceuticals, hormone therapy, psychoeducation, interpersonal and social rhythm therapy, cognitive remediation, mindfulness, e-Health and brain stimulation techniques. Relevant articles in these areas were selected for further review. This paper provides a narrative review of adjunctive treatment options and is not a systematic review of the literature. A number of pharmacotherapeutic, psychological and neuromodulation treatment options are available. These have varying efficacy but all have shown benefit to people with bipolar disorder. Due to the complex nature of treating the disorder, combination treatments are often required. Adjunctive treatments to traditional pharmacological and psychological therapies are proving useful in closing the gap between initial symptom remission and full functional recovery. Given that response to monotherapy is often inadequate, combination regimens for bipolar disorder are typical. Correspondingly, psychiatric research is working towards a better understanding of the disorder's underlying biology. Therefore, treatment options are changing and adjunctive therapies are being increasingly recognized as providing significant tools to improve patient outcomes. Towards this end, this paper provides an overview of novel treatments that may improve clinical outcomes for people with bipolar disorder. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Emerging treatment options for meibomian gland dysfunction

Directory of Open Access Journals (Sweden)

Qiao J

2013-09-01

Full Text Available Jing Qiao, Xiaoming YanDepartment of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, People's Republic of ChinaAbstract: Meibomian gland dysfunction (MGD is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A.Keywords: meibomian gland dysfunction, dry eye, emerging treatment

Cyanobacterial Treatment Options: Permanganate and Powdered Activated Carbon

Science.gov (United States)

This presentation will begin with a brief overview of drinking water treatment options for cyanobacteria and their toxins. The treatment discussion will focus on the impacts of permanganate addition to suspensions of toxin-producing Microcystis aeruginosa, followed by powdered ac...

The option value of innovative treatments in the context of chronic myeloid leukemia.

Science.gov (United States)

Sanchez, Yuri; Penrod, John R; Qiu, Xiaoli Lily; Romley, John; Thornton Snider, Julia; Philipson, Tomas

2012-11-01

To quantify in the context of chronic myeloid leukemia (CML) the additional value patients receive when innovative treatments enable them to survive until the advent of even more effective future treatments (ie, the "option value"). Observational study using data from the Surveillance, Epidemiology and End Results (SEER) cancer registry comprising all US patients with CML diagnosed between 2000 and 2008 (N = 9,760). We quantified the option value of recent breakthroughs in CML treatment by first conducting retrospective survival analyses on SEER data to assess the effectiveness of TKI treatments, and then forecasting survival from CML and other causes to measure expected future medical progress. We then developed an analytical framework to calculate option value of innovative CML therapies, and used an economic model to value these gains. We calculated the option value created both by future innovations in CML treatment and by medical progress in reducing background mortality. For a recently diagnosed CML patient, the option value of innovative therapies from future medical innovation amounts to 0.76 life-years. This option value is worth $63,000, equivalent to 9% of the average survival gains from existing treatments. Future innovations in CML treatment jointly account for 96% of this benefit. The option value of innovative treatments has significance in the context of CML and, more broadly, in disease areas with rapid innovation. Incorporating option value into traditional valuations of medical innovations is both a feasible and a necessary practice in health technology assessment.

Tooth wear : a systematic review of treatment options

NARCIS (Netherlands)

Muts, Erik-Jan; van Pelt, Hans; Edelhoff, Daniel; Krejci, Ivo; Cune, Marco

2014-01-01

STATEMENT OF PROBLEM: Treatment of tooth wear is increasing. Because no evidence-based guidelines are available, the clinician may have difficulties deciding which treatment option to choose to resolve complex situations. PURPOSE: The purpose of this systematic review was to identify similarities

Stereotactic Neurosurgical Treatment Options for Childhood Craniopharyngioma

Directory of Open Access Journals (Sweden)

Michael eTrippel

2012-05-01

Full Text Available Craniopharyngioma are the most common non glial tumors in childhood. The results of different studies indicate that radical excision surgery is not an appropriate treatment strategy for childhood craniopharyngioma with hypothalamic involvement. Stereotactic neurosurgery provides save, minimal invasive and cost efficient options in the treatment of childhood craniopharyngioma. In this review a summary of the contribution of the stereotactic neurosurgery in the interdisciplinary treatment regime of childhood craniopharyngioma will be given and discussed in detail.

Lack of tolerable treatment options for patients with schizophrenia

Directory of Open Access Journals (Sweden)

Citrome L

2015-12-01

Full Text Available Leslie Citrome,1 Anna Eramo,2 Clement Francois,2 Ruth Duffy,3 Susan N Legacy,3 Steve J Offord,3 Holly B Krasa,3 Stephen S Johnston,4 Alice Guiraud-Diawara,5 Siddhesh A Kamat,3 Patricia Rohman3 1Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, 2Lundbeck, Deerfield, IL, 3Otsuka America Pharmaceuticals, Princeton, NJ, 4Truven Health Analytics, Bethesda, MD, USA; 5Lundbeck SAS, Issy-les-Moulineaux, France Purpose: Atypical antipsychotics (AAs, an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. Patients and methods: AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. Results: A high proportion of patients (>80% were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60% and obesity (>40%. From the nine treatment

Treatment options for patellofemoral instability in sports traumatology

Directory of Open Access Journals (Sweden)

Philippe M. Tscholl

2013-09-01

Full Text Available Patellofemoral instability not only involves lateral patellar dislocation, patellar mal-tracking or subluxation but can also cause a limiting disability for sports activities. Its underlying causes are known as morphological anomalies of the patellofemoral joint or the mechanical axis, femorotibial malrotation, variants of the knee extensor apparatus, and ligamentous insufficiencies often accompanied by poor proprioception. Athletes with such predisposing factors are either suffering from unspecific anterior knee pain or from slightly traumatic or recurrent lateral patellar dislocation Treatment options of patellar instability are vast, and need to be tailored individually depending on the athlete’s history, age, complaints and physical demands. Different conservative and surgical treatment options are reviewed and discussed, especially limited expectations after surgery.

Nonsurgical Treatment Options for Basal Cell Carcinoma

International Nuclear Information System (INIS)

Lien, M. H.; Sondak, V. K.; Sondak, V. K.

2011-01-01

Basal cell carcinoma (BCC) remains the most common form of non melanoma skin cancer (NMSC) in Caucasians, with perhaps as many as 2 million new cases expected to occur in the United States in 2010. Many treatment options, including surgical interventions and nonsurgical alternatives, have been utilized to treat BCC. In this paper, two non-surgical options, imiquimod therapy and photodynamic therapy (PDT), will be discussed. Both modalities have demonstrated acceptable disease control rates, cosmetically superior outcomes, and short-term cost-effectiveness. Further studies evaluating long-term cure rates and long-term cost effectiveness of imiquimod therapy and PDT are needed.

Review of Saccharomyces boulardii as a treatment option in IBD.

Science.gov (United States)

Sivananthan, Kavitha; Petersen, Andreas Munk

2018-05-17

Review of the yeast Saccharomyces boulardii as a treatment option for the inflammatory bowel diseases (IBD) ulcerative colitis and Crohn's disease. IBD is caused by an inappropriate immune response to gut microbiota. Treatment options could therefore be prebiotics, probiotics, antibiotics and/or fecal transplant. In this review, we have looked at the evidence for the yeast S. boulardii as a treatment option. Searches in PubMed and the Cochrane Library with the MeSH words 'Saccharomyces boulardii AND IBD', 'Saccharomyces boulardii AND Inflammatory Bowel Disease', 'Saccharomyces boulardii AND ulcerative colitis' and 'Saccharomyces boulardii AND Crohn's disease' gave total a total of 80 articles. After exclusions because of irrelevance, articles in other languages and some articles that were not available, 16 articles were included in this review. Three of the clinical trials showed a positive effect of S. boulardii in IBD patients (two Crohn's disease, one ulcerative colitis), while there was one trial that didn't prove any effect (Crohn's disease). Included Animal trials and cell assays describes different anti-inflammatory mechanisms of S. boulardii supporting a possible effect when treating IBD patients. The number of studies of S. boulardii as treatment for IBD is limited. Furthermore, the existing trials have small populations and short duration. We do not have enough evidence to prove the effect of S. boulardii in IBD. Saccharomyces boulardii is, however, a plausible treatment option in the future, but more placebo-controlled clinical studies on both patients with ulcerative colitis and Crohn's disease are needed.

Acute intermittent porphyria: Diagnostic dilemma and treatment options

Directory of Open Access Journals (Sweden)

Mohan Deep Kaur

2015-01-01

Full Text Available Acute intermittent porphyria (AIP presents with diverse group of symptoms making its early diagnosis difficult. Delaying diagnosis and treatment of AIP can be fatal or can cause long term or permanent neurological damage. We present here a case report of AIP where the diagnosis was missed. The diversity of symptoms and details concerning the treatment options for AIP are discussed.

Acute intermittent porphyria: Diagnostic dilemma and treatment options

Science.gov (United States)

Kaur, Mohan Deep; Hazarika, Nita; Saraswat, Namita; Sood, Rajesh

2015-01-01

Acute intermittent porphyria (AIP) presents with diverse group of symptoms making its early diagnosis difficult. Delaying diagnosis and treatment of AIP can be fatal or can cause long term or permanent neurological damage. We present here a case report of AIP where the diagnosis was missed. The diversity of symptoms and details concerning the treatment options for AIP are discussed. PMID:26330726

A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient?

Science.gov (United States)

Hatzimouratidis, Konstantinos; Hatzichristou, Dimitrios G

2005-01-01

The field of erectile dysfunction (ED) has been revolutionised over the last two decades. Several treatment options are available today, most of which are associated with high efficacy rates and favourable safety profiles. A MEDLINE search was undertaken in order to evaluate all currently available data on treatment modalities for ED. Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil) are currently the first-choice of most physicians and patients for the treatment of ED. PDE5 inhibitors have differences in their pharmacological profiles, the most obvious being the long duration of action of tadalafil, but there are no data supporting superiority for any one of them in terms of efficacy or safety. Sublingual apomorphine has limited efficacy compared with the PDE5 inhibitors, and its use is limited to patients with mild ED. Treatment failures with oral drugs may be due to medication, clinician and patient issues. The physician needs to address all of these issues in order to identify true treatment failures. Patients who are truly unresponsive to oral drugs may be offered other treatment options.Intracavernous injections of alprostadil alone, or in combination with other vasoactive agents (papaverine and phentolamine), remain an excellent treatment option, with proven efficacy and safety over time. Topical pharmacotherapy is appealing in nature, but currently available formulations have limited efficacy. Vacuum constriction devices may be offered mainly to elderly patients with occasional intercourse attempts, as younger patients show limited preference because of the unnatural erection that is associated with this treatment modality. Penile prostheses are generally the last treatment option offered, because of invasiveness, cost and non-reversibility; however, they are associated with high satisfaction rates in properly selected patients. All treatment options are associated with particular strengths and weaknesses. A patient

Treatment Options for Narcolepsy.

Science.gov (United States)

Barateau, Lucie; Lopez, Régis; Dauvilliers, Yves

2016-05-01

Narcolepsy type 1 and narcolepsy type 2 are central disorders of hypersomnolence. Narcolepsy type 1 is characterized by excessive daytime sleepiness and cataplexy and is associated with hypocretin-1 deficiency. On the other hand, in narcolepsy type 2, cerebrospinal fluid hypocretin-1 levels are normal and cataplexy absent. Despite major advances in our understanding of narcolepsy mechanisms, its current management is only symptomatic. Treatment options may vary from a single drug that targets several symptoms, or multiple medications that each treats a specific symptom. In recent years, narcolepsy treatment has changed with the widespread use of modafinil/armodafinil for daytime sleepiness, antidepressants (selective serotonin and dual serotonin and noradrenalin reuptake inhibitors) for cataplexy, and sodium oxybate for both symptoms. Other psychostimulants can also be used, such as methylphenidate, pitolisant and rarely amphetamines, as third-line therapy. Importantly, clinically relevant subjective and objective measures of daytime sleepiness are required to monitor the treatment efficacy and to provide guidance on whether the treatment goals are met. Associated symptoms and comorbid conditions, such as hypnagogic/hypnopompic hallucinations, sleep paralysis, disturbed nighttime sleep, unpleasant dreams, REM- and non REM-related parasomnias, depressive symptoms, overweight/obesity, and obstructive sleep apnea, should also be taken into account and managed, if required. In the near future, the efficacy of new wake-promoting drugs, anticataplectic agents, hypocretin replacement therapy and immunotherapy at the early stages of the disease should also be evaluated.

Desmoid tumors: clinical features and treatment options: a case ...

African Journals Online (AJOL)

Desmoid tumors: clinical features and treatment options: a case report and a review of literature. Amel Achour Jenayah, Hajer Bettaieb, Sarra Saoudi, Anissa Gharsa, Ezzeddine Sfar, Fethia Boudaya, Dalenda Chelli ...

Engineered Option Treatment of Remediated Nitrate Salts: Surrogate Batch-Blending Testing

Energy Technology Data Exchange (ETDEWEB)

Anast, Kurt Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-03-11

This report provides results from batch-blending test work for remediated nitrate salt (RNS) treatment. Batch blending was identified as a preferred option for blending RNS and unremediated nitrate salt (UNS) material with zeolite to effectively safe the salt/Swheat material identified as ignitable (U.S. Environmental Protection Agency code D001). Blending with zeolite was the preferred remediation option identified in the Options Assessment Report and was originally proposed as the best option for remediation by Clark and Funk in their report, Chemical Reactivity and Recommended Remediation Strategy for Los Alamos Remediated Nitrate Salt (RNS) Wastes, and also found to be a preferred option in the Engineering Options Assessment Report: Nitrate Salt Waste Stream Processing. This test work evaluated equipment and recipe alternatives to achieve effective blending of surrogate waste with zeolite.

Current status in the treatment options for esophageal achalasia.

Science.gov (United States)

Chuah, Seng-Kee; Chiu, Chien-Hua; Tai, Wei-Chen; Lee, Jyong-Hong; Lu, Hung-I; Changchien, Chi-Sin; Tseng, Ping-Huei; Wu, Keng-Liang

2013-09-07

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an "on-demand" strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further.

Angina pectoris: current therapy and future treatment options.

Science.gov (United States)

Parikh, Raj; Kadowitz, Philip J

2014-02-01

Angina pectoris is the consequence of an inequality between the demand and supply of blood to the heart. Angina manifests itself as chest pain or discomfort and is a common complaint of patients in the hospital and in the clinic. There are, in fact, roughly half a million new cases of angina per year. Chest pain, while having many etiologies, is generally considered to be most lethal when related to a cardiac cause. In this review, the authors outline the current medical and surgical therapies that are used in the management of angina. Highlights of the various clinical trials that have assisted in the investigation of these therapies are summarized also. Then, the authors provide a focused review of the novel therapy options for angina that are currently being explored. From new medical treatments to revised surgical techniques to the discovery of stem cell therapy, many innovative options are being investigated for the treatment of angina.

Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species.

Science.gov (United States)

Sobel, J D; Sobel, R

2018-06-22

Clinicians are increasingly challenged by patients with refractory vulvovaginal candidiasis (VVC) caused by azole-resistant Candida species. Fluconazole resistant C.albicans is a growing and perplexing problem following years of indiscriminate drug prescription and unnecessary drug exposure and for which there are few therapeutic alternatives. Regrettably, although the azole class of drugs has expanded, new classes of antifungal drugs have not been forthcoming, limiting effective treatment options in patients with azole resistant Candida vaginitis. Areas covered: This review covers published data on epidemiology, pathophysiology and treatment options for women with azole-resistant refractory VVC. Expert opinion: Fluconazole resistant C.albicans adds to the challenge of azole resistant non-albicans Candida spp. Both issues follow years of indiscriminate drug prescription and unnecessary fluconazole exposure. Although an understanding of azole resistance in yeast has been established, this knowledge has not translated into useful therapeutic advantage. Treatment options for such women with refractory symptoms are extremely limited. New therapeutic options and strategies are urgently needed to meet this challenge of azole drug resistance.

New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review.

Science.gov (United States)

O'Brien, Anthony P; McNeil, Karen A; Fletcher, Richard; Conrad, Agatha; Wilson, Amanda J; Jones, Donovan; Chan, Sally W

2017-07-01

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

Current treatment options for meningioma.

Science.gov (United States)

Apra, Caroline; Peyre, Matthieu; Kalamarides, Michel

2018-03-01

With an annual incidence of 5/100,000, meningioma is the most frequent primary tumor of the central nervous system. Risk factors are radiotherapy and hormone intake. Most meningiomas are grade I benign tumors, but up to 15% are atypical and 2% anaplastic according to the WHO 2016 histological criteria. Areas covered: This review details the current standard therapy based on international guidelines and recent literature, and describes new approaches developed to treat refractory cases. First-line treatments are observation and surgery, but adjuvant radiotherapy/radiosurgery is discussed for atypical and indicated for anaplastic meningiomas. The most problematic cases include skull base meningiomas that enclose vasculo-nervous structures and surgery- and radiation-refractory tumors that present with significant morbidity and mortality. The treatment of recurrent tumors is based on radiotherapy and repeated surgery. Systematic therapies are not effective in general but several clinical trials are ongoing. Expert commentary: Molecular characterization of the tumors, based on genetic mutations such as NF2, SMO, TERT, TRAF7, and on the methylation profile are developing, completing the histological classification and giving new insights into prognosis and treatment options.

Neonatal hepatic haemangioendothelioma: treatment options and dilemmas

International Nuclear Information System (INIS)

Meijs, Bram B. van der; Merks, Johannes H.M.; Haan, Timo R. de; Tabbers, Merit M.; Rijn, Rick R. van

2009-01-01

We describe a case of rapidly progressive neonatal diffuse hepatic haemangioendotheliomas. The clinical picture was characterized by respiratory insufficiency due to gross abdominal enlargement, coagulopathy, and the development of cardiovascular insufficiency during the course of disease. Pharmacological, radiotherapeutic and endovascular treatment options all proved ineffective. We describe our own experience and the steps taken to treat this child. Unfortunately, the child died as a consequence of the disease. As cases like this are rare and are associated with severe morbidity and high mortality, more knowledge needs to be gained on infantile hepatic haemangioendotheliomas and their optimal treatment. The use of a web-based data registry could be beneficial. (orig.)

Reliability and safety of a new upper cervical spine injury treatment algorithm

Directory of Open Access Journals (Sweden)

Andrei Fernandes Joaquim

Full Text Available ABSTRACT In the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer using the Kappa index. Results The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle

NARCIS (Netherlands)

Witteveen, Angelique G. H.; Hofstad, Cheriel J.; Kerkhoffs, Gino M. M. J.

2015-01-01

Background The cause of ankle osteoarthritis (OA) is usually trauma. Patients are relatively young, since ankle trauma occurs at a relatively young age. Several conservative treatment options are available, evidence of the benefits and harms of these options are lacking. Objectives To assess the

Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options

OpenAIRE

Lamb, Ruth; Rohrer, Jonathan D.; Lees, Andrew J.; Morris, Huw R.

2016-01-01

Opinion statement There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specif...

Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options

OpenAIRE

Lamb, R.; Rohrer, J. D.; Lees, A. J.; Morris, H. R.

2016-01-01

There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specifically bradykinesi...

Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?

Science.gov (United States)

Oliveira, Matheus Fernandes de; Teixeira, Manoel Jacobsen; Reis, Rodolfo Casimiro; Petitto, Carlo Emanuel; Gomes Pinto, Fernando Campos

2016-08-01

Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

24-h Efficacy of Glaucoma Treatment Options.

Science.gov (United States)

Konstas, Anastasios G P; Quaranta, Luciano; Bozkurt, Banu; Katsanos, Andreas; Garcia-Feijoo, Julian; Rossetti, Luca; Shaarawy, Tarek; Pfeiffer, Norbert; Miglior, Stefano

2016-04-01

Current management of glaucoma entails the medical, laser, or surgical reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which is commensurate with either stability or delayed progression of visual loss. In the published literature, the hypothesis is often made that IOP control implies a single IOP measurement over time. Although the follow-up of glaucoma patients with single IOP measurements is quick and convenient, such measurements often do not adequately reflect the untreated IOP characteristics, or indeed the quality of treated IOP control during the 24-h cycle. Since glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous, it is logical that we should aim to understand the efficacy of all treatment options throughout the 24-h period. This article first reviews the concept and value of diurnal and 24-h IOP monitoring. It then critically evaluates selected available evidence on the 24-h efficacy of medical, laser and surgical therapy options. During the past decade several controlled trials have significantly enhanced our understanding on the 24-h efficacy of all glaucoma therapy options. Nevertheless, more long-term evidence is needed to better evaluate the 24-h efficacy of glaucoma therapy and the precise impact of IOP characteristics on glaucomatous progression and visual prognosis.

Current options for the treatment of facial angiofibromas.

Science.gov (United States)

Salido-Vallejo, R; Garnacho-Saucedo, G; Moreno-Giménez, J C

2014-01-01

Facial angiofibromas are hamartomatous growths that are closely associated with tuberous sclerosis complex and, in fact, they constitute one of the main diagnostic criteria for that disease. These lesions composed of blood vessels and fibrous tissue appear on the face at an early age. Since they have important physical and psychological repercussions for patients, several treatment options have been used to remove them or improve their appearance. However, the lack of treatment guidelines prevents us from developing a common protocol for patients with this condition. The present article aims to review the treatments for facial angiofibromas used to date and to propose a new evidence-based treatment protocol. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

Alternative pharmacological treatment options for agitation in Alzheimer’s disease

Directory of Open Access Journals (Sweden)

Francesco Panza

2015-11-01

Full Text Available In patients with dementia and Alzheimer’s disease (AD, treatment of neuropsychiatric symptoms (NPS is a major concern in the management of these devastating diseases. Among NPS in AD, agitation and aggression are common with earlier institutionalization, increased morbidity and mortality, and greater caregiver burden. Pharmacological treatments for AD-related agitation, specifically off-label use of atypical antipsychotics, showed only modest improvements, with increased side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred firstline option. However, when such treatments fail, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for agitation/aggression in AD and dementia. Unfortunately, progresses have been slow, with a small number of methodologically heterogeneous randomized controlled trials (RCTs, with disappointing results. However, evidence coming from recently completed RCTs on novel or repositioned drugs (mibampator, dextromethorphan/ quinidine, cannabinoids, and citalopram showed some promise in treating agitation in AD, but still with safety concerns. Further evidence will come from ongoing Phase II and III trials on promising novel drugs for treating these distressing symptoms in patients with AD and dementia.

Current Treatment Options for Auricular Hematomas.

Science.gov (United States)

MacPhail, Catriona

2016-07-01

Ear disease, such as otitis externa, resulting in aggressive head shaking or ear scratching, is the most common cause of the development of aural hematomas in dogs and cats. An underlying immunologic cause has also been proposed to explain cartilage and blood vessel fragility. Numerous options exist for management of aural hematomas, from medical management alone with corticosteroids, to simple hematoma centesis, to surgical intervention. Because this condition is usually secondary to another disease process, regardless of mode of treatment, likelihood of recurrence is low if the underlying condition is managed properly. Copyright © 2016 Elsevier Inc. All rights reserved.

Reliability models for Space Station power system

Science.gov (United States)

Singh, C.; Patton, A. D.; Kim, Y.; Wagner, H.

1987-01-01

This paper presents a methodology for the reliability evaluation of Space Station power system. The two options considered are the photovoltaic system and the solar dynamic system. Reliability models for both of these options are described along with the methodology for calculating the reliability indices.

Assessment of Options for the Treatment of Nitrate Salt Wastes at Los Alamos National Laboratory

International Nuclear Information System (INIS)

Robinson, Bruce Alan; Funk, David John; Stevens, Patrice Ann

2016-01-01

This paper summarizes the methodology used to evaluate options for treatment of the remediated nitrate salt waste containers at Los Alamos National Laboratory. The method selected must enable treatment of the waste drums, which consist of a mixture of complex nitrate salts (oxidizer) improperly mixed with sWheat Scoop®1, an organic kitty litter and absorbent (fuel), in a manner that renders the waste safe, meets the specifications of waste acceptance criteria, and is suitable for transport and final disposal in the Waste Isolation Pilot Plant located in Carlsbad, New Mexico. A Core Remediation Team was responsible for comprehensively reviewing the options, ensuring a robust, defensible treatment recommendation. The evaluation process consisted of two steps. First, a prescreening process was conducted to cull the list on the basis for a decision of feasibility of certain potential options with respect to the criteria. Then, the remaining potential options were evaluated and ranked against each of the criteria in a consistent methodology. Numerical scores were established by consensus of the review team. Finally, recommendations were developed based on current information and understanding of the scientific, technical, and regulatory situation. A discussion of the preferred options and documentation of the process used to reach the recommended treatment options are presented.

Assessment of Options for the Treatment of Nitrate Salt Wastes at Los Alamos National Laboratory

Energy Technology Data Exchange (ETDEWEB)

Robinson, Bruce Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Funk, David John [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Stevens, Patrice Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-03-17

This paper summarizes the methodology used to evaluate options for treatment of the remediated nitrate salt waste containers at Los Alamos National Laboratory. The method selected must enable treatment of the waste drums, which consist of a mixture of complex nitrate salts (oxidizer) improperly mixed with sWheat Scoop®1, an organic kitty litter and absorbent (fuel), in a manner that renders the waste safe, meets the specifications of waste acceptance criteria, and is suitable for transport and final disposal in the Waste Isolation Pilot Plant located in Carlsbad, New Mexico. A Core Remediation Team was responsible for comprehensively reviewing the options, ensuring a robust, defensible treatment recommendation. The evaluation process consisted of two steps. First, a prescreening process was conducted to cull the list on the basis for a decision of feasibility of certain potential options with respect to the criteria. Then, the remaining potential options were evaluated and ranked against each of the criteria in a consistent methodology. Numerical scores were established by consensus of the review team. Finally, recommendations were developed based on current information and understanding of the scientific, technical, and regulatory situation. A discussion of the preferred options and documentation of the process used to reach the recommended treatment options are presented.

Reliability analysis of common hazardous waste treatment processes

International Nuclear Information System (INIS)

Waters, R.D.

1993-05-01

Five hazardous waste treatment processes are analyzed probabilistically using Monte Carlo simulation to elucidate the relationships between process safety factors and reliability levels. The treatment processes evaluated are packed tower aeration, reverse osmosis, activated sludge, upflow anaerobic sludge blanket, and activated carbon adsorption

Reliability analysis of common hazardous waste treatment processes

Energy Technology Data Exchange (ETDEWEB)

Waters, Robert D. [Vanderbilt Univ., Nashville, TN (United States)

1993-05-01

Five hazardous waste treatment processes are analyzed probabilistically using Monte Carlo simulation to elucidate the relationships between process safety factors and reliability levels. The treatment processes evaluated are packed tower aeration, reverse osmosis, activated sludge, upflow anaerobic sludge blanket, and activated carbon adsorption.

For Some Breast Cancers, New Drug May Be Treatment Option

Science.gov (United States)

Results from an international clinical trial suggest that women with metastatic, HER2-positive breast cancer that is no longer responding to the targeted therapy trastuzumab (Herceptin) may soon have a new treatment option.

Analysis and assessment of water treatment plant reliability

Directory of Open Access Journals (Sweden)

Szpak Dawid

2017-03-01

Full Text Available The subject of the publication is the analysis and assessment of the reliability of the surface water treatment plant (WTP. In the study the one parameter method of reliability assessment was used. Based on the flow sheet derived from the water company the reliability scheme of the analysed WTP was prepared. On the basis of the daily WTP work report the availability index Kg for the individual elements included in the WTP, was determined. Then, based on the developed reliability scheme showing the interrelationships between elements, the availability index Kg for the whole WTP was determined. The obtained value of the availability index Kg was compared with the criteria values.

Municipal solid waste options : integrating organics management and residual disposal treatment : executive summary

Energy Technology Data Exchange (ETDEWEB)

Cant, M. (comp.) [Totten Sims Hubicki Associates Ltd., Calgary, AB (Canada); Van der Werf, P. [2cg Inc., Edmonton, AB (Canada); Kelleher, M. [Kelleher Environmental, Toronto, ON (Canada); Merriman, D. [MacViro Consultants, Markham, ON (Canada); Fitcher, K. [Gartner Lee Ltd., Toronto, ON (Canada); MacDonald, N. [CH2M Hill Engineering Ltd., Calgary, AB (Canada)

2006-04-15

The Municipal Solid Waste (MSW) Options Report explored different MSW management options for 3 community sizes: 20,000, 80,000 and 200,0000 people. It was released at a time when many communities were developing waste management plans to cost-effectively reduce environmental impacts and conserve landfill capacity. The purpose of this report was to provide a greater understanding on the environmental, social, economic, energy recovery/utilization and greenhouse gas (GHG) considerations of MSW management. The report also demonstrated the interrelationships between the management of organics and residuals. It was based on information from existing waste diversion and organics management options and emerging residual treatment technology options. The following organics management and residual treatment disposal options were evaluated: composting; anaerobic digestion; sanitary landfills; bioreactor landfills; and thermal treatment. Composting was examined with reference to both source separated organics (SSO) and mixed waste composting. SSO refers to the separation of materials suitable for composting solid waste from households, while mixed waste composting refers to the manual or mechanical removal of recyclable material from the waste, including compost. The composting process was reviewed along with available technologies such as non-reactor windrow; aerated static pile; reactor enclosed channel; and, container tunnel. An evaluation of SSO and mixed waste composting was then presented in terms of environmental, social, financial and GHG impacts. refs., tabs., figs.

Current options for the treatment of optic neuritis

Directory of Open Access Journals (Sweden)

Pula JH

2012-07-01

Full Text Available John H Pula,1 Christopher J MacDonald21Division of Neuro-ophthalmology, University of Illinois College of Medicine at Peoria, Peoria; 2University of Illinois College of Medicine at Urbana-Champaign, Champaign, IL, USAAbstract: Optic neuritis can be defined as typical (associated with multiple sclerosis, improving independent of steroid treatment, or atypical (not associated with multiple sclerosis, steroid-dependent improvement. Causes of atypical optic neuritis include connective tissue diseases (eg, lupus, vasculitis, sarcoidosis, or neuromyelitis optica. In this manuscript, updated treatment options for both typical and atypical optic neuritis are reviewed. Conventional treatments, such as corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin therapy are all discussed with commentary regarding evidence-based outcomes. Less commonly used treatments and novel purported therapies for optic neuritis are also reviewed. Special scenarios in the treatment of optic neuritis – pediatric optic neuritis, acute demyelinating encephalomyelitis, and optic neuritis occurring during pregnancy – are specifically examined.Keywords: optic neuritis, optic neuropathy, treatment, neuroophthalmology

Current and emerging treatment options for nasopharyngeal carcinoma

Directory of Open Access Journals (Sweden)

Spratt DE

2012-10-01

Full Text Available Daniel E Spratt, Nancy LeeDepartment of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: In this article, we focus on the current and emerging treatments in nasopharyngeal cancer (NPC. A detailed evolution of the current standard of care, and new techniques and treatment options will be reviewed. Intergroup 0099 established the role for chemoradiotherapy (chemo-RT in the treatment of nasopharyngeal carcinoma. Multiple randomized Phase III trials have shown the benefit of chemo-RT; however, none of these studies utilized modern radiotherapy (RT techniques of intensity-modulated radiation therapy (IMRT. IMRT has the ability to deliver high doses of radiation to the target structures while sparing adjacent bystander healthy tissues, and has now become the preferred RT treatment modality. Chemotherapy also has had a shifting paradigm of induction and/or adjuvant chemotherapy combined with RT alone, to the investigation with concurrent chemo-RT. New treatment options including targeted monoclonal antibodies and small molecule tyrosine kinase inhibitors are being studied in NPC. These new biologic therapies have promising in vitro activity for NPC, and emerging clinical studies are beginning to define their role. RT continues to expand its capabilities, and since IMRT and particle therapy, specifically intensity-modulated proton therapy (IMPT, has reports of impressive dosimetric efficacy in-silica. Adaptive RT is attempting to reduce toxicity while maintaining treatment efficacy, and the clinical results are still in their youth. Lastly, Epstein–Barr virus (EBV DNA has recently been studied for prediction of tumor response and its use as a biomarker is increasingly promising to aid in early detection as well as supplementing the current staging system. RT with or without chemotherapy remains the standard of care for nasopharyngeal carcinoma. Advances in RT technique, timing of chemotherapy, biologically

Treatment Options for Primary Nocturnal Enuresis by Parents in a ...

African Journals Online (AJOL)

femi oloka

common treatment option was waking up child at intervals during the night to void by 103 (45.2 ... patient/family education, simple behavioral ... nocturnal enuresis were employing in managing ..... Dental and Medical Sciences 2014;13:41 – 4.

Current and emerging treatment options for myopic choroidal neovascularization

Directory of Open Access Journals (Sweden)

El Matri L

2015-04-01

Full Text Available Leila El Matri, Ahmed Chebil, Fedra Kort Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia Abstract: Choroidal neovascularization (CNV is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV, with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed. Keywords: myopia, choroidal neovascularization, current treatment, emerging treatment

Current and future treatment options in osteoporosis.

LENUS (Irish Health Repository)

Brewer, Linda

2012-02-01

PURPOSE: The incidence of osteoporosis-related fractures will increase substantially over the coming decades as the population ages globally. This has important economic and public health implications, contributing substantially to morbidity and excess mortality in this population. METHODS: When prescribing for older patients the effectiveness profile of drugs needs to be balanced against their tolerability in individual patients. RESULTS: Currently we have good anti-fracture data to support the use of many available anti-resorptive and anabolic drugs including bisphosphonates, strontium ranelate and recombinant human parathyroid hormone. We also have evidence to demonstrate the importance of calcium and vitamin D repletion in these patients. However, in recent years our understanding of normal bone physiology and the mechanisms underlying the development of osteoporosis has significantly advanced and this has led to the development of new therapies. Novel agents, particularly denosumab, but also inhibitors of cathepsin K and anabolic agents that act on Wnt signalling, will increase the therapeutic options for clinicians in the coming years. CONCLUSION: This review discusses the evidence supporting the use of currently available treatment options for osteoporosis and potential future advances in drug therapy. Particular consideration should be given when prescribing for certain older patients who have issues with compliance or tolerance and also in those with co-morbidities or levels of frailty that may restrict the choice of therapy. Understanding the evidence for the benefit and possible harm of osteoporosis treatments is critical to appropriate management of this patient population.

Options Assessment Report: Treatment of Nitrate Salt Waste at Los Alamos National Laboratory

Energy Technology Data Exchange (ETDEWEB)

Robinson, Bruce Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Stevens, Patrice Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-12-17

This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognizes that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and that a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL’s preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

Options assessment report: Treatment of nitrate salt waste at Los Alamos National Laboratory

Energy Technology Data Exchange (ETDEWEB)

Robinson, Bruce Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Stevens, Patrice Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-09-16

This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognized that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and the a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL's preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

Gastroparesis: a review of current and emerging treatment options

Directory of Open Access Journals (Sweden)

Enweluzo C

2013-09-01

Full Text Available Chijioke Enweluzo, Fahad AzizHospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USAAbstract: Gastroparesis is a motility disorder of the stomach causing delay in food emptying from the stomach without any evidence of mechanical obstruction. The majority of cases are idiopathic. Patients need to be diagnosed properly by formal testing, and the evaluation of the severity of the gastroparesis may assist in guiding therapy. Initially, dietary modifications are encouraged, which include frequent and small semisolid-based meals. Promotility medications, like erythromycin, and antiemetics, like prochlorperazine, are offered for symptom relief. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, can be considered. Hemin therapy and gastric electric stimulation are emerging treatment options that are still at different stages of research. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future.Keywords: Gastroparesis, gastric emptying, gastric electrical stimulation, hemin

SURGICAL TREATMENT OF HEMORRHOIDS: A CRITICAL APPRAISAL OF THE CURRENT OPTIONS

Science.gov (United States)

CERATO, Marlise Mello; CERATO, Nilo Luiz; PASSOS, Patrícia; TREIGUE, Alberto; DAMIN, Daniel C.

2014-01-01

Introduction Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results. PMID:24676303

Current options for palliative treatment in patients with pancreatic cancer.

Science.gov (United States)

Ridwelski, K; Meyer, F

2001-01-01

Palliative treatment is often the only remaining option in the management of pancreatic carcinoma, but its efficacy is poor due to low tumor sensitivity and inadequate treatment protocols. There are several options of palliative treatment with antitumor or supportive intention. Classical end points of palliative treatment are survival, tumor response, and quality of life. A decade ago, palliative chemotherapy consisted mainly of 5-fluorouracil as the standard agent in combination with either other agents and/or radiotherapy. Only the new antineoplastic drug gemcitabine, which was introduced simultaneously with the definition of novel end points of chemotherapy such as clinical benefit, allowed to achieve some progress. However, while gemcitabine monotherapy appeared to be superior to 5-fluorouracil and improved important parameters of quality of life, it could not provide a significant improvement of survival. A novel concept, therefore, is to improve this beneficial cytostatic response in pancreatic carcinoma using a gemcitabine-based protocol by combining it with antineoplastic drugs such as taxanes or platin analogs. This strategy may have the potential to improve the outcome in palliative chemotherapy of pancreatic carcinoma patients with advanced tumor growth or metastases. Best supportive care in pancreatic cancer consists of the treatment of symptoms, such as pain, jaundice, duodenal obstruction, weight loss, exocrine pancreatic insufficiency, and tumor-associated depression. Copyright 2001 S. Karger AG, Basel

Managing AVN following internal fixation: treatment options and clinical results.

Science.gov (United States)

Hoskinson, Simon; Morison, Zachary; Shahrokhi, Shahram; Schemitsch, Emil H

2015-03-01

Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results. Copyright © 2014 Elsevier Ltd. All rights reserved.

Grey water characteristics and treatment options for rural areas in Jordan.

Science.gov (United States)

Halalsheh, M; Dalahmeh, S; Sayed, M; Suleiman, W; Shareef, M; Mansour, M; Safi, M

2008-09-01

Low water consumption in rural areas in Jordan had resulted in the production of concentrated grey water. Average COD, BOD and TSS values were 2568mg/l, 1056mg/l and 845mg/l, respectively. The average grey water generation was measured to be 14L/c.d. Three different treatment options were selected based on certain criterions, and discussed in this article. The examined treatment systems are septic tank followed by intermittent sand filter; septic tank followed by wetlands; and UASB-hybrid reactor. Advantages and disadvantages of each system are presented. It was concluded that UASB-hybrid reactor would be the most suitable treatment option in terms of compactness and simplicity in operation. The volume of UASB-hybrid reactor was calculated to be 0.268m(3) with a surface area of 0.138m(2) for each house having 10 inhabitants on average. Produced effluent is expected to meet Jordanian standards set for reclaimed water reuse in irrigating fruit trees.

Accounting treatment of currency options

Directory of Open Access Journals (Sweden)

Prošić Danica

2016-01-01

Full Text Available Currency options are often used to mitigate currency risk resulting from corporate activities. Their implementation can be complex, and there could be problems if the essential elements and principles are not fully understood. Although they are not the simplest financial products, currency options are interesting and useful to those who are trying to make a step forward in the area of currency risk management. This paper aims to present the general principles and specifics of accounting records and valuation of currency options used for hedging against risk. It is a complex process which, in addition to numerous conditions, also involves the implementation of accounting rules that deviate from the generally accepted accounting principles.

Current Treatment Options in Challenging Oral Diseases: Burning Mouth Syndrome

OpenAIRE

Bilgen Erdoğan; Murat Yılmaz

2012-01-01

Burning mouth syndrome is a chronic condition characterized by burning pain without any signs of an oral mucosal pathology, that usually affects postmenopausal women. Burning sensation is often accompanied by dysgeusia and xerostomia. The pathogenesis of the disease is unknown and an effective treatment option for most of the patients has not been defined yet. The aim of this review is to present current pharmacological and physicological treatments of burning mouth syndrome.

Current Treatment Options in Challenging Oral Diseases: Burning Mouth Syndrome

Directory of Open Access Journals (Sweden)

Bilgen Erdoğan

2012-12-01

Full Text Available Burning mouth syndrome is a chronic condition characterized by burning pain without any signs of an oral mucosal pathology, that usually affects postmenopausal women. Burning sensation is often accompanied by dysgeusia and xerostomia. The pathogenesis of the disease is unknown and an effective treatment option for most of the patients has not been defined yet. The aim of this review is to present current pharmacological and physicological treatments of burning mouth syndrome.

Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options.

Science.gov (United States)

Tanbo, Tom; Fedorcsak, Peter

2017-06-01

Endometriosis is a common condition in women of reproductive age. In addition to pain, endometriosis may also reduce fertility. The causes of infertility in women with endometriosis may range from anatomical distortions due to adhesions and fibrosis to endocrine abnormalities and immunological disturbances. In some cases, the various pathophysiological disturbances seem to interact through mechanisms so far not fully understood. Whether surgery should be offered as a treatment option in endometriosis-associated infertility has become controversial, partly due to its modest or undocumented effect. Medical or hormonal treatment alone has little or no effect and should only be used in conjunction with assisted reproductive technology (ART). Of the various methods of ART, intrauterine insemination, due to its simplicity, can be recommended in women with minimal or mild peritoneal endometriosis, even though insemination may yield a lower success rate than in women without endometriosis. In vitro fertilization (IVF) is an effective treatment option in less-advanced disease stages, and the success rates are similar to the results in other causes of infertility. However, women with more advanced stages of endometriosis have lower success rates with IVF. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Treatment options for permanent teeth with deep caries

OpenAIRE

Marending, Monika; Attin, Thomas; Zehnder, Matthias

2016-01-01

The goal of this narrative review was to summarize and compare treatment options for permanent teeth carious lesions that are radiographically close to the pulp chamber. Thanks to adhesive restorative materials, minimally invasive approaches are possible. In this context, the old question arises as to whether caries must be excavated completely, i.e., down to hard dentin, or whether it could be advantageous to leave some soft dentin, or even merely seal the whole lesion. To answer this questi...

Intra-extramedullary drainage as an effective option for treatment of intramedullary ependymal cyst of thoracic spine: technical note.

Science.gov (United States)

Landi, Alessandro; Pietrantonio, Andrea; Marotta, Nicola; Mancarella, Cristina; Delfini, Roberto

2014-03-01

Intramedullary neuroepithelial cysts are extremely rare and only 15 cases have been reported in the literature. Clinico-radiological features are not indicative of a specific diagnosis; for this reason, diagnosis is based mainly on the histological features. In the literature, total surgical removal is considered the treatment of choice. The risk of recurrence is higher after partial removal and in cases of occlusion of intra-extramedullary shunt. For this reason, a surgical strategy that ensures the shunt patency in case of incomplete removal of the cyst becomes a very safe option for treatment of this pathology. We report the case of a 51-year-old woman who was found to have a dorsal (D9) intramedullary neuroepithelial cyst. She underwent surgical treatment with partial removal and placement of a Nelaton drainage device (8 French) inside the intra-extramedullary shunt. The patient experienced a complete regression of preoperative symptoms and magnetic resonance imaging (MRI) follow-up showed no radiological evidence of recurrence 24 months after surgical treatment. Spinal ependymal cysts show a high frequency of recurrence, especially in cases of partial removal of the cyst wall. Unfortunately, the cyst walls are often closely adherent to the spinal cord, making total removal impossible. Intra-extramedullary shunting is a viable option, although there is a high frequency of recurrence in cases of obstruction of the shunt. Placing an 8 Ch Nelaton drain between the dorsal columns is a reliable technique, especially in cases of partial removal. In fact, it allows continuous drainage of cyst fluid and subsequent resolution of symptoms, and it decreases the incidence of recurrences due to obstruction of the shunt. Georg Thieme Verlag KG Stuttgart · New York.

Effluent treatment options for nuclear thermal propulsion system ground tests

International Nuclear Information System (INIS)

Shipers, L.R.; Brockmann, J.E.

1992-01-01

A variety of approaches for handling effluent from nuclear thermal propulsion system ground tests in an environmentally acceptable manner are discussed. The functional requirements of effluent treatment are defined and concept options are presented within the framework of these requirements. System concepts differ primarily in the choice of fission-product retention and waste handling concepts. The concept options considered range from closed cycle (venting the exhaust to a closed volume or recirculating the hydrogen in a closed loop) to open cycle (real time processing and venting of the effluent). This paper reviews the strengths and weaknesses of different methods to handle effluent from nuclear thermal propulsion system ground tests

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

DEFF Research Database (Denmark)

Uhlving, H H; Buchvald, F; Heilmann, C J

2012-01-01

Bronchiolitis obliterans (BO) following allogeneic haematopoietic SCT (HSCT) is a serious complication affecting 1.7-26% of the patients, with a reported mortality rate of 21-100%. It is considered a manifestation of chronic graft-versus-host disease, but our knowledge of aetiology and pathogenes...... treatment options for BO and presents the treatment results with HDPM in a paediatric national HSCT-cohort.Bone Marrow Transplantation advance online publication, 29 August 2011; doi:10.1038/bmt.2011.161....

[Female sexual dysfunction: Drug treatment options].

Science.gov (United States)

Alcántara Montero, A; Sánchez Carnerero, C I

2016-01-01

Many women will likely experience a sexual problem in their lifetime. Female sexual dysfunction is a broad term used to describe 3 categories of disorders of a multifactorial nature. Effective, but limited pharmacotherapeutic options exist to address female sexual dysfunction. The FDA recently approved the first agent for treatment of hypoactive sexual desire disorder in pre-menopausal women. Off-label use of hormonal therapies, particularly oestrogen and testosterone, are the most widely employed for female sexual dysfunction, particularly in post-menopausal women. Other drugs currently under investigation include phosphodiesterase inhibitors and agents that modulate dopamine or melanocortin receptors. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Assessment of options for the treatment of Sizewell PWR liquid effluent

International Nuclear Information System (INIS)

Hornby, J.; Allam, J.; Knibbs, R.H.

1992-01-01

This report describes the origins of PWR liquid waste streams, their composition and rates of arising. Data has been collected from operational PWRs and estimates obtained for Sizewell B PWR liquid waste streams. Current liquid waste treatment practices are reviewed and assessments made of established and novel treatment techniques which could be applicable to Sizewell B. A short list of treatment options is given and recommendations are made relating to established treatment technologies suitable for Sizewell B and also to development work on more novel treatments which could lead to a reduction in waste disposal volumes. (author)

Ragweed-induced allergic rhinoconjunctivitis: current and emerging treatment options

Directory of Open Access Journals (Sweden)

Ihler F

2015-02-01

Full Text Available Friedrich Ihler, Martin CanisDepartment of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, GermanyAbstract: Ragweed (Ambrosia spp. is an annually flowering plant whose pollen bears high allergenic potential. Ragweed-induced allergic rhinoconjunctivitis has long been seen as a major immunologic condition in Northern America with high exposure and sensitization rates in the general population. The invasive occurrence of ragweed (A. artemisiifolia poses an increasing challenge to public health in Europe and Asia as well. Possible explanations for its worldwide spread are climate change and urbanization, as well as pollen transport over long distances by globalized traffic and winds. Due to the increasing disease burden worldwide, and to the lack of a current and comprehensive overview, this study aims to review the current and emerging treatment options for ragweed-induced rhinoconjunctivitis. Sound clinical evidence is present for the symptomatic treatment of ragweed-induced allergic rhinoconjunctivitis with oral third-generation H1-antihistamines and leukotriene antagonists. The topical application of glucocorticoids has also been efficient in randomized controlled clinical trials. Combined approaches employing multiple agents are common. The mainstay of causal treatment to date, especially in Northern America, is subcutaneous immunotherapy with the focus on the major allergen, Amb a 1. Beyond this, growing evidence from several geographical regions documents the benefit of sublingual immunotherapy. Future treatment options promise more specific symptomatic treatment and fewer side effects during causal therapy. Novel antihistamines for symptomatic treatment are aimed at the histamine H3-receptor. New adjuvants with toll-like receptor 4 activity or the application of the monoclonal anti-immunoglobulin E antibody, omalizumab, are supposed to enhance conventional immunotherapy. An approach targeting toll-like receptor 9 by

Vaccines against drugs of abuse: a viable treatment option?

Science.gov (United States)

Kantak, Kathleen M

2003-01-01

Drug addiction is a chronically relapsing brain disorder. There is an urgent need for new treatment options for this disease because the relapse rate among drug abusers seeking treatment is quite high. During the past decade, many groups have explored the feasibility of using vaccines directed against drugs of abuse as a means of eliminating illicit drug use as well as drug overdose and neurotoxicity. Vaccines work by inducing drug-specific antibodies in the bloodstream that bind to the drug of abuse and prevent its entry into the brain. The majority of work in this area has been conducted with vaccines and antibodies directed against cocaine and nicotine. On the basis of preclinical work, vaccines for cocaine and nicotine are now in clinical trials because they can offer long-term protection with minimal treatment compliance. In addition, vaccines and antibodies for phencyclidine, methamphetamine and heroin abuse are currently under development. An underlying theme in this research is the need for high concentrations of circulating drug-specific antibodies to reduce drug-seeking and drug-taking behaviour when the drug is repeatedly available, especially in high doses. Although vaccines against drugs of abuse may become a viable treatment option, there are several drawbacks that need to be considered. These include: a lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice;a lack of an effect on drug craving that predisposes an addict to relapse; and tremendous individual variability in antibody formation. Forced or coerced vaccination is not likely to work from a scientific perspective, and also carries serious legal and ethical concerns. All things considered, vaccination against a drug of abuse is likely to work best with individuals who are highly motivated to quit using drugs altogether and as part of a comprehensive treatment programme. As such, the medical treatment of drug abuse will not be radically

[Fasciocutaneous flap reliable by deep femoral artery perforator for the treatment of ischial pressure ulcers].

Science.gov (United States)

Gebert, L; Boucher, F; Lari, A; Braye, F; Mojallal, A; Ismaïl, M

2018-04-01

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

New treatment options for fibromyalgia: critical appraisal of duloxetine

Directory of Open Access Journals (Sweden)

Nurcan Üçeyler

2008-06-01

Full Text Available Nurcan Üçeyler1, Martin Offenbächer2, Frank Petzke3, Winfried Häuser4, Claudia Sommer11Department of Neurology, University of Würzburg, Germany; 2GRP – Generation Research Program, Human Science Center, University of Munich, Germany; 3Department of Anesthesiology, University of Cologne, Germany; 4Center of Pain Therapy, Klinikum Saarbrücken gGmbH, Winterberg 1, Saarbrücken, GermanyAbstract: Fibromyalgia syndrome (FMS is a chronic condition characterized by widespread pain, tender points, fatigue, and sleep disturbance. FMS leads to high disability levels, poor quality of life, and extensive use of medical care. Effective pharmacological treatment options are rare, and treatment effects are often of limited duration. Duloxetine is a new selective serotonin and norepinephrine reuptake inhibitor that is licensed for the treatment of pain in diabetic neuropathy. So far two randomized, placebo-controlled trials have investigated the short-term safety and efficacy of duloxetine 60 mg/day and 120 mg/day in patients suffering from FMS over a period of 12 weeks. Both dosages were superior to placebo in pain relief, and improvement in quality of life and depressive symptoms. The analgesic effect was largely independent of the antidepressant action of duloxetine. The higher dose of 120 mg/day further reduced the tender point count and elevated the tender point pain thresholds. Only mild to moderate adverse effects were reported. Duloxetine 60 mg/day and 120 mg/day has proven to be beneficial in the treatment of FMS symptoms. As true for other antidepressants further studies are needed to assess the long-term efficacy and safety of duloxetine as an additional pharmacological treatment option in FMS.Keywords: fibromyalgia syndrome, duloxetine, antidepressant, review, SNRI

Pelvic radiation disease: Updates on treatment options

Science.gov (United States)

Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

2015-01-01

Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities.

Science.gov (United States)

Ryder, Justin R; Fox, Claudia K; Kelly, Aaron S

2018-06-01

Severe obesity is the only obesity classification increasing in prevalence among children and adolescents. Treatment options that produce meaningful and sustained weight loss and comorbidity resolution are urgently needed. The purpose of this review is to provide a brief overview of the current treatment options for pediatric severe obesity and offer suggestions regarding future opportunities for accelerating the development and evaluation of innovative treatment strategies. At present, there are three treatment options for youth with severe obesity: lifestyle modification therapy, pharmacotherapy, and bariatric surgery. Lifestyle modification therapy can be useful for improving many chronic disease risk factors and comorbid conditions but often fails to achieve clinically meaningful and sustainable weight loss. Pharmacotherapy holds promise as an effective adjunctive treatment but remains in the primordial stages of development in the pediatric population. Bariatric surgery provides robust weight loss and risk factor/comorbidity improvements but is accompanied by higher risks and lower uptake compared to lifestyle modification therapy and pharmacotherapy. New areas worth pursuing include combination pharmacotherapy, device therapy, identification of predictors of response aimed at precision treatment, and interventions in the postbariatric surgical setting to improve long-term outcomes. Treating pediatric severe obesity effectively and safely is extremely challenging. Some progress has been made, but substantially more effort and innovation are needed in the future to combat this serious and ongoing medical and public health issue. © 2018 The Obesity Society.

Reliability-based econometrics of aerospace structural systems: Design criteria and test options. Ph.D. Thesis - Georgia Inst. of Tech.

Science.gov (United States)

Thomas, J. M.; Hanagud, S.

1974-01-01

The design criteria and test options for aerospace structural reliability were investigated. A decision methodology was developed for selecting a combination of structural tests and structural design factors. The decision method involves the use of Bayesian statistics and statistical decision theory. Procedures are discussed for obtaining and updating data-based probabilistic strength distributions for aerospace structures when test information is available and for obtaining subjective distributions when data are not available. The techniques used in developing the distributions are explained.

Ustekinumab as an Alternative Treatment Option for Chronic Pityriasis Rubra Pilaris

Directory of Open Access Journals (Sweden)

Mudit Chowdhary

2015-03-01

Full Text Available Pityriasis rubra pilaris (PRP is an exceptionally rare, chronic inflammatory dermatosis of unknown etiology. Patients classically present with small, follicular keratosis and salmon-colored plaques that begin at the head and neck and slowly progress to widespread erythroderma including the palms and soles. It is difficult to distinguish PRP from other inflammatory dermatoses; however, features that help aid in the diagnosis include ‘islands' of spared skin, orangish hue and typical findings on biopsy. There are no specific guidelines on therapy and treatment options include corticosteroids, vitamin D analogs, retinoids, methotrexate, cyclosporine, azathioprine and tumor necrosis factor alpha antagonists. Unfortunately options are limited for patients when these drugs do not work. We report a case of chronic PRP, refractory to conventional treatment, successfully treated with ustekinumab monotherapy. The patient was treated with 90 mg subcutaneous ustekinumab injections and began to show improvement within only 8 weeks. Long-term control of the disease has been attained without any significant side effects. We report this case to show that ustekinumab can be used as an alternative treatment method for patients with chronic, unremitting PRP. Treatment response is remarkably rapid and the infrequent dosing leads to patient compliance and a significantly improved quality of life.

Redefining reliability

International Nuclear Information System (INIS)

Paulson, S.L.

1995-01-01

Want to buy some reliability? The question would have been unthinkable in some markets served by the natural gas business even a few years ago, but in the new gas marketplace, industrial, commercial and even some residential customers have the opportunity to choose from among an array of options about the kind of natural gas service they need--and are willing to pay for. The complexities of this brave new world of restructuring and competition have sent the industry scrambling to find ways to educate and inform its customers about the increased responsibility they will have in determining the level of gas reliability they choose. This article discusses the new options and the new responsibilities of customers, the needed for continuous education, and MidAmerican Energy Company's experiment in direct marketing of natural gas

Treatment options for polycystic ovary syndrome

Directory of Open Access Journals (Sweden)

Ahmed Badawy

2011-02-01

Full Text Available Ahmed Badawy1 Abubaker Elnashar21Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt; 2Department of Obstetrics and Gynecology, Benha University, Benha, EgyptAbstract: Polycystic ovary syndrome (PCOS is the most common endocrine disorder in women. The clinical manifestation of PCOS varies from a mild menstrual disorder to severe disturbance of reproductive and metabolic functions. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or androgen-related symptoms. Weight loss improves the endocrine profile and increases the likelihood of ovulation and pregnancy. Normalization of menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight. The treatment of obesity includes modifications in lifestyle (diet and exercise and medical and surgical treatment. In PCOS, anovulation relates to low follicle-stimulating hormone concentrations and the arrest of antral follicle growth in the final stages of maturation. This can be treated with medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic ovarian drilling. In vitro fertilization will remain the last option to achieve pregnancy when others fail. Chronic anovulation over a long period of time is also associated with an increased risk of endometrial hyperplasia and carcinoma, which should be seriously investigated and treated. There are androgenic symptoms that will vary from patient to patient, such as hirsutism, acne, and/or alopecia. These are troublesome presentations to the patients and require adequate treatment. Alternative medicine has been emerging as one of the commonly practiced medicines for different health problems, including PCOS. This review underlines the contribution to the treatment of different symptoms.Keywords: treatment, polycystic ovary

Approved and Off-Label Uses of Obesity Medications, and Potential New Pharmacologic Treatment Options

Directory of Open Access Journals (Sweden)

Fernando Cordido

2010-01-01

Full Text Available Available anti-obesity pharmacotherapy options remain very limited and development of more effective drugs has become a priority. The potential strategies to achieve weight loss are to reduce energy intake by stimulating anorexigenic signals or by blocking orexigenic signals, and to increase energy expenditure. This review will focus on approved obesity medications, as well as potential new pharmacologic treatment options.

The Effects of Accounting Treatment and Financial Crisis on the Stock Option Plans of Italian Companies

Directory of Open Access Journals (Sweden)

Francesco Avallone

2014-03-01

Full Text Available Many studies state that favourable accounting treatment has been one of the main reasons behind employee stock options. In addition, stock options have recently been the target of growing criticism with a possible influence on incentive effectiveness and outrage costs. In such a perspective, the main purpose of the paper is to explore the impact of IFRS 2 and of the recent financial crisis on stock option compensation. Empirical evidence suggests that: (i IFRS 2 did not have a significant effect on stock option granting, (ii the issue of stock options is less likely to occur during the financial crisis.

Safety of treatment options for spondyloarthritis: a narrative review.

Science.gov (United States)

D'Angelo, Salvatore; Carriero, Antonio; Gilio, Michele; Ursini, Francesco; Leccese, Pietro; Palazzi, Carlo

2018-05-01

Spondyloarthritis (SpA) are chronic inflammatory diseases with overlapping pathogenic mechanisms and clinical features. Treatment armamentarium against SpA includes non-steroidal anti-inflammatory drugs, glucocorticoids, conventional disease-modifying antirheumatic drugs (DMARDs, including sulfasalazine, methotrexate, leflunomide, cyclosporine), targeted synthetic DMARDs (apremilast) and biological DMARDs (TNF inhibitors, anti-IL 12/23 and anti-IL-17 agents). Areas covered: A narrative review of published literature on safety profile of available SpA treatment options was performed. Readers will be provided with a comprehensive overview on frequent and rare adverse events associated with each drug listed in current SpA treatment recommendations. Expert opinion: The overall safety profile of such molecules is good and serious adverse events are rare but need to be promptly recognized and treated. However, the monitoring of adverse events is a major challenge for clinicians because it is not adequately addressed by current treatment recommendations. A tailored treatment is crucial and rheumatologists must accurately select patients in order to identify those more susceptible to develop adverse events.

Empowering Variable Renewables - Options for Flexible Electricity Systems

Energy Technology Data Exchange (ETDEWEB)

Chandler, Hugo [Renewable Energy Unit, International Energy Agency, Paris (France)

2008-07-01

A flexible electricity system is one that can respond reliably, and rapidly, to large fluctuations in supply and demand. Flexibility is already present in all power systems, in order to manage fluctuations in demand, and it is crucial for high performance and economic and reliable operation. This paper looks at measures to increase flexibility. but careful cost/benefit analysis is essential, and specific national and regional circumstances will influence the choice of option(s).

Treatment options for diabetic foot osteomyelitis.

Science.gov (United States)

Senneville, Eric; Robineau, Olivier

2017-06-01

Diabetic foot osteomyelitis therapeutical options are based on antibiotic therapy and surgical resection of the infected bone(s). Surgical and medical approaches of patients suffering from a diabetic foot osteomyelitis do not oppose but are complementary and need to be discussed as a tailored manner. Areas covered: The aim of the present article is to discuss data issued from the most recent guidelines of the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot on the management of the diabetic foot infection and from a search in the current literature using the terms diabetic foot osteomyelitis and treatment/therapy/therapeutical in both PubMed and Medline, restricted to the last five years. Expert opinion: Surgical removal of the entire infected bone(s) has been considered in the past as the standard treatment but medical approach of these patients has now proven efficacy in selected situations. The current emergence of bacteria, especially among Gram negative rods, resistant to almost all the available antibiotics gradually augments the complexity of the management of these patients and is likely to decrease the place of the medical approach and to worsen the outcome of these infections in the next future.

Facial Pores: Definition, Causes, and Treatment Options.

Science.gov (United States)

Lee, Sang Ju; Seok, Joon; Jeong, Se Yeong; Park, Kui Young; Li, Kapsok; Seo, Seong Jun

2016-03-01

Enlarged skin pores refer to conditions that present with visible topographic changes of skin surfaces. Although not a medical concern, enlarged pores are a cosmetic concern for a large number of individuals. Moreover, clear definition and possible causes of enlarged pores have not been elucidated. To review the possible causes and treatment options for skin pores. This article is based on a review of the medical literature and the authors' clinical experience in investigating and treating skin pores. There are 3 major clinical causes of enlarged facial pores, namely high sebum excretion, decreased elasticity around pores, and increased hair follicle volume. In addition, chronic recurrent acne, sex hormones, and skin care regimen can affect pore size. Given the different possible causes for enlarged pores, therapeutic modalities must be individualized for each patient. Potential factors that contribute to enlarged skin pores include excessive sebum, decreased elasticity around pores, and increased hair follicle volume. Because various factors cause enlarged facial pores, it might be useful to identify the underlying causes to be able to select the appropriate treatment.

Neuroimaging in aphasia treatment research: Standards for establishing the effects of treatment

Science.gov (United States)

Kiran, Swathi; Ansaldo, Ana; Bastiaanse, Roelien; Cherney, Leora R.; Howard, David; Faroqi-Shah, Yasmeen; Meinzer, Marcus; Thompson, Cynthia K

2012-01-01

The goal of this paper is to discuss experimental design options available for establishing the effects of treatment in studies that aim to examine the neural mechanisms associated with treatment-induced language recovery in aphasia, using functional magnetic resonance imaging (fMRI). We present both group and single-subject experimental or case-series design options for doing this and address advantages and disadvantages of each. We also discuss general components of and requirements for treatment research studies, including operational definitions of variables, criteria for defining behavioral change and treatment efficacy, and reliability of measurement. Important considerations that are unique to neuroimaging-based treatment research are addressed, pertaining to the relation between the selected treatment approach and anticipated changes in language processes/functions and how such changes are hypothesized to map onto the brain. PMID:23063559

Patients' Values Related to Treatment Options for Teeth with Apical Periodontitis.

Science.gov (United States)

Azarpazhooh, Amir; Dao, Thuan; Ungar, Wendy J; Da Costa, Jose; Figueiredo, Rafael; Krahn, Murray; Friedman, Shimon

2016-03-01

This study aimed to explore patients' values when selecting treatment for a tooth with apical periodontitis (AP), namely retention via root canal treatment (RCT) and extraction without replacement or replacement with implant-supported crowns or fixed or removable partial prostheses. Through 2 surveys of patients (800 university patients and 200 community patients, response rate = 43%) and dentists (498 Ontario endodontists, periodontists, prosthodontists, oral and maxillofacial surgeons, response rate = 40% and 1983 Ontario general dentists, response rate = 15%), the importance of values that might be considered important to patients when selecting treatment options for a tooth with AP were recorded. Chi-square and Kendall's tau tests were used to respectively compare the importance rating frequency by each surveyed group and its correlation to their demographic variables (P ≤ .05). Patients considered communication and trust (94%), tooth retention (90%), esthetic outcome (84% regardless of location), cost (83%), longevity (83%), and preoperative pain (81%) as the most important decision values. Dentists overrated the importance of patients' previous experience with the treatment options (94% vs. 72%), dental insurance (90% vs. 70%), and intraoperative pain (79% vs. 60%) while underestimating the importance of maintenance cost (60% vs. 79%). Dentists should respect patients' views about esthetic outcome, longevity, and cost associated with treatment options for a tooth with AP. In particular, this survey highlights the value of communication and trust between patient and dentist and preservation of the natural tooth through RCT over implant-supported crown replacement when planning treatment for a tooth with AP. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Options for Healthcare Waste Management and Treatment in China

Institute of Scientific and Technical Information of China (English)

无

2006-01-01

Healthcare waste management and treatment is one of the national priority tasks of China's Tenth Five-Year Plan.Numerous installations disposing medical waste have already operated the project or under construction to the operation in 2006. This paper focuses on the assessment of existing and fu~re options to handle medical waste (MW). Internationally available and so far in China applied technologies and management practice are analysed, including the problems how to materials. Non-hazardous MW can be managed and treated in analogue to municipal solid waste (MSW). In most of the European countries decentralised hospital incinerators have been, because of high operation costs and pollution problems,widely banned and replaced by pre-treatment technologies at the source and centralised incineration plants for hazardous MW.Information for adapting and further developing MW management solutions and treatment technologies in China and applying the most appropriate MWM practice is provided.

Current treatment options for the management of patent ductus arteriosus

Directory of Open Access Journals (Sweden)

Takeuchi K

2013-03-01

Full Text Available Koh Takeuchi,1 Atsushi Hirota,2 Sachito Minegishi,1 Jotaro Kobayashi,1 Keiji Tsuchiya3 1Division of Cardiovascular Surgery, 2Department of Neonatology, 3Department of Pediatrics, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan Abstract: Pharmacological and/or surgical closure of a hemodynamically significant patent ductus arteriosus (PDA in the very premature infant has been the standard of care over the past few decades. However, the rationale for closure of PDA has recently been challenged. In this article, three ways of approaching the closure of PDA including pharmacological treatment, catheter intervention, and surgical intervention, are reviewed in detail. In addition, the different treatment strategies applied in clinical care are evaluated with a focus on the discussion of the available evidence of PDA treatment in the literature. Keywords: patent ductus arteriosus, premature infant, treatment option

Treatment options for permanent teeth with deep caries.

Science.gov (United States)

Marending, Monika; Attin, Thomas; Zehnder, Matthias

The goal of this narrative review was to summarize and compare treatment options for permanent teeth carious lesions that are radiographically close to the pulp chamber. Thanks to adhesive restorative materials, minimally invasive approaches are possible. In this context, the old question arises as to whether caries must be excavated completely, i.e., down to hard dentin, or whether it could be advantageous to leave some soft dentin, or even merely seal the whole lesion. To answer this question, the microbiological aspects of the lesion must be considered, along with the immunological response in the dental pulp, with the concurrent possible negative outcomes for the patient. Both aspects are considered in this review, and clinical studies comparing different treatment modalities are discussed. Situations in which calcium silicate cements could be advantageous over the gold standard calcium hydroxide preparations for covering the dentin/pulp wound are also discussed.

Pazopanib for metastatic pulmonary epithelioid hemangioendothelioma—a suitable treatment option: case report and review of anti-angiogenic treatment options

International Nuclear Information System (INIS)

Semenisty, Valeriya; Naroditsky, Inna; Keidar, Zohar; Bar-Sela, Gil

2015-01-01

Epithelioid hemangioendothelioma is a rare vascular tumor of borderline or low-grade malignancy. The lungs and liver are the two common primary organs affected. Metastatic disease was reported in more than 100 cases in the literature. However, no firm conclusions can be determined for recommended treatment options. The current case presents a patient with metastatic pulmonary epithelioid hemangioendothelioma to the cervical and mediastinal lymph nodes, lungs and liver that has been treated with pazopanib for more than two years with PET avid complete metabolic response in the mediastinum and lungs, and long-lasting stable disease. Target therapies that block VEGFR have a logical base in this rare malignancy. The current case is the first to report objective, long-lasting response to pazopanib

Excoriation (skin-picking disorder: a systematic review of treatment options

Directory of Open Access Journals (Sweden)

Lochner C

2017-07-01

Full Text Available Christine Lochner,1 Annerine Roos,1 Dan J Stein2 1SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa; 2SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa Abstract: Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking disorder (ED, also known as neurotic excoriation, psychogenic excoriation, or dermatillomania, is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive–compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder. Arguably, its inclusion and delineation in the diagnostic nomenclature will lead to increased awareness of the condition, more research, and ultimately in treatment advances. This systematic review aims to provide readers with an up-to-date view of current treatment options for ED. A MEDLINE search of the ED treatment literature was conducted to collate relevant articles published between 1996 and 2017. The findings indicate that a number of randomized controlled trails on ED have now been published, and that current management options include behavioral therapy (habit reversal or acceptance-enhanced behavior therapy, and medication (selective serotonin reuptake inhibitors or N-acetyl cysteine. Keywords: excoriation, skin-picking, treatment, habit reversal therapy, behavioral therapy, pharmacotherapy, systematic review

The significance of motivation in periodontal treatment: validity and reliability of the motivation assessment scale among patients undergoing periodontal treatment.

Science.gov (United States)

Pac, A; Oruba, Z; Olszewska-Czyż, I; Chomyszyn-Gajewska, M

2014-03-01

The individual evaluation of patients' motivation should be introduced to the protocol of periodontal treatment, as it could impact positively on effective treatment planning and treatment outcomes. However, a standardised tool measuring the extent of periodontal patients' motivation has not yet been proposed in the literature. Thus, the objective of the present study was to determine the validity and reliability of the Zychlińscy motivation scale adjusted to the needs of periodontology. Cross sectional study. Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland. 199 adult periodontal patients, aged 20-78. 14-item questionnaire. The items were adopted from the original Zychlińscy motivation assessment scale. Validity and reliability of the proposed motivation assessment instrument. The assessed Cronbach's alpha of 0.79 indicates the scale is a reliable tool. Principal component analysis revealed a model with three factors, which explained half of the total variance. Those factors represented: the patient's attitude towards treatment and oral hygiene practice; previous experiences during treatment; and the influence of external conditions on the patient's attitude towards treatment. The proposed scale proved to be a reliable and accurate tool for the evaluation of periodontal patients' motivation.

The safety of treatment options available for gout.

Science.gov (United States)

Schlesinger, Naomi

2017-04-01

Gout is the most common inflammatory arthritis in humans. Gout treatment includes rapid initiation of anti-inflammatory medications for acute attacks and chronically treating with urate lowering drugs as well as chronic anti-inflammatory prophylaxis. Areas covered: This review aims to provide an overview and discussion of the safety concerns of current treatment options available for gout. Expert opinion: Gout is a curable disease with appropriate treatment. The advent of new therapies provides encouraging opportunities to improve gout management. However, clinicians should be aware of some of the safety concerns of medications used to treat acute and chronic gout. When prescribing medications for gout one has to be mindful of the presence of comorbidities commonly affecting gout patients that may affect drug safety and efficacy, especially in the elderly and in patients treated with multiple drugs. The benefits of gout drugs, usually, outweigh their safety concerns. Studies are needed in gout patients with chronic kidney disease and/or cardiovascular disease, so that escalation of dosing /combination of anti-inflammatory drugs needed to suppress gouty inflammation as well as escalation of dosing/combination of urate lowering drugs needed to achieve target serum urate level will lead to better understanding of gout treatment safety issues.

A Multi-Criteria Decision Analysis of Waste Treatment Options for Food and Biodegradable Waste Management in Japan

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Micky A. Babalola

2015-10-01

Full Text Available Dealing with large-scale Food and Biodegradable Waste (FBW often results in many logistical problems and environmental impacts to be considered. These can become great hindrances when the integration of solid waste management is concerned. Extra care is needed to plan such waste disposal or treatment services and facilities, especially with respect to the ecological impact. Decision-making with regards to the sustainable use of these facilities also involves tradeoffs between a number of conflicting objectives, since increasing one benefit may decrease the others. In this study a Multi-Criteria Decision Analysis (MCDA is presented to evaluate different waste management options and their applicability in Japan. The analytical process aims at selecting the most suitable waste treatment option, using pairwise comparisons conducted within a decision hierarchy that was developed through the Analytical Hierarchy Process (AHP. The results of this study show that anaerobic digestion should be chosen as the best FBW treatment option with regards to resource recovery. The study also presents some conditions and recommendations that can enhance the suitability of other options like incineration and composting.

Therapeutic Success of the Ketogenic Diet as a Treatment Option for Epilepsy: a Meta-analysis

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Li, Hai-feng; Zou, Yan; Ding, Gangqiang

2013-01-01

Objective To systematically evaluate therapeutic success of the ketogenic diet (KD) as a treatment option for epilepsy. Methods Using MEDLINE and Google Scholar search, we searched for studies investigating the therapeutic success of ketogenic diet for epilepsy. We estimated therapeutic success rate for ketogenic diet as a treatment option for epilepsy and its 95% CIs using generic inverse variance method. Findings A total of 38 studies met the inclusion criteria. In retrospective studies, the weighted success rate of the patients who take the KD as a treatment option for epilepsy was 58.4% (95% confidence interval (95%CI)=48.7% – 69.9%) at 3 months (n=336); 42.8% (95%CI =36.3% – 50.3%) at 6 months (n=492), and 30.1% (95%CI =24.3% – 37.2%) at 12 months (n=387); in prospective studies, weighted success rate was 53.9% (95%CI 45.5% – 63.8%) at 3 months (n=474); 53.2% (95%CI =44.0% – 64.2%) at 6 months (n=321), and 55.0% (95%CI =45.9% – 65.9%) at 12 months (n=347). Conclusion This meta-analysis provides formal statistical support for the efficacy of the ketogenic diet in the treatment of epileptic patients. PMID:24910737

Emerging treatment options for acute bacterial skin and skin structure infections: focus on intravenous delafloxacin

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Righi E

2018-04-01

Full Text Available Elda Righi, Alessia Carnelutti, Antonio Vena, Matteo Bassetti Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy Abstract: The increase in hospitalization due to acute bacterial skin and skin structure infections (ABSSSI caused by resistant pathogens supports the need for new treatment options. Antimicrobial options for ABSSSI that provide broad-spectrum coverage, including gram-negative pathogens and multidrug-resistant gram-positive bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA, are limited. Delafloxacin is a novel fluoroquinolone available as intravenous and oral formulations and is characterized by an increased efficacy in acidic environments and activity on bacterial biofilm. Delafloxacin displays enhanced in vitro activity against MRSA, and enterococci, while maintaining efficacy against gram-negative pathogens and anaerobes. Delafloxacin has been studied for the treatment of ABSSSI and respiratory infections. Phase III studies have demonstrated noninferiority of delafloxacin compared to vancomycin, linezolid, tigecycline, and the combination of vancomycin plus aztreonam in the treatment of ABSSSI. Due to its favorable pharmacokinetic characteristics, the wide spectrum of action, and the potential for sequential therapy, delafloxacin represents a promising option in the empirical and targeted treatment of ABSSSI, both in hospital- and in community-based care. Keywords: bacterial skin and skin structure infections, multidrug-resistant bacteria, methicillin-resistant Staphylococcus aureus, delafloxacin

Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

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Li, Yike; Garrett, Gaelyn; Zealear, David

2017-01-01

Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP. PMID:28669149

Remediation options and the significance of water treatment at former uranium production sites in Eastern Germany

International Nuclear Information System (INIS)

Gatzweiler, R.; Jakubick, A.T.; Kiessig, G.

2000-01-01

The WISMUT remediation project in the States of Saxony and Thuringia, Germany, comprises several mine and mill sites including large volumes of production residues. Due to the climate, the intensive land use and the regulatory conditions, the water path is most important in evaluating remediation options. Water treatment is an integral part of mine flooding, mine dump and tailings remediation, and treatment costs represent a major portion of the overall costs of the project. Uncertainties in the estimations of quantities of mine and seepage waters, variations in quality from site to site, and changing conditions in time demand a strategic approach to the selection and optimization of water treatment methods. The paper describes options considered and experience gained including efforts to limit long-term treatment costs by developing and applying passive treatment systems and negotiating acceptable discharge limits. (author)

Informing patients about emerging treatment options: creating "saviour siblings" for haemopoietic stem cell transplant.

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Strong, Kimberly A

2009-05-04

In June 2008, the ABC screened a television documentary involving a couple who decided to have an additional child in the hope of obtaining umbilical cord blood to treat their daughter who had leukaemia. The couple conceived naturally, meaning that there was a one in four chance that their child would be suitably matched. They seemed to be unaware of technologies that, if successful, could provide a near certainty that the next child would be a matched "saviour sibling". This story raises questions about whether clinicians have an obligation to discuss emerging and morally contentious treatment options. Ignorance of technology, assumptions about availability, and medical assessment of burdens and benefits may affect attitudes towards treatment options, but they do not justify non-disclosure of information.

Solidification of radioactive liquid wastes, Treatment options for spent resins and concentrates - 16405

International Nuclear Information System (INIS)

Roth, Andreas

2009-01-01

Ion exchange is one of the most common and effective treatment methods for liquid radioactive waste. However, spent ion exchange resins are considered to be problematic waste that in many cases require special approaches and pre-conditioning during its immobilization to meet the acceptance criteria for disposal. Because of the function that they fulfill, spent ion exchange resins often contain high concentrations of radioactivity and pose special handling and treatment problems. Another very common method of liquid radioactive waste treatment and water cleaning is the evaporation or diaphragm filtration. Both treatment options offer a high volume reduction of the total volume of liquids treated but generate concentrates which contain high concentrations of radioactivity. Both mentioned waste streams, spent resins as well as concentrates, resulting from first step liquid radioactive waste treatment systems have to be conditioned in a suitable manner to achieve stable waste products for final disposal. Spent resin and concentrate treatment often appear as a specific task in decommissioning projects, because in the past those waste streams typically had been stored in tanks for the lifetime of the plant and needs to be retrieved, conditioned and packed prior to dismantling activities. Additionally a large amount of contaminated liquids will be generated by utilizing decontamination processes and needs to be processed further on. Such treatment options need to achieve waste products acceptable for final disposal, because due to the closure of the site no interim storage can be envisaged. The most common method of treatment of such waste streams is the solidification in a solid matrix with additional inactive material like cement, polymer etc. In the past good results have been achieved and the high concentration of radioactivity can be reduced by adding the inactive material. On the other hand, under the environment of limited space for interim storage and the absence

Process options for treatment of organic containing ILWs by wet oxidation

International Nuclear Information System (INIS)

Holman, D.J.

1989-01-01

The process chemistry, applications and experience with several wet oxidation options are reviewed along with criteria for the selection of viable systems and plant designs, covering a range of organic wastes, including solvents, cellulosic filters, chelant decontamination reagents and ion exchange resins. The use of hydrogen peroxide to treat water-cooled reactor residues containing mixed inorganic and organic filter materials with ion exchange resins is examined in further detail along with treatment of secondary arisings. The technical and financial justifications for treatment are examined along with the engineering requirements to retro-fit the required plant to an existing cement encapsulation facility. (author)

Treatment of central sensitization in patients with 'unexplained' chronic pain: what options do we have?

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Nijs, Jo; Meeus, Mira; Van Oosterwijck, Jessica; Roussel, Nathalie; De Kooning, Margot; Ickmans, Kelly; Matic, Milica

2011-05-01

Central sensitization accounts for chronic 'unexplained' pain in a wide variety of disorders, including chronic whiplash-associated disorders, temporomandibular disorders, chronic low back pain, osteoarthritis, fibromyalgia, chronic fatigue syndrome and chronic tension-type headache among others. Given the increasing evidence supporting the clinical significance of central sensitization in those with unexplained chronic pain, the awareness is growing that central sensitization should be a treatment target in these patients. This article provides an overview of the treatment options available for desensitizing the CNS in patients with chronic pain due to central sensitization. It focuses on those strategies that specifically target pathophysiological mechanisms known to be involved in central sensitization. In addition, pharmacological options, rehabilitation and neurotechnology options are discussed. Acetaminophen, serotonin-reuptake inhibitor drugs, selective and balanced serototin and norepinephrine-reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, N-methyl-d-aspartate (NMDA)-receptor antagonists, calcium-channel alpha(2)delta (a2δ) ligands, transcranial magnetic stimulation, transcutaneous electric nerve stimulation (TENS), manual therapy and stress management each target central pain processing mechanisms in animals that - theoretically - desensitize the CNS in humans. To provide a comprehensive treatment for 'unexplained' chronic pain disorders characterized by central sensitization, it is advocated to combine the best evidence available with treatment modalities known to target central sensitization. © 2011 Informa UK, Ltd

Taxing Options: Do Ceos Respond To Favorable Tax Treatment Of Stock Options?

OpenAIRE

Martin Gritsch; Tricia Coxwell Snyder

2007-01-01

CEO stock option compensation increased tremendously during the 1990s. During this period, the spread between the marginal income and capital gains tax rates increased substantially, creating the potential for tax avoidance. Using ExecuComp data from 1992-2000, we estimate CEOs’ responsiveness to changes in these tax rates. Our findings show that an increase in the marginal income and a decrease in the capital gains tax rate create a significant increase in stock option compensation. Furtherm...

New and current preventive treatment options in actinic keratosis.

Science.gov (United States)

Arenberger, P; Arenbergerova, M

2017-09-01

Actinic keratosis (AK) is a characteristic skin lesion on skin areas of subjects with mainly phototype I and phototype II, or with specific genetic factors and who are exposed to prolonged ultraviolet radiation. AK may be considered a precursor of in situ squamous cell carcinoma (SCC), a type of non-melanoma skin cancer (NMSC). However, it is still not possible to predict which AK lesions will develop into SCC. Early treatment of AK is therefore recommended. Despite the increasing number of patients with AK developing into SCC, to date, there is still no clear suggestion of therapeutic strategy for AK. Current treatment consists of a multitude of topical lesion-directed or field-directed therapies or a combination of both. Recently, orally administered nicotinamide has shown to significantly reduce rates of new NMSC and AK in high-risk patients. This study aims to provide an update on the most relevant information about AK and to provide an insight into current and new treatment options. © 2017 European Academy of Dermatology and Venereology.

Thyroid Cancer Treatment Choice: A pilot study of a tool to facilitate conversations with patients with papillary microcarcinomas considering treatment options.

Science.gov (United States)

Brito, Juan P; Moon, Jae Hoon; Zeuren, Rebecca; Kong, Sung Hye; Kim, Yeo Koon; Iñiguez-Ariza, Nicole M; Choi, June Young; Lee, Kyu Eun; Kim, Ji-Hoon; Hargraves, Ian; Bernet, Victor; Montori, Victor; Park, Young Joo; Tuttle, R Michael

2018-06-15

The 2015 American Thyroid Association guidelines recognize active surveillance as an alternative to immediate surgery in patients with papillary microcarcinomas (PMCs). As a way to incorporate active surveillance as one of the management options for patients with PMCs, we describe the development and initial testing of a tool to support conversations between clinicians and patients with PMCs considering treatment options. Thyroid Cancer Treatment Choice was developed using an iterative process based on the principles of interaction, design and participatory action research. To evaluate the impact of the tool on treatment choice, a prospective study was conducted in two thyroid cancer clinics in Seongnam-si and Seoul, South Korea: both clinics had the expertise to offer active surveillance as well as immediate surgery. One clinic was trained in the use of the conversation aid, while the other clinic continued to care for patients without access to the conversation aid. Between May 2016 and April 2017, 278 patients mostly women (n=220, 79%) were included in the study; 152 (53%) received care at the clinic using the conversation aid. Age, gender, and mean tumor size [6.6 mm (SD 1.6) and 6.5 mm (SD 1.9)] distributions were similar across clinics. Overall, 233 (84%) patients opted for active surveillance and 53 (16%) for thyroid surgery. Patients in the conversation aid group were more likely to choose active surveillance than the patients seen in the usual care clinic [relative risk (RR) = 1.16; 95% confidence interval (CI), 1.04 - 1.29]. Of all patients opting for active surveillance, more patients in the conversation aid group had thyroid cancer nodules > 5 mm than in the usual care group (81% vs. 67% P = 0.013). Thyroid Cancer Treatment Choice is an evidence-based tool that supports the presentation of treatment options for PMCs. Pilot testing suggests that this conversation tool increases acceptance of active surveillance, suggesting that this option is an

Ozone-augmented percutaneous discectomy: A novel treatment option for refractory discogenic sciatica

International Nuclear Information System (INIS)

Crockett, M.T.; Moynagh, M.; Long, N.; Kilcoyne, A.; Dicker, P.; Synnott, K.; Eustace, S.J.

2014-01-01

Aim: To assess the short and medium-term efficacy and safety of a novel, minimally invasive therapeutic option combining automated percutaneous lumbar discectomy, intradiscal ozone injection, and caudal epidural: ozone-augmented percutaneous discectomy (OPLD). Materials and methods: One hundred and forty-seven patients with a clinical and radiological diagnosis of discogenic sciatica who were refractory to initial therapy were included. Fifty patients underwent OPLD whilst 97 underwent a further caudal epidural. Outcomes were evaluated using McNab's score, improvement in visual analogue score (VAS) pain score, and requirement for further intervention. Follow-up occurred at 1 and 6 months, and comparison was made between groups. Results: OPLD achieved successful outcomes in almost three-quarters of patients in the short and medium term. OPLD achieved superior outcomes at 1 and 6 months compared to caudal epidural. There was a reduced requirement for further intervention in the OPLD group. No significant complications occurred in either group. Discussion: OPLD is a safe and effective treatment for patients with refractory discogenic sciatica in the short and medium term. OPLD has the potential to offer an alternative second-line minimally invasive treatment option that could reduce the requirement for surgery in this patient cohort. - Highlights: • Discogenic sciatica is a common condition which causes significant morbidity. • Ozone augmented percutaneous lumbar discectomy (OPLD) is a novel treatment. • Comparison was made to caudal epidural injection. • All outcomes were superior in the OPLD treatment group. • OPLD appears is an effective treatment for refractory discogenic sciatica

Insurance status effects on stage of diagnosis and surgical options used in the treatment of breast cancer.

Science.gov (United States)

Lukavsky, Robert; Sariego, Jack

2015-05-01

Insurance status has the potential to play a significant role in an individual's health care by affecting the time of diagnosis and the treatment options used. Our study reviewed insurance status as a determinant of the time of a breast cancer diagnosis as well as the surgical treatment options offered. The American College of Surgeons' National Cancer Database benchmark reports were used to examine first-course surgery stratified by the stage of breast cancer diagnosed between 2000 and 2010. The data were stratified according to insurance status with a focus on insured patients versus underinsured patients. The relations among insurance status, breast cancer stage at the time of presentation, and initial treatment offered were then evaluated. There was a statistically significant relation between breast cancer stage at the time of diagnosis and insurance status. There also was a relation between insurance status and the treatment offered. Adequately insured patients presented at an earlier stage than did underinsured patients. In addition, in patients who present with early-stage disease, insured patients had a higher rate of breast-conserving surgery than did underinsured patients, 62.4% and 55.5%, respectively. This trend continued in late-stage breast cancer, in which mastectomy was the predominant treatment option overall. Despite this, insured patients underwent breast-conserving therapy more frequently than did underinsured patients, 24.2% and 21.2%, respectively. The discrepancy of the stage of diagnosis between insured patients and underinsured patients can be attributed to a host of factors, among which are access to regular office visits and screening tests for breast cancer. In addition, the surgical treatment options used may depend on the cost of treatment and accessibility to and compliance with follow-up care.

Current and emerging treatment options for Peyronie's disease

Directory of Open Access Journals (Sweden)

Gokce A

2013-01-01

Full Text Available Ahmet Gokce, Julie C Wang, Mary K Powers, Wayne JG HellstromDepartment of Urology, Tulane University – School of Medicine, New Orleans, LA, USAAbstract: Peyronie's disease (PD is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3–9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated.Keywords: oral therapy, intralesional treatment, topical therapy, extracorporeal shockwave therapy, traction devices, plication, incision and grafting, penile prosthesis.

Depression in Parkinson’s disease: Health risks, etiology, and treatment options

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Pasquale G Frisina

2008-03-01

Full Text Available Pasquale G Frisina1,2, Joan C Borod3,4, Nancy S Foldi3,5, Harriet R Tenenbaum61Leir Parkinson’s Disease Program, The Jewish Home and Hospital Lifecare System, New York, NY, USA; 2Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY, USA; 3Department of Psychology, Queens College and The Graduate Center of the City University of New York (CUNY, Flushing, NY, USA; 4Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA; 5Department of Medicine, Winthrop-University Hospital, State University of New York, Stony Brook School of Medicine; 6Department of Psychology, Kingston University, Kingston upon Thames, UKAbstract: Depression is found in about 30%–40% of all patients with Parkinson’s disease (PD, but only a small percentage (about 20% receive treatment. As a consequence, many PD patients suffer with reduced health-related quality of life. To address quality of life in depressed PD patients, we reviewed the literature on the health correlates of depression in PD (eg, cognitive function, etiology of depression in PD, and treatment options (ie, antidepressants, electroconvulsive therapy, and psychotherapy. The current review is unique in its focus on psychosocial aspects, as well as neuropathological factors, of depression in PD. Overall, we conclude that neurochemical (eg, serotonin and psychosocial factors (eg, coping style, self-esteem, and social support contribute to the affective disturbances found in this neuropsychiatric population. Therefore, we recommend that a multidisciplinary (eg, pharmacotherapeutic, psychoeducational, and/or psychotherapeutic approach to treatment be taken with depressed PD patients.Keywords: depression, Parkinson’s disease, health outcomes, treatment options

Gas inventory charges and peak-load reliability

International Nuclear Information System (INIS)

Lyon, T.P.; Hackett, S.C.

1990-01-01

The natural gas industry has historically been organized through a vertical sequence of long-term contracts, the first between wellhead producer and pipeline, and the second between pipeline and local distribution company (LDC). These long-term contracts contained provisions, variously called take-or-pay (TOP) clauses or minimum bills, that required buyers to pay for a minimum level of supply in all later time periods, regardless of the buyers' actual demand requirements. As a result, the pipeline's purchase obligation was typically offset by the distributor's purchase obligation, so that the pipeline essentially passed the minimum purchase requirement directly from producer to distributor. The authors focus on the role GICs (Gas Inventory Charges) can play in the provision of peak-load reliability, and the effects of GICs and their treatment by regulators on pipeline system design. In particular, they compare the various options available to local distribution companies (LDCs) for providing peak-load reliability, emphasizing the alternative downstream storage. They find that the ratemaking decisions of state regulators may distort LDC choices between different gas supply options, inducing what may be an inefficient demand for new storage facilities. GICs, when competitively prices, offer state regulators a means of circumventing these distortions

HEMISECTION: A TREATMENT OPTION FOR AN ENDODONTICALLY TREATED MOLAR WITH VERTICAL ROOT FRACTURE

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Anitha

2015-05-01

Full Text Available Vertical root fractures in endodontically treated teeth have long been reported and pose diagnostic difficulties. A h emisection/Root resection procedure which removes the fractured fragments completely, and retains a portion of the compromised tooth offers a predictable treatment option. The key to this rests in ideal case selection invol ving balancing all indications and contraindications. The success of the treatment depends on careful case selection based on a firm set of guidelines. This article presents a case with vertical root fracture in an endodontic treated molar. This article de scribes the case of a 60 - year - old man with a vertical root fracture on the mesial root and a healthy periodontium supporting the distal root making it ideal for retention as well as restoration and support of the final prosthesis. Also, the patient was mot ivated to try and save as much of the tooth as possible. Post - operatively no untoward complication was reported making it an alternative treatment option in patients with vertical root fracture in a molar, willing to retain the remaining tooth portion. Wit h all other factors balanced, it allows for retaining the remaining intact portion of the tooth structure.

FTR-option formulation and pricing

International Nuclear Information System (INIS)

Parmeshwaran, Vijay; Muthuraman, Kumar

2009-01-01

Recent changes in electricity markets have advocated the use of Local Marginal Prices (LMP) for congestion management and pricing. From the perspective of market participants, the LMPs pose a risk since they are not known before a transaction on the grid is made. Financial transmission rights (FTR) are instruments that help market participants hedge this risk and are issuable in two flavors - obligations and options. While pricing obligations are much easier, pricing FTR options pose a significant challenge. In this paper we develop a computational method for pricing FTR options. We also discuss the problem of designing financial instrument sets that assure revenue adequacy for the issuer. We point out the difficulty in assuring revenue adequacy when FTR options are present and propose a scheme for overcoming the difficulty. The proposed pricing method can be used to compute prices of options and obligations in the primary market or as a reliable pricing tool to compute option prices in the secondary market. Finally using a test network we present and discuss numerical results. (author)

Bevacizumab as a treatment option for radiation-induced cerebral necrosis

Energy Technology Data Exchange (ETDEWEB)

Matuschek, Christiane; Boelke, Edwin; Budach, Wilfried [Univ. Hospital Duesseldorf (Germany). Dept. of Radiation Oncology; Nawatny, Jens [Univ. Hospital Duesseldorf (Germany). Dept. of Radiology; Hoffmann, Thomas K. [Duisburg-Essen Univ., Essen (Germany). Dept. of Otorhinolaryngology; Peiper, Matthias; Orth, Klaus [Hospital Essen-Sued, Essen (Germany). Dept. of Surgery; Gerber, Peter Arne [Univ. Hospital Duesseldorf (Germany). Dept. of Dermatology; Rusnak, Ethelyn [State Univ. of New York, Buffalo, NY (United States). Dept. of Anesthesiology; Lammering, Guido [Univ. Hospital Duesseldorf (Germany). Dept. of Radiation Oncology; MAASTRO Clinic, Maastricht (Netherlands). Radiation Oncology

2011-02-15

Radiation necrosis of normal CNS tissue represents one of the main risk factors of brain irradiation, occurring more frequently and earlier at higher total doses and higher doses per fraction. At present, it is believed that the necrosis results due to increasing capillary permeability caused by cytokine release leading to extracellular edema. This process is sustained by endothelial dysfunction, tissue hypoxia, and subsequent necrosis. Consequently, blocking the vascular endothelial growth factor (VEGF) at an early stage could be an option to reduce the development of radiation necrosis by decreasing the vascular permeability. This might help to reverse the pathological mechanisms, improve the symptoms and prevent further progression. A patient with radiation-induced necrosis was treated with an anti-VEGF antibody (bevacizumab), in whom neurologic signs and symptoms improved in accordance with a decrease in T1-weighted fluid-attenuated inversion recovery signals. Our case report together with the current literature suggests bevacizumab as a treatment option for patients with symptoms and radiological signs of cerebral necrosis induced by radiotherapy. (orig.)

Bevacizumab as a treatment option for radiation-induced cerebral necrosis

International Nuclear Information System (INIS)

Matuschek, Christiane; Boelke, Edwin; Budach, Wilfried; Nawatny, Jens; Hoffmann, Thomas K.; Peiper, Matthias; Orth, Klaus; Gerber, Peter Arne; Rusnak, Ethelyn; Lammering, Guido; MAASTRO Clinic, Maastricht

2011-01-01

Radiation necrosis of normal CNS tissue represents one of the main risk factors of brain irradiation, occurring more frequently and earlier at higher total doses and higher doses per fraction. At present, it is believed that the necrosis results due to increasing capillary permeability caused by cytokine release leading to extracellular edema. This process is sustained by endothelial dysfunction, tissue hypoxia, and subsequent necrosis. Consequently, blocking the vascular endothelial growth factor (VEGF) at an early stage could be an option to reduce the development of radiation necrosis by decreasing the vascular permeability. This might help to reverse the pathological mechanisms, improve the symptoms and prevent further progression. A patient with radiation-induced necrosis was treated with an anti-VEGF antibody (bevacizumab), in whom neurologic signs and symptoms improved in accordance with a decrease in T1-weighted fluid-attenuated inversion recovery signals. Our case report together with the current literature suggests bevacizumab as a treatment option for patients with symptoms and radiological signs of cerebral necrosis induced by radiotherapy. (orig.)

Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature

Directory of Open Access Journals (Sweden)

T. Roshna

2012-01-01

Full Text Available Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review.

[The Probabilistic Efficiency Frontier: A Value Assessment of Treatment Options in Hepatitis C].

Science.gov (United States)

Mühlbacher, Axel C; Sadler, Andrew

2017-06-19

Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV). This case study shows how methodological challenges could be overcome in order to use the efficiency frontier for economic analysis and health care decision-making. Method The operationalization of patient benefit was carried out on several patient-relevant endpoints. Preference data from a discrete choice experiment (DCE) study and clinical data based on clinical trials, which reflected the patient and the clinical perspective, respectively, were used for the aggregation of an overall benefit score. A probabilistic efficiency frontier was constructed in a Monte Carlo simulation with 10000 random draws. Patient-relevant endpoints were modeled with a beta distribution and preference data with a normal distribution. The assessment of overall benefit and costs provided information about the adequacy of the treatment prices. The parameter uncertainty was illustrated by the price-acceptability-curve and the net monetary benefit. Results Based on the clinical and preference data in Germany, the interferon-free treatment options proved to be efficient for the current price level. The interferon-free therapies of the latest generation achieved a positive net cost-benefit. Within the decision model, these therapies

Acupuncture as a therapeutic treatment option for threatened miscarriage

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Betts Debra

2012-03-01

Full Text Available Abstract Background Threatened miscarriage involves vaginal bleeding in a pregnancy that remains viable. This is a common early pregnancy complication with increased risk factors for early pregnancy loss, preterm premature rupture of membranes (PPROM, preterm delivery, low birth weight babies and maternal antepartum haemorrhage. Currently there are no recommended medical treatment options, rather women receive advice that centres on a 'wait and see' approach. For women with a history of unexplained recurrent miscarriage providing supportive care in a subsequent pregnancy improves live birthing outcomes, but the provision of supportive care to women experiencing threatened miscarriage has to date not been examined. Discussion While it is known that 50-70% of miscarriages occur due to chromosomal abnormalities, the potential for therapeutic intervention amongst the remaining percentage of women remains unknown. Complementary and alternative medicine (CAM therapies have the potential to provide supportive care for women presenting with threatened miscarriage. Within fertility research, acupuncture demonstrates beneficial hormonal responses with decreased miscarriage rates, raising the possibility acupuncture may promote specific beneficial effects in early pregnancy. With the lack of current medical options for women presenting with threatened miscarriage it is timely to examine the possible treatment benefits of providing CAM therapies such as acupuncture. Summary Despite vaginal bleeding being a common complication of early pregnancy there is often reluctance from practitioners to discuss with women and medical personal how and why CAM may be beneficial. In this debate article, the physiological processes of early pregnancy together with the concept of providing supportive care and acupuncture are examined. The aim is to raise awareness and promote discussion as to the beneficial role CAM may have for women presenting with threatened miscarriage.

Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management.

Science.gov (United States)

Ikpeze, Tochukwu C; Mesfin, Addisu

2017-06-01

Spinal cord injuries (SCIs) are sustained by more than 12 500 patients per year in the United States and more globally. The SCIs disproportionately affect the elderly, especially men. Approximately 60% of these injuries are sustained traumatically through falls, but nontraumatic causes including infections, tumors, and medication-related epidural bleeding have also been documented. Preexisting conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis can render the spine stiff and are risk factors as well as cervical spondylosis and ensuing cervical stenosis. Treatment options vary depending on the severity, location, and complexity of the injury. Surgical management has been growing in popularity over the years and remains an option as it helps reduce spinal cord compression and alleviate pain. Elevating mean arterial pressures to prevent spinal cord ischemia and avoiding the second hit of SCI have become more common as opposed to high dose steroids. Ongoing clinical trials with pharmacological agents such as minocycline and riluzole have shown early, promising results in their ability to reduce cellular damage and facilitate recovery. Though SCI can be life changing, the available treatment options have aimed to reduce pain and minimize complications and maintain quality of life alongside rehabilitative services.

Mixed waste management options

International Nuclear Information System (INIS)

Owens, C.B.; Kirner, N.P.

1992-01-01

Currently, limited storage and treatment capacity exists for commercial mixed waste streams. No commercial mixed waste disposal is available, and it has been estimated that if and when commercial mixed waste disposal becomes available, the costs will be high. If high disposal fees are imposed, generators may be willing to apply extraordinary treatment or regulatory approaches to properly dispose of their mixed waste. This paper explores the feasibility of several waste management scenarios and management options. Existing data on commercially generated mixed waste streams are used to identify the realm of mixed waste known to be generated. Each waste stream is evaluated from both a regulatory and technical perspective in order to convert the waste into a strictly low-level radioactive or a hazardous waste. Alternative regulatory approaches evaluated in this paper include a delisting petition) no migration petition) and a treatability variance. For each waste stream, potentially available treatment options are identified that could lead to these variances. Waste minimization methodology and storage for decay are also considered. Economic feasibility of each option is discussed broadly. Another option for mixed waste management that is being explored is the feasibility of Department of Energy (DOE) accepting commercial mixed waste for treatment, storage, and disposal. A study has been completed that analyzes DOE treatment capacity in comparison with commercial mixed waste streams. (author)

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Science.gov (United States)

Graziani, Filippo; Karapetsa, Dimitra; Alonso, Bettina; Herrera, David

2017-10-01

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Antenatal Hydronephrosis: Differential Diagnosis, Evaluation, and Treatment Options

Science.gov (United States)

Herndon, C.D. Anthony

2006-01-01

The diagnosis, evaluation and management of antenatal hydronephrosis has undergone a two stage paradigm shift since the advent of prenatal ultrasonography in the early 1980s. Initially the identification of a large number of asymptomatic infants appeared to afford the surgeon the opportunity for preemptive intervention. However, it has now become apparent that antenatal hydronephrosis (AH) is far more difficult to interpret thanoriginally perceived. The initial enthusiasm for surgery has now been replaced by a much more conservative approach to ureteropelvic junction(UPJ) obstruction, multi-cystic dysplastic kidney(MCDK), vesicoureteral reflux and the non-refluxing megaureter. This review will highlight the postnatal evaluation of AH and include an overview of the Society for Fetal Urology grading system for hydronephrosis. The differential diagnosis and treatment options for UPJ obstruction, vesicoureteral reflux, MCDK, duplication anomalies, megaureter, and posterior urethral valves will be discussed. PMID:17619702

Transepidermal drug delivery: a new treatment option for areata alopecia?

Science.gov (United States)

Issa, Maria Claudia Almeida; Pires, Marianna; Silveira, Priscilla; Xavier de Brito, Esther; Sasajima, Cristiane

2015-02-01

Transepidermal drug delivery (TED) is a new potential method in dermatology. Permeability alterations induced by ablative fractional resurfacing have been described with the aim to increasing the delivery of different substances into the skin. To evaluate clinical response and side effects of TED in areata alopecia (AA) treatment using ablative fractional methods associated with acoustic pressure ultrasound (US) to deliver triamcinolone solution into the skin. Five cases of AA underwent treatment which comprised of 3 steps: 1) Ablative fractioned RF or CO2 laser 2) topical application of triamcinolone 3) acoustic pressure wave US. The number of sessions varied according to the clinical response, ranging from one to six sessions. All patients had complete recovery of the area treated. Two of them treated with ablative fractional RF + triamcinolone + US had complete response after three and six sessions. The other two treated with ablative fractional CO2 + triamcinolone + US had complete response after one session. Fractioned ablative resurfacing associated with acoustic pressure wave US is a new option to areata alopecia treatment with good clinical result and low incidence of side effects.

Chronic migraine--classification, characteristics and treatment

DEFF Research Database (Denmark)

Diener, Hans-Christoph; Dodick, David W; Goadsby, Peter J

2012-01-01

excluded patients who had headaches for =15 days per month. Despite this lack of reliable data, a wealth of expert opinion and a few evidence-based treatment options are available for managing chronic migraine. Trial data are available for topiramate and botulinum toxin type A, and expert opinion suggests...

Reliability and risk treatment centered maintenance

International Nuclear Information System (INIS)

Pexa, Martin; Hladik, Tomas; Ales, Zdenek; Legat, Vaclav; Muller, Miroslav; Valasek, Petr; Havlu, Vit

2014-01-01

We propose a new methodology for application of well-known tools - RCM, RBI and SIF pro - with the aim to treat risks by means of suitable maintenance. The basis of the new methodology is the complex application of all three methods at the same time and not separately as is typical today. The proposed methodology suggests having just one managing team for reliability and risk treatment centred maintenance (RRTCM), employing existing RCM, RBI, and SIFpro tools concurrently. This approach allows for significant reduction of engineering activities' duration. In the proposed methodology these activities are staged into five phases and structured to eliminate all duplication resulting from separate application of the three tools. The newly proposed methodology saves 45% to 50% of the engineering workload and dequate significant financial savings.

Reliability and risk treatment centered maintenance

Energy Technology Data Exchange (ETDEWEB)

Pexa, Martin; Hladik, Tomas; Ales, Zdenek; Legat, Vaclav; Muller, Miroslav; Valasek, Petr [Czech University of Life Sciences Prague, Kamycka (Czech Republic); Havlu, Vit [Unipetrol A. S, Prague (Czech Republic)

2014-10-15

We propose a new methodology for application of well-known tools - RCM, RBI and SIF pro - with the aim to treat risks by means of suitable maintenance. The basis of the new methodology is the complex application of all three methods at the same time and not separately as is typical today. The proposed methodology suggests having just one managing team for reliability and risk treatment centred maintenance (RRTCM), employing existing RCM, RBI, and SIFpro tools concurrently. This approach allows for significant reduction of engineering activities' duration. In the proposed methodology these activities are staged into five phases and structured to eliminate all duplication resulting from separate application of the three tools. The newly proposed methodology saves 45% to 50% of the engineering workload and dequate significant financial savings.

The fair value of operational reliability

International Nuclear Information System (INIS)

Patino-Echeverri, Dalia; Morel, Benoit

2005-01-01

Information about the uncertainties that surround the operation of the power system can be used to enlighten the debate of how much reliability should be pursued and how resources should be allocated to pursue it. In this paper we present a method to determine the value of having flexible generators to react to load fluctuations. This value can be seen as the value of hedging against the uncertainty on the load due to the volatility of the demand and the possibility of congestion. Because having this flexibility can be related to a financial option, we will use an extension of options theory and in particular the risk-neutral valuation method, to find a risk neutral quantification of its value. We illustrate our point valuing the flexibility that leads to ''operational reliability'' in the PJM market. Our formula for that value is what we call ''the fair value'' of operational reliability. (Author)

Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options.

Science.gov (United States)

Vora, Molly; Curry, Emily; Chipman, Amanda; Matzkin, Elizabeth; Li, Xinning

2017-12-14

Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS.

Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options

Science.gov (United States)

Vora, Molly; Curry, Emily; Chipman, Amanda; Matzkin, Elizabeth; Li, Xinning

2018-01-01

Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS. PMID:29564075

Decision theory, the context for risk and reliability analysis

International Nuclear Information System (INIS)

Kaplan, S.

1985-01-01

According to this model of the decision process then, the optimum decision is that option having the largest expected utility. This is the fundamental model of a decision situation. It is necessary to remark that in order for the model to represent a real-life decision situation, it must include all the options present in that situation, including, for example, the option of not deciding--which is itself a decision, although usually not the optimum one. Similarly, it should include the option of delaying the decision while the authors gather further information. Both of these options have probabilities, outcomes, impacts, and utilities like any option and should be included explicitly in the decision diagram. The reason for doing a quantitative risk or reliability analysis is always that, somewhere underlying there is a decision to be made. The decision analysis therefore always forms the context for the risk or reliability analysis, and this context shapes the form and language of that analysis. Therefore, they give in this section a brief review of the well-known decision theory diagram

Process and technological options for odorous emissions control in wastewater treatment plants

International Nuclear Information System (INIS)

Cernuschi, S.; Torretta, V.

1996-01-01

The emissions of odorous substances together with noise and issues related to proper architectural design within the existing territorial context, have certainly to be considered one of the most significant environmental effects determined by wastewater treatment plants particularly in the most frequent case of their localization in dense urban areas. Following a brief introduction on the chemical properties of odorous compounds and the corresponding methods for representing their concentration levels in air, present work reports on the main qualitative and quantitative characteristics of odorous emissions originating from single unit operations of typical wastewater treatment plants and on the technological and process options available for their control

Mine Drainage Generation and Control Options.

Science.gov (United States)

Wei, Xinchao; Rodak, Carolyn M; Zhang, Shicheng; Han, Yuexin; Wolfe, F Andrew

2016-10-01

This review provides a snapshot of papers published in 2015 relevant to the topic of mine drainage generation and control options. The review is broken into 3 sections: Generation, Prediction and Prevention, and Treatment Options. The first section, mine drainage generation, focuses on the characterization of mine drainage and the environmental impacts. As such, it is broken into three subsections focused on microbiological characterization, physiochemical characterization, and environmental impacts. The second section of the review is divided into two subsections focused on either the prediction or prevention of acid mine drainage. The final section focuses on treatment options for mine drainage and waste sludge. The third section contains subsections on passive treatment, biological treatment, physiochemical treatment, and a new subsection on beneficial uses for mine drainage and treatment wastes.

[Evidence-based therapy for cartilage lesions in the knee - regenerative treatment options].

Science.gov (United States)

Proffen, B; von Keudell, A; Vavken, P

2012-06-01

The treatment of cartilage defects has seen a shift from replacement to regeneration in the last few years. The rationale behind this development is the improvement in the quality-of-care for the growing segment of young patients who are prone to arthroplasty complications because of their specific characteristics - young age, high level of activity, high demand for functionality. These days, two of the most popular regenerative treatments are microfracture and autologous chondrocyte implantation (ACI). Although these new options show promising results, no final algorithm for the treatment of cartilage lesions has been established as yet. The objective of this review is to describe and compare these two treatment options and to present an evidence-based treatment algorithm for focal cartilage defects. Microfracture is a cost-effective, arthroscopic one-stage procedure, in which by drilling of the subchondral plate, mesenchymal stem cells from the bone marrow migrate into the defect and rebuild the cartilage. ACI is a two-stage procedure in which first chondrocytes are harvested, expanded in cell culture and in a second open procedure reimplanted into the cartilage defect. Microfracture is usually used for focal cartilage defects osteophyte, and for the ACI patient, periosteal hypertrophy and the need for two procedures in ACI. Only a few studies provide detailed and evidence-based information on a comparative assessment. These studies, however, are showing widely similar clinical outcomes but better histological results for ACI, which are likely to translate into better long-term outcomes. Although evidence-based studies comparing microfracture and ACI have not found significant differences in the clinical outcome, the literature does show that choosing the treatment based on the size and characteristics of the osteochondral lesion might be beneficial. The American Association of Orthopedic Surgeons suggest that contained lesions < 4 cm2 should be treated by

Cryoablation in fibro-adipose vascular anomaly (FAVA): a minimally invasive treatment option

International Nuclear Information System (INIS)

Shaikh, Raja; Alomari, Ahmad I.; Kerr, Cindy L.; Miller, Patricia; Spencer, Samantha A.

2016-01-01

Fibro-adipose vascular anomaly (FAVA) is a complex vascular malformation that typically presents with persistent pain, discomfort, contracture and other disabling symptoms. There are no minimally invasive treatment options to effectively control these symptoms. Image-guided percutaneous cryoablation, which has been used to control pain in people with cancer, could be used for similar indications in FAVA. To assess the role of image-guided percutaneous cryoablation for control of symptoms in FAVA lesions. We conducted a retrospective cohort study of 20 children and young adults with FAVA who underwent percutaneous cryoablation at 26 sites, from September 2013 to August 2015. The outcome was based on the brief pain inventory scoring (BPI), concurrent symptoms, clinical response and patient satisfaction. After cryoablation there was significant improvement in pain, which dropped by 3 points (pain now) to 3.7 points (pain in the last 24 h). Most patients indicated that pain interfered less in their everyday social life. Concurrent symptoms like swelling, physical limitations and skin hyperesthesia also improved. Clinical response was greatest at 2-5 months follow-up after cryoablation, with acceptable patient satisfaction thereafter. Technical response was 100%. There were no major complications. Image-guided percutaneous cryoablation is a safe and effective option for treatment of symptomatic FAVA lesions. (orig.)

Ozone-augmented percutaneous discectomy: a novel treatment option for refractory discogenic sciatica.

Science.gov (United States)

Crockett, M T; Moynagh, M; Long, N; Kilcoyne, A; Dicker, P; Synnott, K; Eustace, S J

2014-12-01

To assess the short and medium-term efficacy and safety of a novel, minimally invasive therapeutic option combining automated percutaneous lumbar discectomy, intradiscal ozone injection, and caudal epidural: ozone-augmented percutaneous discectomy (OPLD). One hundred and forty-seven patients with a clinical and radiological diagnosis of discogenic sciatica who were refractory to initial therapy were included. Fifty patients underwent OPLD whilst 97 underwent a further caudal epidural. Outcomes were evaluated using McNab's score, improvement in visual analogue score (VAS) pain score, and requirement for further intervention. Follow-up occurred at 1 and 6 months, and comparison was made between groups. OPLD achieved successful outcomes in almost three-quarters of patients in the short and medium term. OPLD achieved superior outcomes at 1 and 6 months compared to caudal epidural. There was a reduced requirement for further intervention in the OPLD group. No significant complications occurred in either group. OPLD is a safe and effective treatment for patients with refractory discogenic sciatica in the short and medium term. OPLD has the potential to offer an alternative second-line minimally invasive treatment option that could reduce the requirement for surgery in this patient cohort. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Economic assessment of preeclampsia : Screening, diagnosis, treatment options, and long term outcomes - A systematic review

NARCIS (Netherlands)

Zakiyah, Neily; Van Asselt, Antoinette D.; Baker, Philip N.; Postma, Maarten J.

OBJECTIVES: Provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis, and treatment options in preeclampsia. METHODS: A systematic literature search was undertaken using three electronic databases (MEDLINE, Embase, Cochrane) to identify all English

The genetics of age-related macular degeneration (AMD)--Novel targets for designing treatment options?

Science.gov (United States)

Grassmann, Felix; Fauser, Sascha; Weber, Bernhard H F

2015-09-01

Age-related macular degeneration (AMD) is a progressive disease of the central retina and the main cause of legal blindness in industrialized countries. Risk to develop the disease is conferred by both individual as well as genetic factors with the latter being increasingly deciphered over the last decade. Therapeutically, striking advances have been made for the treatment of the neovascular form of late stage AMD while for the late stage atrophic form of the disease, which accounts for almost half of the visually impaired, there is currently no effective therapy on the market. This review highlights our current knowledge on the genetic architecture of early and late stage AMD and explores its potential for the discovery of novel, target-guided treatment options. We reflect on current clinical and experimental therapies for all forms of AMD and specifically note a persisting lack of efficacy for treatment in atrophic AMD. We further explore the current insight in AMD-associated genes and pathways and critically question whether this knowledge is suited to design novel treatment options. Specifically, we point out that known genetic factors associated with AMD govern the risk to develop disease and thus may not play a role in its severity or progression. Treatments based on such knowledge appear appropriate rather for prevention than treatment of manifest disease. As a consequence, future research in AMD needs to be greatly focused on approaches relevant to the patients and their medical needs. Copyright © 2015 Elsevier B.V. All rights reserved.

Economic assessment of preeclampsia : Screening, diagnosis, treatment options, and long term outcomes, a systematic review

NARCIS (Netherlands)

Zakiyah, N.; Van Asselt, A.; Baker, P.; Postma, M.J.

2014-01-01

Objectives: To provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis, and treatment options in preeclampsia. Methods: A systematic literature search was undertaken using three electronic databases (MEDLINE, Embase, Cochrane) to identify all English

24 CFR 35.120 - Options.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Options. 35.120 Section 35.120... and Definitions for All Programs. § 35.120 Options. (a) Standard treatments. Where interim controls are required by this part, the designated party has the option to presume that lead-based paint or...

The fair value of operational reliability

Energy Technology Data Exchange (ETDEWEB)

Patino-Echeverri, Dalia; Morel, Benoit

2005-12-15

Information about the uncertainties that surround the operation of the power system can be used to enlighten the debate of how much reliability should be pursued and how resources should be allocated to pursue it. In this paper we present a method to determine the value of having flexible generators to react to load fluctuations. This value can be seen as the value of hedging against the uncertainty on the load due to the volatility of the demand and the possibility of congestion. Because having this flexibility can be related to a financial option, we will use an extension of options theory and in particular the risk-neutral valuation method, to find a risk neutral quantification of its value. We illustrate our point valuing the flexibility that leads to ''operational reliability'' in the PJM market. Our formula for that value is what we call ''the fair value'' of operational reliability. (Author)

Cocaine Addiction Treatments to improve Control and reduce Harm (CATCH): new pharmacological treatment options for crack-cocaine dependence in the Netherlands

NARCIS (Netherlands)

Nuijten, Mascha; Blanken, Peter; van den Brink, Wim; Hendriks, Vincent

2011-01-01

Cocaine, particularly in its base form ('crack'), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options

Reliability, validity and treatment sensitivity of the Schizophrenia Cognition Rating Scale.

Science.gov (United States)

Keefe, Richard S E; Davis, Vicki G; Spagnola, Nathan B; Hilt, Dana; Dgetluck, Nancy; Ruse, Stacy; Patterson, Thomas D; Narasimhan, Meera; Harvey, Philip D

2015-02-01

Cognitive functioning can be assessed with performance-based assessments such as neuropsychological tests and with interview-based assessments. Both assessment methods have the potential to assess whether treatments for schizophrenia improve clinically relevant aspects of cognitive impairment. However, little is known about the reliability, validity and treatment responsiveness of interview-based measures, especially in the context of clinical trials. Data from two studies were utilized to assess these features of the Schizophrenia Cognition Rating Scale (SCoRS). One of the studies was a validation study involving 79 patients with schizophrenia assessed at 3 academic research centers in the US. The other study was a 32-site clinical trial conducted in the US and Europe comparing the effects of encenicline, an alpha-7 nicotine agonist, to placebo in 319 patients with schizophrenia. The SCoRS interviewer ratings demonstrated excellent test-retest reliability in several different circumstances, including those that did not involve treatment (ICC> 0.90), and during treatment (ICC>0.80). SCoRS interviewer ratings were related to cognitive performance as measured by the MCCB (r=-0.35), and demonstrated significant sensitivity to treatment with encenicline compared to placebo (Pcognition in schizophrenia, and may be useful for clinical practice. The weaknesses of the SCoRS include its reliance on informant information, which is not available for some patients, and reduced validity when patient's self-report is the sole information source. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

[Novel current and future therapy options for treatment of dry eye disease].

Science.gov (United States)

Messmer, E M

2018-02-01

Dry eye disease was redefined by the dry eye workshop (DEWS II) in May 2017. According to the new definition "dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms". The current definition encompasses etiological factors, such as instability and hyperosmolarity of the tear film, ocular surface inflammation and damage as well as a new aspect compared to the former definition, neurosensory abnormalities. Recent and future therapeutic options for dry eye focus on treatment of the aforementioned pathogenetic events. New tear substitutes, medications and devices to stimulate tear production, innovative anti-inflammatory treatment, medications to influence corneal innervation and new methods for treatment of Meibomian gland dysfunction are already available or will be available in the near future.

End-stage renal disease treatment options education: What matters most to patients and families.

Science.gov (United States)

St Clair Russell, Jennifer; Boulware, L Ebony

2018-03-01

Treatment modality education can offer many important benefits to patients and their families. Evidence suggests such education can increase use of home dialysis, reduce catheter use, decrease 90-day mortality, and increase transplantation. While these benefits are encouraging, not all patients are offered options education and when they are, it may not be presented in a way that is immediately applicable to them and their lives. Furthermore, little is known regarding specific characteristics (e.g. format such as group or individual or in-person or online, duration, teaching methods, location, content) of educational programs that are most successful. No single approach has emerged as a best practice. In the absence of such evidence, adult learning principles, such as involving patients and families in the development programs and materials, can serve as a guide for educational development. Adult learning principles can enhance options education, evolving them from information delivery to a person-centered, values-based endeavor that helps match treatment to values and lifestyle. © 2018 Wiley Periodicals, Inc.

Treatment Options

Science.gov (United States)

... one that is tailored to your symptoms. article Protecting your eyesight when taking Plaquenil Some lupus treatments have the potential for eye health side-effects. Know the warning signs. article ​ ...

Cost-effectiveness analysis of Option B+ for HIV prevention and treatment of mothers and children in Malawi.

Science.gov (United States)

Fasawe, Olufunke; Avila, Carlos; Shaffer, Nathan; Schouten, Erik; Chimbwandira, Frank; Hoos, David; Nakakeeto, Olive; De Lay, Paul

2013-01-01

The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option. A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi. If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice. In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child

Kalaeloa Energy System Redevelopment Options Including Advanced Microgrids.

Energy Technology Data Exchange (ETDEWEB)

Hightower, Marion Michael [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Baca, Michael J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); VanderMey, Carissa [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2017-03-01

In June 2016, the Department of Energy's (DOE's) Office of Energy Efficiency and Renewable Energy (EERE) in collaboration with the Renewable Energy Branch for the Hawaii State Energy Office (HSEO), the Hawaii Community Development Authority (HCDA), the United States Navy (Navy), and Sandia National Laboratories (Sandia) established a project to 1) assess the current functionality of the energy infrastructure at the Kalaeloa Community Development District, and 2) evaluate options to use both existing and new distributed and renewable energy generation and storage resources within advanced microgrid frameworks to cost-effectively enhance energy security and reliability for critical stakeholder needs during both short-term and extended electric power outages. This report discusses the results of a stakeholder workshop and associated site visits conducted by Sandia in October 2016 to identify major Kalaeloa stakeholder and tenant energy issues, concerns, and priorities. The report also documents information on the performance and cost benefits of a range of possible energy system improvement options including traditional electric grid upgrade approaches, advanced microgrid upgrades, and combined grid/microgrid improvements. The costs and benefits of the different improvement options are presented, comparing options to see how well they address the energy system reliability, sustainability, and resiliency priorities identified by the Kalaeloa stakeholders.

An estimation of US horse-owner/caregiver willingness-to-pay for daily use and infectious upper respiratory disease treatment options.

Science.gov (United States)

Kibler, M L; Pendell, D L; Costanigro, M; Traub-Dargatz, J

2018-07-01

Equine injury and disease cause two types of costs for those financially responsible for treating and caring for the infected horse(s); direct costs of treating the horse and indirect cost of lost use of the horse for a period of time to the user of the horse (daily horse use). Indirect costs are more difficult to estimate but pose significant financial implications for equine-owners/caregivers. Additionally, there exists a gap in existing research regarding the valuation of infectious treatment options in horses. To estimate the value a US horse-owner/caregiver places on daily horse use and describe respondents' willingness-to-pay for various attributes of equine treatment options. Online questionnaire survey. An online questionnaire was provided to equine-owners and caretakers, and owner demographic, horse care and horse use information from respondents were requested. Additionally, respondents were presented with hypothetical disease treatment options with the following attributes: daily dosage, number of days of rest required, route of administration and out-of-pocket cost to the owner/caretaker through a choice experiment. Data were analysed using a rank-ordered logit analysis and willingness-to-pay estimates for daily use and treatment options were calculated. Results suggest that the average horse-owner with an uninsured and insured horse is willing to pay $12.07 (95% confidence interval: -$15.01, -$9.69) and $17.95 (95% confidence interval: -$25.30, -$11.20) per day to reduce lost use days required (due to need for rest) respectively. Respondents showed preferences for oral administration over treatments requiring i.m. injections. As this study employed an online survey it was subjected to self-selection bias and a sample size calculation was not performed. Veterinarians and pharmaceutical companies may use these results when promoting various treatment options to horse-owners/caregivers and in product development. Additionally, promotion efforts may be

Split high-dose oral levothyroxine treatment as a successful therapy option in myxedema coma.

Science.gov (United States)

Charoensri, Suranut; Sriphrapradang, Chutintorn; Nimitphong, Hataikarn

2017-10-01

High-dose intravenous thyroxine (T4) is the preferable treatment for myxedema coma. We describe the clinical course of a 69-year-old man who presented with myxedema coma and received oral levothyroxine (LT4) therapy (1 mg) in a split dose. This suggests split high-dose oral LT4 as a therapeutic option in myxedema coma.

Atypical antipsychotics as a possible treatment option for irritable bowel syndrome.

Science.gov (United States)

Pae, Chi-Un; Lee, Soo-Jung; Han, Changsu; Patkar, Ashwin A; Masand, Prakash S

2013-05-01

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder (FGID) that is characterised by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. Although the pathophysiology of IBS is not fully understood, it is believed that psychiatric comorbidities are highly common in such patients. A variety of psychotropic medications are widely used in the treatment of IBS, particularly older antidepressants such as tricyclic antidepressants (TCAs). With the advent of newer antidepressant classes with better safety and tolerability compared with TCAs, such as serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), clinicians now have more advanced treatment options for treating IBS. Additionally, some atypical antipsychotics (AAs) have recently received approval for treatment of major depressive disorder (MDD). Some AAs may have potentials based on their pharmacodynamic profile and proven benefit for mood symptoms, pain, anxiety and sleep disturbances. This article describes the potential rationale, clinical data and practical aspects involved in the use of AAs for patients with IBS. Atypical antipsychotics (AAs) may have a role in the treatment of irritable bowel syndrome (IBS) based on the currently available findings, although there is no clear evidence, and a number of clinical issues to be addressed in the use of AAs for the treatment of IBS.

Tadalafil once daily: Narrative review of a treatment option for female sexual dysfunctions (FSD in midlife and older women

Directory of Open Access Journals (Sweden)

Chiara Borghi

2017-03-01

Full Text Available Female Sexual Disorders (FSD include a complex, multidimensional, individual experience that can change as an individual age, suggesting that these problems are caused by multiple factors including psychosocial factors, personal relationships, pathologic changes caused by diseases, and pharmacologic influences. Menopause is an important time for middle aged women and postmenopausal physiological changes could have a significant role in the development of FSD. Few is still known about their correct definition and treatment. Their incidence, prevalence and risk factors are difficult to define because of a high level of overlap in the experience of problems with desire, arousal, and orgasm. Little evidences are known about the best therapeutic approach, and both non-pharmacological and pharmacological treatment options have been described. Among these, phosphodiesterase type 5 inhibitors could be an effective option for many subtypes of female sexual disorders, with an improvement in different aspects of sexual function, such as desire, arousal, orgasm and sexual satisfaction. In this paper authors reviewed what is already known about the use of these vasoactive agents, particularly tadalafil, as a treatment option for female sexual disturbances.

Can Reliability of Multiple Component Measuring Instruments Depend on Response Option Presentation Mode?

Science.gov (United States)

Menold, Natalja; Raykov, Tenko

2016-01-01

This article examines the possible dependency of composite reliability on presentation format of the elements of a multi-item measuring instrument. Using empirical data and a recent method for interval estimation of group differences in reliability, we demonstrate that the reliability of an instrument need not be the same when polarity of the…

Maturity onset diabetes of the young: Diagnosis and treatment options

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Serghei Covanțev

2016-12-01

Full Text Available Diabetes is a complicated disease, so multiple factors are involved in its development. Nevertheless some of the patients with type 1 and 2 diabetes mellitus have a monogenic form of this disease which has different treatment options and usually fewer complications. It is estimated that about 5% of patients with type 2 diabetes melitus (T2DM and about 10% of type 1 diabetes melitus (T1DM are misdiagnosed and have maturity onset diabetes of the young (MODY. We present a review study of the management of most frequent monogenic forms of diabetes such as MODY 1, 2 and 3 and the possibilities of their diagnosis including in resource limited situations.

Laryngeal manifestations of relapsing polychondritis and a novel treatment option.

Science.gov (United States)

Childs, Lesley F; Rickert, Scott; Wengerman, Oscar C; Lebovics, Robert; Blitzer, Andrew

2012-09-01

Laryngotracheal involvement in relapsing polychondritis (RP) is rare. However, it is one of the most common causes of death in this patient population. We present three patients who primarily presented with laryngeal manifestations of RP and a novel treatment option for bamboo nodules. Retrospective chart review and comprehensive review of the literature. Two patients first presented to an otolaryngologist because of hoarseness and chronic cough that eventually progressed to dyspnea upon exertion. Laryngeal examination revealed subglottic stenoses. Upon rheumatologic workup both were diagnosed with RP. After treatment with steroids and immunosuppressive drugs, one of the patient's laryngeal symptoms improved, whereas the other required dilation procedures. Neither patient had classic auricular or nasal symptoms upon initial presentation. The third patient was being treated for spasmodic dysphonia and was noted to have bamboo nodules with accompanying dysphonia. Rheumatologic workup revealed RP and systemic treatment ensued. Unfortunately, her symptoms of hoarseness persisted despite systemic treatment. A pulsed-potassium-titanyl-phosphate (KTP) laser was applied to the bilateral bamboo nodules, which eventually caused resolution of her vocal fold lesions and dysphonia. We present three patients with RP, all of whom sought health care by an otolaryngologist primarily. Awareness of this disease entity and the possibility for early laryngeal involvement is crucial for proper care of those with this life-threatening disease. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Reliability and validity of the Treatment Satisfaction Questionnaire for Medication among Portuguese-speaking Brazilian patients with hypertension.

Science.gov (United States)

Sauer Liberato, Ana Carolina; Cunha Matheus Rodrigues, Roberta; Kim, MyoungJin; Mallory, Caroline

2016-07-01

This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. Cross-sectional descriptive exploratory study. A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. Correlational analyses, internal consistency (Cronbach's alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. Within known limitations, clinicians will

Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients

OpenAIRE

Song, Guang-Ying; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Baumrind, Sheldon; Geng, Zhi; Xu, Tian-Min

2013-01-01

This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 pat...

Rapidly changing treatment options adding burden to the management of typhoid fever

Directory of Open Access Journals (Sweden)

Jaspal Kaur

2015-01-01

Full Text Available Typhoid fever continues to be a global public health problem. It is caused by the facultative intracellular organisms Salmonella enteric serotype Typhi and Salmonella paratyphi. Antimicrobial therapy is the mainstay for treatment of typhoid fever. Chloramphenicol, ampicillin, and cotrimoxazole had been in use for decades for treating enteric fever. But the emergence and rapid spread of drug resistance has resulted in rapid shift of treatment options from chloramphenicol to fluoroquinolones to third generation cephalosporins to azithromycin with tigecycline and carbapenems in line, thus adding burden to the health-care sector in developing countries. Rational and judicious antibiotic prescribing practices by health professionals are necessary to prevent further development of drug resistance and help in re-emergence of sensitive strains.

Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution.

Science.gov (United States)

Swords, Darden C; Al-Geizawi, Samer M; Farney, Alan C; Rogers, Jeffrey; Burkart, John M; Assimos, Dean G; Stratta, Robert J

2013-01-01

Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive. © 2013 John Wiley & Sons A/S.

Reducing the number of options on multiple-choice questions: response time, psychometrics and standard setting.

Science.gov (United States)

Schneid, Stephen D; Armour, Chris; Park, Yoon Soo; Yudkowsky, Rachel; Bordage, Georges

2014-10-01

Despite significant evidence supporting the use of three-option multiple-choice questions (MCQs), these are rarely used in written examinations for health professions students. The purpose of this study was to examine the effects of reducing four- and five-option MCQs to three-option MCQs on response times, psychometric characteristics, and absolute standard setting judgements in a pharmacology examination administered to health professions students. We administered two versions of a computerised examination containing 98 MCQs to 38 Year 2 medical students and 39 Year 3 pharmacy students. Four- and five-option MCQs were converted into three-option MCQs to create two versions of the examination. Differences in response time, item difficulty and discrimination, and reliability were evaluated. Medical and pharmacy faculty judges provided three-level Angoff (TLA) ratings for all MCQs for both versions of the examination to allow the assessment of differences in cut scores. Students answered three-option MCQs an average of 5 seconds faster than they answered four- and five-option MCQs (36 seconds versus 41 seconds; p = 0.008). There were no significant differences in item difficulty and discrimination, or test reliability. Overall, the cut scores generated for three-option MCQs using the TLA ratings were 8 percentage points higher (p = 0.04). The use of three-option MCQs in a health professions examination resulted in a time saving equivalent to the completion of 16% more MCQs per 1-hour testing period, which may increase content validity and test score reliability, and minimise construct under-representation. The higher cut scores may result in higher failure rates if an absolute standard setting method, such as the TLA method, is used. The results from this study provide a cautious indication to health professions educators that using three-option MCQs does not threaten validity and may strengthen it by allowing additional MCQs to be tested in a fixed amount

Current and potential treatment options for hyperphosphatemia.

Science.gov (United States)

Carfagna, Fabio; Del Vecchio, Lucia; Pontoriero, Giuseppe; Locatelli, Francesco

2018-05-21

Hyperphosphatemia is common in late stages of chronic kidney disease and is often associated with elevated parathormone levels, abnormal bone mineralization, extra-osseous calcification, and increased risk of cardiovascular events and death. Several classes of oral phosphate binders are available to help control plasma phosphorus levels. Although effective at lowering serum phosphorus, they all have safety, tolerability, and compliance issues that need to be considered when selecting which one to use. Areas covered: This paper reviews the most established treatment options for hyperphosphatemia, in patients with chronic kidney disease, focusing on the new inhibitors of active phosphate absorption. Expert opinion: The prevention and the treatment of hyperphosphatemia is today far to be satisfactory. Nonetheless, an extending range of phosphate binders are now available. Aluminum has potentially serious toxic risks. Calcium-based binders are very effective but can lead to hypercalcemia and/or positive calcium balance and progression of cardiovascular calcification. No long-term data are available for the new calcium acetate/magnesium combination product. Lanthanum is an effective phosphate binder, and long-term effects of tissue deposition seem clinically irrelevant. Sevelamer, appear to have profiles that would lead to pleiotropic effects and reduced progression of vascular calcification, and the main adverse events seen with these agents are gastrointestinal. Iron has a powerful capability of binding phosphate, thus numerous preparations are available, both with and without significant systemic absorption of the iron component. The inhibitors of active intestinal phosphate transport, with their very selective mechanism of action and low pill burden seem the most interesting approach; however, do not seem at present to be effective alone, in reducing serum phosphorus levels.

Surgical options for lumbosacral fusion: biomechanical stability, advantage, disadvantage and affecting factors in selecting options.

Science.gov (United States)

Yoshihara, Hiroyuki

2014-07-01

Numerous surgical procedures and instrumentation techniques for lumbosacral fusion (LSF) have been developed. This is probably because of its high mechanical demand and unique anatomy. Surgical options include anterior column support (ACS) and posterior stabilization procedures. Biomechanical studies have been performed to verify the stability of those options. The options have their own advantage but also disadvantage aspects. This review article reports the surgical options for lumbosacral fusion, their biomechanical stability, advantages/disadvantages, and affecting factors in option selection. Review of literature. LSF has lots of options both for ACS and posterior stabilization procedures. Combination of posterior stabilization procedures is an option. Furthermore, combinations of ACS and posterior stabilization procedures are other options. It is difficult to make a recommendation or treatment algorithm of LSF from the current literature. However, it is important to know all aspects of the options and decision-making of surgical options for LSF needs to be tailored for each patient, considering factors such as biomechanical stress and osteoporosis.

Split high‐dose oral levothyroxine treatment as a successful therapy option in myxedema coma

OpenAIRE

Charoensri, Suranut; Sriphrapradang, Chutintorn; Nimitphong, Hataikarn

2017-01-01

Key Clinical Message High‐dose intravenous thyroxine (T4) is the preferable treatment for myxedema coma. We describe the clinical course of a 69‐year‐old man who presented with myxedema coma and received oral levothyroxine (LT4) therapy (1 mg) in a split dose. This suggests split high‐dose oral LT4 as a therapeutic option in myxedema coma.

Shungnak Energy Configuration Options.

Energy Technology Data Exchange (ETDEWEB)

Rosewater, David Martin [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Eddy, John P. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2017-10-01

Power systems in rural Alaska villages face a unique combination of challenges that can increase the cost of energy and lowers energy supply reliability. In the case of the remote village of Shungnak, diesel and heating fuel is either shipped in by barge or flown in by aircraft. This report presents a technical analysis of several energy infrastructure upgrade and modification options to reduce the amount of fuel consumed by the community of Shungnak. Reducing fuel usage saves money and makes the village more resilient to disruptions in fuel supply. The analysis considers demand side options, such as energy efficiency, alongside the installation of wind and solar power generation options. Some novel approaches are also considered including battery energy storage and the use of electrical home heating stoves powered by renewable generation that would otherwise be spilled and wasted. This report concludes with specific recommendations for Shungnak based on economic factors, and fuel price sensitivity. General conclusions are also included to support future work analyzing similar energy challenges in remote arctic regions.

An overview of seasonal affective disorder and its treatment options.

Science.gov (United States)

Howland, Robert H

2009-12-01

Seasonal affective disorder (SAD) is defined as a history of major depressive episodes that recur regularly at a particular time of year. Depending on the diagnostic instruments and criteria available, the reported prevalence (1%-10%) varies. Neurotransmitter abnormalities have been implicated in the pathophysiology, but they do not necessarily explain the seasonal pattern or the known chronobiological abnormalities in SAD compared with nonseasonal depression. Circadian rhythm abnormalies have been hypothesized to account for these aspects of SAD, and they provide a rationale for the therapeutic use of light therapy. Family history, twin, and molecular genetics studies suggest that hereditary factors are also involved. Light therapy and antidepressant medication are effective treatment options, with limited evidence for the efficacy of psychotherapy. Some studies demonstrate that narrow-band short wavelength "blue" light, naturalistic dawn simulation, and high-density negative air ionization are effective. Patients should be informed of the benefits of diet and exercise. Light therapy should be clinically monitored in the same manner, as it is done for other antidepressant treatments.

A review of treatment options for Graves' disease: why total thyroidectomy is a viable option in selected patients.

Science.gov (United States)

Mohan, Vinuta; Lind, Robert

2016-01-01

Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I(131)iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves' disease.

Management of patients with hormone receptor–positive breast cancer with visceral disease: challenges and treatment options

International Nuclear Information System (INIS)

Harb, Wael A

2015-01-01

Endocrine therapy is an important treatment option for women with hormone receptor–positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor ® ), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin ® ) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed

Management of stage IV rectal cancer: Palliative options

Science.gov (United States)

Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

2011-01-01

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease. PMID:21412493

Computer-aided reliability and risk assessment

International Nuclear Information System (INIS)

Leicht, R.; Wingender, H.J.

1989-01-01

Activities in the fields of reliability and risk analyses have led to the development of particular software tools which now are combined in the PC-based integrated CARARA system. The options available in this system cover a wide range of reliability-oriented tasks, like organizing raw failure data in the component/event data bank FDB, performing statistical analysis of those data with the program FDA, managing the resulting parameters in the reliability data bank RDB, and performing fault tree analysis with the fault tree code FTL or evaluating the risk of toxic or radioactive material release with the STAR code. (orig.)

CANDU Digital Control Computer upgrade options

International Nuclear Information System (INIS)

De Jong, M.S.; De Grosbois, J.; Qian, T.

1997-01-01

This paper reviews the evolution of Digital Control Computers (DCC) in CANDU power plants to the present day. Much of this evolution has been to meeting changing control or display requirements as well as the replacement of obsolete, or old and less reliable technology with better equipment that is now available. The current work at AECL and Canadian utilities to investigate DCC upgrade options, alternatives, and strategies are examined. The dependence of a particular upgrade strategy on the overall plant refurbishment plans are also discussed. Presently, the upgrade options range from replacement of individual obsolete system components, to replacement of the entire DCC hardware without changing the software, to complete replacement of the DCCs with a functionally equivalent system using new control computer equipment and software. Key issues, constraints and objectives associated with these DCC upgrade options are highlighted. (author)

The Assumption of a Reliable Instrument and Other Pitfalls to Avoid When Considering the Reliability of Data

Science.gov (United States)

Nimon, Kim; Zientek, Linda Reichwein; Henson, Robin K.

2012-01-01

The purpose of this article is to help researchers avoid common pitfalls associated with reliability including incorrectly assuming that (a) measurement error always attenuates observed score correlations, (b) different sources of measurement error originate from the same source, and (c) reliability is a function of instrumentation. To accomplish our purpose, we first describe what reliability is and why researchers should care about it with focus on its impact on effect sizes. Second, we review how reliability is assessed with comment on the consequences of cumulative measurement error. Third, we consider how researchers can use reliability generalization as a prescriptive method when designing their research studies to form hypotheses about whether or not reliability estimates will be acceptable given their sample and testing conditions. Finally, we discuss options that researchers may consider when faced with analyzing unreliable data. PMID:22518107

Management options of varicoceles

Directory of Open Access Journals (Sweden)

Peter Chan

2011-01-01

Full Text Available Varicocele is one of the most common causes of male infertility. Treatment options for varicoceles includes open varicocelectomy performed at various anatomical levels. Laparoscopic varicocelectomy has been established to be a safe and effective treatment for varicoceles. Robotic surgery has been introduced recently as an alternative surgical option for varicocelectomy. Microsurgical varicocelectomy has gained increasing popularity among experts in male reproductive medicine as the treatment of choice for varicocele because of its superior surgical outcomes. There is a growing volume of literature in the recent years on minimal invasive varicocele treatment with percutaneous retrograde and anterograde venous embolization/sclerotherapy. In this review, we will discuss the advantages and limitations associated with each treatment modality for varicoceles. Employment of these advanced techniques of varicocelectomy can provide a safe and effective approach aiming to eliminate varicocele, preserve testicular function and, in a substantial number of men, increase semen quality and the likelihood of pregnancy.

Pre-eclampsia Diagnosis and Treatment Options: A Review of Published Economic Assessments.

Science.gov (United States)

Zakiyah, Neily; Postma, Maarten J; Baker, Philip N; van Asselt, Antoinette D I

2015-10-01

Pre-eclampsia is a pregnancy complication affecting both mother and fetus. Although there is no proven effective method to prevent pre-eclampsia, early identification of women at risk of pre-eclampsia could enhance appropriate application of antenatal care, management and treatment. Very little is known about the cost effectiveness of these and other tests for pre-eclampsia, mainly because there is no clear treatment path. The aim of this study was to provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis and treatment options in pre-eclampsia. We searched three electronic databases (PubMed, EMBASE and the Cochrane Library) for studies on screening, diagnosis, treatment or prevention of pre-eclampsia, published between 1994 and 2014. Only full papers written in English containing complete economic assessments in pre-eclampsia were included. From an initial total of 138 references, six papers fulfilled the inclusion criteria. Three studies were on the cost effectiveness of treatment of pre-eclampsia, two of which evaluated magnesium sulphate for prevention of seizures and the third evaluated the cost effectiveness of induction of labour versus expectant monitoring. The other three studies were aimed at screening and diagnosis, in combination with subsequent preventive measures. The two studies on magnesium sulphate were equivocal on the cost effectiveness in non-severe cases, and the other study suggested that induction of labour in term pre-eclampsia was more cost effective than expectant monitoring. The screening studies were quite diverse in their objectives as well as in their conclusions. One study concluded that screening is probably not worthwhile, while two other studies stated that in certain scenarios it may be cost effective to screen all pregnant women and prophylactically treat those who are found to be at high risk of developing pre-eclampsia. This study is the first to provide a comprehensive overview

Comparative study of the efficacy of different treatment options in patients with chronic blepharitis.

Science.gov (United States)

Arrúa, M; Samudio, M; Fariña, N; Cibils, D; Laspina, F; Sanabria, R; Carpinelli, L; Mino de Kaspar, H

2015-03-01

To compare the efficacy of 3 treatment options in patients with chronic blepharitis. An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Solidification of radioactive liquid wastes. A comparison of treatment options for spent resins and concentrates

International Nuclear Information System (INIS)

Roth, A.; Willmann, F.; Ebata, M.; Wendt, S.

2008-01-01

Ion exchange is one of the most common and effective treatment methods for liquid radioactive waste. However, spent ion exchange resins are considered to be problematic waste that in many cases require special approaches and pre-conditioning during its immobilization to meet the acceptance criteria for disposal. Because of the function that they fulfill, spent ion exchange resins often contain high concentrations of radioactivity and pose special handling and treatment problems. Another very common method of liquid radioactive waste treatment and water cleaning is the evaporation or diaphragm filtration. Both treatment options offer a high volume reduction of the total volume of liquids treated but generate concentrates which contain high concentrations of radioactivity. Both mentioned waste streams, spent resins as well as concentrates, resulting from first step liquid radioactive waste treatment systems have to be conditioned in a suitable manner to achieve stable waste products for final disposal. The most common method of treatment of such waste streams is the solidification in a solid matrix with additional inactive material like cement, polymer etc. In the past good results have been achieved and the high concentration of radioactivity can be reduced by adding the inactive material. On the other hand, under the environment of limited space for interim storage and the absence of a final repository site, the built-up of additional volume has to be considered as very critical. Moreover, corrosive effects on cemented drums during long-term interim storage at the surface have raised doubts about the long-term stability of such waste products. In order to avoid such disadvantages solidification methods have been improved in order to get a well-defined product with a better load factor of wastes in the matrix. In a complete different approach, other technologies solidify the liquid radioactive wastes without adding of any inactive material by means of drying

Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

International Nuclear Information System (INIS)

Mitra, Kakali; Prabhudesai, Vikramaditya; James, R. Lester; Jones, Robert W. A.; French, Michael E.; Cowling, Mark; West, David J.

2004-01-01

Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy

Emerging treatment options for refractory angina pectoris: ranolazine, shock wave treatment, and cell-based therapies.

Science.gov (United States)

Gennari, Marco; Gambini, Elisa; Bassetti, Beatrice; Capogrossi, Maurizio; Pompilio, Giulio

2014-01-01

A challenge of modern cardiovascular medicine is to find new, effective treatments for patients with refractory angina pectoris, a clinical condition characterized by severe angina despite optimal medical therapy. These patients are not candidates for surgical or percutaneous revascularization. Herein we review the most up-to-date information regarding the modern approach to the patient with refractory angina pectoris, from conventional medical management to new medications and shock wave therapy, focusing on the use of endothelial precursor cells (EPCs) in the treatment of this condition. Clinical limitations of the efficiency of conventional approaches justify the search for new therapeutic options. Regenerative medicine is considered the next step in the evolution of organ replacement therapy. It is driven largely by the same health needs as transplantation and replacement therapies, but it aims further than traditional approaches, such as cell-based therapy. Increasing knowledge of the role of circulating cells derived from bone marrow (EPCs) on cardiovascular homeostasis in physiologic and pathologic conditions has prompted the clinical use of these cells to relieve ischemia. The current state of therapeutic angiogenesis still leaves many questions unanswered. It is of paramount importance that the treatment is delivered safely. Direct intramyocardial and intracoronary administration has demonstrated acceptable safety profiles in early trials, and may represent a major advance over surgical thoracotomy. The combined efforts of bench and clinical researchers will ultimately answer the question of whether cell therapy is a suitable strategy for treatment of patients with refractory angina.

Dosimetric verification of a software for planning of radio therapeutical treatments

International Nuclear Information System (INIS)

Alfonso, R.; Huerta, U.; Alfonso, J.L.; Torres, M.

1995-01-01

A software for radiation treatment planning was recently developed by medical physicists at the Hermanos Ameijeiras Hospital in Havana. Selected locations in head and neck region were used to evaluate the reliability of calculated dose distributions in patients, taking as a reference the results of dosimetric measurements with TLD-700 powder in a RANDO type phantom. The different options is shown. Causes of discrepancies are analyzed and recommendations are made for the use of data acquisitions options

Reliability analysis of the epidural spinal cord compression scale.

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Bilsky, Mark H; Laufer, Ilya; Fourney, Daryl R; Groff, Michael; Schmidt, Meic H; Varga, Peter Paul; Vrionis, Frank D; Yamada, Yoshiya; Gerszten, Peter C; Kuklo, Timothy R

2010-09-01

The evolution of imaging techniques, along with highly effective radiation options has changed the way metastatic epidural tumors are treated. While high-grade epidural spinal cord compression (ESCC) frequently serves as an indication for surgical decompression, no consensus exists in the literature about the precise definition of this term. The advancement of the treatment paradigms in patients with metastatic tumors for the spine requires a clear grading scheme of ESCC. The degree of ESCC often serves as a major determinant in the decision to operate or irradiate. The purpose of this study was to determine the reliability and validity of a 6-point, MR imaging-based grading system for ESCC. To determine the reliability of the grading scale, a survey was distributed to 7 spine surgeons who participate in the Spine Oncology Study Group. The MR images of 25 cervical or thoracic spinal tumors were distributed consisting of 1 sagittal image and 3 axial images at the identical level including T1-weighted, T2-weighted, and Gd-enhanced T1-weighted images. The survey was administered 3 times at 2-week intervals. The inter- and intrarater reliability was assessed. The inter- and intrarater reliability ranged from good to excellent when surgeons were asked to rate the degree of spinal cord compression using T2-weighted axial images. The T2-weighted images were superior indicators of ESCC compared with T1-weighted images with and without Gd. The ESCC scale provides a valid and reliable instrument that may be used to describe the degree of ESCC based on T2-weighted MR images. This scale accounts for recent advances in the treatment of spinal metastases and may be used to provide an ESCC classification scheme for multicenter clinical trial and outcome studies.

Options for Steam Generator Decommissioning

International Nuclear Information System (INIS)

Krause, Gregor; Amcoff, Bjoern; Robinson, Joe

2016-01-01

Selecting the best option for decommissioning steam generators is a key consideration in preparing for decommissioning PWR nuclear power plants. Steam Generators represent a discrete waste stream of large, complex items that can lend themselves to a variety of options for handling, treatment, recycling and disposal. Studsvik has significant experience in processing full size Steam Generators at its metal recycling facility in Sweden, and this paper will introduce the Studsvik steam generator treatment concept and the results achieved to date across a number of projects. The paper will outline the important parameters needed at an early stage to assess options and to help consider the balance between off-site and on-site treatment solutions, and the role of prior decontamination techniques. The paper also outlines the use of feasibility studies and demonstration projects that have been used to help customers prepare for decommissioning. The paper discusses physical, radiological and operational history data, Pro and Contra factors for on- and off-site treatment, the role of chemical decontamination prior to treatment, planning for off-site shipments as well as Studsvik experience This paper has an original focus upon the coming challenges of steam generator decommissioning and potential external treatment capacity constraints in the medium term. It also focuses on the potential during operations or initial shut-down to develop robust plans for steam generator management. (authors)

Biofeedback as complementary treatment in patients with epilepsy – an underestimated therapeutic option? Review, results, discussion

Directory of Open Access Journals (Sweden)

Uhlmann Carmen

2016-12-01

Full Text Available Background. Biofeedback methods represent side effect free complementary options in the treatment of epilepsy. In this paper we review the current status of these methods in terms of clinical study results and their evaluation by systematic review papers. Possible mechanisms of action in biofeedback methods are discussed.

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

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Hill, Jonathan C.; Foster, Nadine E.; Protheroe, Joanne

2017-01-01

Background & aims Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Methods A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. Results Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. Conclusion This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most

Low-grade MALT lymphoma of the stomach: a review of treatment options

International Nuclear Information System (INIS)

Schechter, Naomi R.; Yahalom, Joachim

2000-01-01

Purpose: Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach (MLS) is often associated with the presence of Helicobacter pylori (H. pylori) bacteria. Eradication of the infection with antibiotic therapy may result in regression of the lymphoma. But when antibiotic treatment fails to reverse the malignant process or if H. pylori is absent, other treatment options should be considered. Because MLS is often confined to the stomach and regional lymph nodes, it is potentially curable with local therapy. Endoscopy and improved imaging, with endoscopic ultrasound (EUS) and computerized tomography (CT), have reduced the prior dependence on surgery for diagnosis and staging of gastric lymphomas. Methods and Results: This review details the advances in the diagnosis, classification, and imaging of MLS. We also describe the experience that supports the use of radiation therapy as the preferred treatment of MLS in patients who have not responded to antibiotic therapy or have not had evidence for H. pylori infection. Conclusions: Radiation therapy for MLS is not only effective and safe, but offers the significant advantage of low morbidity and gastric function preservation

Tank Space Options Report

International Nuclear Information System (INIS)

BOYLES, V.C.

2001-01-01

A risk-based priority for the retrieval of Hanford Site waste from the 149 single-shell tanks (SSTs) has been adopted as a result of changes to the Hanford Federal Facility Agreement and Consent Order (HFFACO) (Ecology et al. 1997) negotiated in 2000. Retrieval of the first three tanks in the retrieval sequence fills available capacity in the double-shell tanks (DSTs) by 2007. As a result, the HFFACO change established a milestone (M-45-12-TO1) requiring the determination of options that could increase waste storage capacity for single-shell tank waste retrieval. The information will be considered in future negotiations. This document fulfills the milestone requirement. This study presents options that were reviewed for the purpose of increasing waste storage capacity. Eight options are identified that have the potential for increasing capacity from 5 to 10 million gallons, thus allowing uninterrupted single-shell tank retrieval until the planned Waste Treatment Plant begins processing substantial volumes of waste from the double-shell tanks in 2009. The cost of implementing these options is estimated to range from less than $1 per gallon to more than $14 per gallon. Construction of new double-shell tanks is estimated to cost about $63 per gallon. Providing 5 to 10 million gallons of available double-shell tank space could enable early retrieval of 5 to 9 high-risk single-shell tanks beyond those identified for retrieval by 2007. These tanks are A-101, AX-101, AX-103, BY-102, C-107, S-105, S-106, S-108, and S-109 (Garfield et al. 2000). This represents a potential to retrieve approximately 14 million total curies, including 3,200 curies of long-lived mobile radionuclides. The results of the study reflect qualitative analyses conducted to identify promising options. The estimated costs are rough-order-of magnitude and, therefore, subject to change. Implementing some of the options would represent a departure from the current baseline and may adversely impact the

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

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Grünewald, Volker; Höfner, Klaus; Thon, Walter F.; Kuczyk, Markus A.; Jonas, Udo

1999-01-01

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.

Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis.

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Andriolo, Luca; Altamura, Sante Alessandro; Reale, Davide; Candrian, Christian; Zaffagnini, Stefano; Filardo, Giuseppe

2018-03-01

Patellar tendinopathy is a condition characterized by anterior knee activity-related pain. It has a high incidence among athletes engaged in jumping sports and may become a chronic condition. Nonoperative management is the first choice in these patients, and several nonsurgical treatment options have been proposed. Nonetheless, clear indications on the most effective approach to address patellar tendinopathy are still lacking. To analyze the evidence on nonoperative options to treat chronic patellar tendinopathy through a systematic review of the literature and to perform a meta-analysis to identify the most effective nonsurgical option. Systematic review and meta-analysis. The search was conducted with the PubMed and Cochrane databases on January 4, 2017. All clinical English-language reports of any level of evidence on nonsurgical treatment of patellar tendinopathy were included. The quality of each article was assessed by use of the Coleman score. A meta-analysis was performed on all articles reporting the Victorian Institute of Sport Assessment scale for patellar tendinopathy to evaluate the results of the most described treatments. A total of 70 studies involving 2530 patients were included in the qualitative data synthesis. The Coleman score showed an overall poor study quality. The most described treatment groups that could be included in the meta-analysis were reported in 22 studies on eccentric exercise, extracorporeal shockwave therapy (ESWT), and platelet-rich plasma (PRP). Single and multiple PRP injections were evaluated separately. Eccentric exercise therapies obtained the best results ( P patellar tendinopathy with important limitations in terms of study quality. The available evidence showed an overall positive outcome, but some differences have been highlighted. Eccentric exercises may seem the strategy of choice in the short-term, but multiple PRP injections may offer more satisfactory results at long-term follow-up and can be therefore considered

Comparative efficacy and safety of treatment options for MDR and XDR Acinetobacter baumannii infections: a systematic review and network meta-analysis.

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Kengkla, Kirati; Kongpakwattana, Khachen; Saokaew, Surasak; Apisarnthanarak, Anucha; Chaiyakunapruk, Nathorn

2018-01-01

To comprehensively compare and rank the efficacy and safety of available treatment options for patients with MDR and XDR Acinetobacter baumannii (AB) infection. We searched PubMed, Embase and the Cochrane register of trials systematically for studies that examined treatment options for patients with MDR- and XDR-AB infections until April 2016. Network meta-analysis (NMA) was performed to estimate the risk ratio (RR) and 95% CI from both direct and indirect evidence. Primary outcomes were clinical cure and microbiological cure. Secondary outcomes were all-cause mortality and nephrotoxic and non-nephrotoxic adverse events. A total of 29 studies with 2529 patients (median age 60 years; 65% male; median APACHE II score 19.0) were included. Although there were no statistically significant differences between treatment options, triple therapy with colistin, sulbactam and tigecycline had the highest clinical cure rate. Colistin in combination with sulbactam was associated with a significantly higher microbiological cure rate compared with colistin in combination with tigecycline (RR 1.23; 95% CI 1.03-1.47) and colistin monotherapy (RR 1.21; 95% CI 1.06-1.38). No significant differences in all-cause mortality were noted between treatment options. Tigecycline-based therapy also appeared less effective for achieving a microbiological cure and is not appropriate for treating bloodstream MDR- and XDR-AB infections. Combination therapy of colistin with sulbactam demonstrates superiority in terms of microbiological cure with a safety profile similar to that of colistin monotherapy. Thus, our findings support the use of this combination as a treatment for MDR- and XDR-AB infections. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Technological Options to Ameliorate Waste Treatment of Intensive Pig Production in China：An Analysis Based on Bio-Economic Model

Institute of Scientific and Technical Information of China (English)

LU Wen-cong; MA Yong-xi; Holger Bergmann

2014-01-01

Ameliorating waste treatment by technological improvements affects the economic and the ecological-environment beneifts of intensive pig production. The objective of the research was to develop and test a method to determine the technical optimization to ameliorate waste treatment methods and gain insight into the relationship between technological options and the economic and ecological effects. We developed an integrated bio-economic model which incorporates the farming production and waste disposal systems to simulate the impact of technological improvements in pig manure treatment on economic and environmental benefits for the case of a pilot farm in Beijing, China. Based on different waste treatment technology options, three scenarios are applied for the simulation analysis of the model. The simulation results reveal that the economic-environmental beneifts of the livestock farm could be improved by reducing the cropland manure application and increasing the composting production with the current technologies. Nevertheless, the technical efifciency, the waste treatment capacity and the economic beneifts could be further improved by the introduction of new technologies. It implies that technological and economic support policies should be implemented comprehensively on waste disposal and resource utilization to promote sustainable development in intensive livestock production in China.

Options Study - Phase II

Energy Technology Data Exchange (ETDEWEB)

R. Wigeland; T. Taiwo; M. Todosow; W. Halsey; J. Gehin

2010-09-01

The Options Study has been conducted for the purpose of evaluating the potential of alternative integrated nuclear fuel cycle options to favorably address the issues associated with a continuing or expanding use of nuclear power in the United States. The study produced information that can be used to inform decisions identifying potential directions for research and development on such fuel cycle options. An integrated nuclear fuel cycle option is defined in this study as including all aspects of the entire nuclear fuel cycle, from obtaining natural resources for fuel to the ultimate disposal of used nuclear fuel (UNF) or radioactive wastes. Issues such as nuclear waste management, especially the increasing inventory of used nuclear fuel, the current uncertainty about used fuel disposal, and the risk of nuclear weapons proliferation have contributed to the reluctance to expand the use of nuclear power, even though it is recognized that nuclear power is a safe and reliable method of producing electricity. In this Options Study, current, evolutionary, and revolutionary nuclear energy options were all considered, including the use of uranium and thorium, and both once-through and recycle approaches. Available information has been collected and reviewed in order to evaluate the ability of an option to clearly address the challenges associated with the current implementation and potential expansion of commercial nuclear power in the United States. This Options Study is a comprehensive consideration and review of fuel cycle and technology options, including those for disposal, and is not constrained by any limitations that may be imposed by economics, technical maturity, past policy, or speculated future conditions. This Phase II report is intended to be used in conjunction with the Phase I report, and much information in that report is not repeated here, although some information has been updated to reflect recent developments. The focus in this Options Study was to

[Reliability of endocervical curettage after conservative treatment of intraepithelial neoplasia of the cervix].

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Lecointre, L; Akladios, C-Y; Averous, G; Lefebvre, F; Baulon, E; Thoma, V; Fender, M; Baldauf, J-J

2015-02-01

To evaluate the reliability of endocervical curettage (ECC) in patients previously treated for CIN. Retrospective analysis of data from 85 patients between January 1985 and December 2011 who received an ECC during monitoring after treatment of CIN. The reliability of the ECC was evaluated by comparison with the final histological analysis of the surgical specimen or the data for subsequent cyto-colpo-histological follow-up. Patients were referred to colposcopy either within the immediate post-treatment monitoring (n=42), meanly 9.7±5.3 months after treatment, or if cytological abnormalities were detected during long-term monitoring, meanly 78.6±52.4 months after treatment. Colposcopy was unsatisfactory in 75.3% of patients and normal colposcopic findings were found in 80% of patients. A perfect agreement between the ECC and the endocervical final diagnosis was noted in 68 patients (80%). For the diagnosis of severe cervical lesions (CIN 2+) ECC had a sensitivity of 86.2% (68.3-96.1), a specificity of 94.6% (85.1-98.9) and positive and negative predictive values of 61.4% (47.6-74.0) and 93% (83.0-98.1), respectively. The high sensitivity and negative predictive value of ECC for the diagnosis of severe post-therapeutic endocervical lesions avoid iterative treatment without increasing the risk of progression of a lesion to cancer. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Evidence-Based Treatment Options in Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck

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Athanassios Argiris

2017-05-01

Full Text Available The major development of the past decade in the first-line treatment of recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN was the introduction of cetuximab in combination with platinum plus 5-fluorouracil chemotherapy (CT, followed by maintenance cetuximab (the “EXTREME” regimen. This regimen is supported by a phase 3 randomized trial and subsequent observational studies, and it confers well-documented survival benefits, with median survival ranging between approximately 10 and 14 months, overall response rates between 36 and 44%, and disease control rates of over 80%. Furthermore, as indicated by patient-reported outcome measures, the addition of cetuximab to platinum-based CT leads to a significant reduction in pain and problems with social eating and speech. Conversely, until very recently, there has been a lack of evidence-based second-line treatment options, and the therapies that have been available have shown low response rates and poor survival outcomes. Presently, a promising new treatment option in R/M SCCHN has emerged: immune checkpoint inhibitors (ICIs, which have demonstrated favorable results in second-line clinical trials. Nivolumab and pembrolizumab are the first two ICIs that were approved by the US Food and Drug Administration. We note that the trials that showed benefit with ICIs included not only patients who previously received ≥1 platinum-based regimens for R/M SCCHN but also patients who experienced recurrence within 6 months after combined modality therapy with a platinum agent for locally advanced disease. In this review, we outline the available clinical and observational evidence for the EXTREME regimen and the initial results from clinical trials for ICIs in patients with R/M SCCHN. We propose that these treatment options can be integrated into a new continuum of care paradigm, with first-line EXTREME regimen followed by second-line ICIs. A number of ongoing clinical trials

Immunotoxin – a new treatment option in patients with relapsed and refractory Hodgkin lymphoma

Science.gov (United States)

Novakovic, Barbara Jezersek

2015-01-01

Background Even though Hodgkin lymphoma is a highly curable disease, some of the patients have either a refractory disease or experience a relapse following a successful primary therapy. Durable responses and remissions in patients with relapsed or refractory disease may be achieved in approximately one-half with salvage chemotherapy followed by high dose chemotherapy (HDT) and autologous hematopoietic cell rescue (SCT). On the other hand, patients who relapse after HDT and autologous SCT or those who have failed at least two prior multi-agent chemotherapy regimens and are not candidates for HDT have limited treatment options. Conclusions A new treatment option in this population is an immunotoxin Brentuximab vedotin composed of a CD30 directed antibody linked to the antitubulin agent monomethyl auristatin E. It has demonstrated a substantial effectiveness and an acceptable toxicity. In the pivotal study, the overall response rate was 75% with 34% of complete remissions. The median durations of response were 20.5 and 6.7 months for those with complete remission and all responding patients, respectively. The median overall survival was 40.5 months (3-years overall survival 54%) and the median progression-free survival 9.3 months. The most common non-hematologic toxicities were peripheral sensory neuropathy, nausea, and fatigue while the most common severe side effects were neutropenia, thrombocytopenia, anemia, and peripheral sensory neuropathy. PMID:26834516

Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy.

Science.gov (United States)

Weidenhagen, Rolf; Hartl, Wolfgang H; Gruetzner, Klaus U; Eichhorn, Martin E; Spelsberg, Fritz; Jauch, Karl W

2010-11-01

Anastomotic leakage after esophagectomy is an important determinant of early and late morbidity and mortality. Control of the septic focus is essential when treating patients with anastomotic leakages. Surgical and endoscopic treatment options are limited. Between 2005 and 2009, we treated 6 patients who experienced an intrathoracic anastomotic leakage after esophageal resection. After all established therapeutic measures had failed, we explored the feasibility of an endoscopically assisted mediastinal vacuum therapy. We were able to heal intrathoracic esophageal leakages in all 6 patients without any local complications and without the need for reoperation. One patient died because of a progressive pneumonia. Endoscopic vacuum-assisted closure of anastomotic leakages may help to overcome the limitations that are associated with intermittent endoscopic treatment and conventional drainage therapy. Our preliminary results suggest that this new concept may be suitable for those patients. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Resource and energy recovery options for fermentation industry residuals

Energy Technology Data Exchange (ETDEWEB)

Chiesa, S C [Santa Clara Univ., CA (USA); Manning, Jr, J F [Alabama Univ., Birmingham, AL (USA)

1989-01-01

Over the last 40 years, the fermentation industry has provided facility planners, plant operators and environmental engineers with a wide range of residuals management challenges and resource/energy recovery opportunities. In response, the industry has helped pioneer the use of a number of innovative resource and energy recovery technologies. Production of animal feed supplements, composts, fertilizers, soil amendments, commercial baking additives and microbial protein materials have all been detailed in the literature. In many such cases, recovery of by-products significantly reduces the need for treatment and disposal facilities. Stable, reliable anaerobic biological treatment processes have also been developed to recover significant amounts of energy in the form of methane gas. Alternatively, dewatered or condensed organic fermentation industry residuals have been used as fuels for incineration-based energy recovery systems. The sale or use of recovered by-products and/or energy can be used to offset required processing costs and provide a technically and environmentally viable alternative to traditional treatment and disposal strategies. This review examines resource recovery options currently used or proposed for fermentation industry residuals and the conditions necessary for their successful application. (author).

Direct visual internal urethrotomy: Is it a durable treatment option?

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Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing.

Treatment options for subjective tinnitus: Self reports from a sample of general practitioners and ENT physicians within Europe and the USA

Directory of Open Access Journals (Sweden)

Hall Deborah A

2011-11-01

Full Text Available Abstract Background Tinnitus affects about 10-15% of the general population and risks for developing tinnitus are rising through increased exposure to leisure noise through listening to personal music players at high volume. The disorder has a considerable heterogeneity and so no single mechanism is likely to explain the presence of tinnitus in all those affected. As such there is no standardized management pathway nor singly effective treatment for the condition. Choice of clinical intervention is a multi-factorial decision based on many factors, including assessment of patient needs and the healthcare context. The present research surveyed clinicians working in six Westernized countries with the aims: a to establish the range of referral pathways, b to evaluate the typical treatment options for categories of subjective tinnitus defined as acute or chronic, and c to seek clinical opinion about levels of satisfaction with current standards of practice. Methods A structured online questionnaire was conducted with 712 physicians who reported seeing at least one tinnitus patients in the previous three months. They were 370 general practitioners (GPs and 365 ear-nose-throat specialists (ENTs from the US, Germany, UK, France, Italy and Spain. Results Our international comparison of health systems for tinnitus revealed that although the characteristics of tinnitus appeared broadly similar across countries, the patient's experience of clinical services differed widely. GPs and ENTs were always involved in referral and management to some degree, but multi-disciplinary teams engaged either neurology (Germany, Italy and Spain or audiology (UK and US professionals. For acute subjective tinnitus, pharmacological prescriptions were common, while audiological and psychological approaches were more typical for chronic subjective tinnitus; with several specific treatment options being highly country specific. All therapy options were associated with low levels

Management of patients with resistant hypertension: current treatment options

Directory of Open Access Journals (Sweden)

Kumar N

2013-10-01

Full Text Available Nilay Kumar,1 David A Calhoun,2 Tanja Dudenbostel21Department of Medicine, 2Division of Cardiovascular Disease, Hypertension and Vascular Biology Program, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: Resistant hypertension (RHTN is an increasingly common clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities. It is defined as uncontrolled blood pressure on optimal doses of three antihypertensive agents, ideally one being a diuretic. The definition also includes controlled hypertension with use of four or more antihypertensive agents. Recent observational studies have advanced the characterization of patients with RHTN. Patients with RHTN have higher rates of cardiovascular events and mortality compared with patients with more easily controlled hypertension. Secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, renovascular disease, are common in patients with RHTN and often coexist in the same patient. In addition, RHTN is often complicated by metabolic abnormalities. Patients with RHTN require a thorough evaluation to confirm the diagnosis and optimize treatment, which typically includes a combination of lifestyle adjustments, and pharmacologic and interventional treatment. Combination therapy including a diuretic, a long-acting calcium channel blocker, an angiotensin-converting enzyme inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist where warranted is the classic regimen for patients with treatment-resistant hypertension. Mineralocorticoid receptor antagonists like spironolactone or eplerenone have been shown to be efficacious in patients with RHTN, heart failure, chronic kidney disease, and primary aldosteronism. Novel interventional therapies, including baroreflex activation and renal denervation, have shown that both of these methods may be used to lower blood pressure safely, thereby providing exciting and promising new

Clinical trials as treatment option: bioethics and health care disparities in substance dependency.

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Timmermans, Stefan; McKay, Tara

2009-12-01

Bioethicists have warned against the dangers of mixing research with treatment. They are concerned that research priorities may take precedence over individual patient needs and that research subjects tend to misunderstand the purpose of research or overestimate the direct medical benefits of participating in studies. Yet, other work has questioned whether clinical research can always be separated from therapeutic benefit for participants. Using in-depth interviews with participants in two phase III randomized U.S. clinical trials for methamphetamine dependency, we examine the treatment options available to participants, their experiences with participating in the trials, and potential problems of trial participation. We find that while participants have experience with four alternative treatment modalities - quitting alone, support groups, in-patient treatment facilities, and consulting primary care physicians - the randomized clinical trials compare favorably to alternatives because they provide access to evidence-based behavioral treatments, specialized medical professionals, non-judgmental staff, and the possibility of receiving an experimental drug. We conclude that while randomized clinical trials are imperfect substitutes for clinical care, they constitute a fragile and sporadic therapeutic niche in a country with fundamental problems in access to health care, a mixed punitive-therapeutic drug addiction policy, and a profit-driven pharmaceutical development and approval process.

[Systematic review on conservative treatment options in non-muscle-invasive bladder cancer patients refractory to Bacillus Calmette-Guérin instillation therapy].

Science.gov (United States)

Martini, Thomas; Wezel, Felix; Löbig, Niklas; Mitterberger, Michael J; Colleselli, Daniela

2017-08-01

Background Adjuvant Bacillus Calmette-Guérin (BCG) intravesical instillation is the recommended standard treatment in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). However, a significant proportion of patients fail treatment, and radical cystectomy (RC) is the subsequent gold standard. On the other hand, there is an unmet need for conservative alternatives for patients who are unfit or unwilling to undergo surgery. This study aimed to identify conservative treatment options in NMIBC patients after BCG failure. Material and Methods We performed a systematic search in the databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, including all randomised controlled trials (RCTs), quasi-RCTs and single-arm studies, in which patients with NMIBC were treated with second-line intravesical or systemic therapy after BCG failure. A minimum of eight patients were included in each treatment arm. Full papers were restricted to English language. Literature research and data analysis were assessed independently by two reviewers. Data on treatment response, recurrence, time to recurrence, progression and rate of cystectomy were collected and analysed. Results  This systematic review included 42 publications with a total of 3521 patients (2371 BCG failures). Valrubicin, taxanes, gemcitabine, combination chemotherapy, thermochemotherapy, photodynamic therapy, combination of BCG and interferon and immunotherapies or targeted therapies were identified as conservative treatment options. For taxanes, gemcitabine and thermochemotherapy there is the highest evidence for a clinical meaningful response with minor toxicities. Conclusions Despite some promising response rates for taxanes, gemcitabine or thermochemotherapy, an evidence-based recommendation for treatment options superior to RC in patients failing BCG therapy cannot be made. The definition of BCG failure is still inconsistent and heterogeneous outcomes in patients with BCG

Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis

Directory of Open Access Journals (Sweden)

Hertel N

2012-03-01

Full Text Available Nadine Hertel1, Robert W Kotchie1, Yevgeniy Samyshkin1, Matthew Radford1, Samantha Humphreys2, Kevin Jameson21IMS Consulting Group, London, UK; 2MSD Ltd, Hoddesdon, UKPurpose: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD, despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting.Patients and methods: A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA, a long-acting beta agonist (LABA, an inhaled corticosteroid (ICS, and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis.Results: Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained. The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13

Forward reliability markets: Less risk, less market power, more efficiency

International Nuclear Information System (INIS)

Cramton, Peter; Stoft, Steven

2008-01-01

A forward reliability market is presented. The market coordinates new entry through the forward procurement of reliability options - physical capacity bundled with a financial option to supply energy above a strike price. The market assures adequate generating resources and prices capacity from the bids of competitive new entry in an annual auction. Efficient performance incentives are maintained from a load-following obligation to supply energy above the strike price. The capacity payment fully hedges load from high spot prices, and reduces supplier risk as well. Market power is reduced in the spot market, since suppliers enter the spot market with a nearly balanced position in times of scarcity. Market power in the reliability market is addressed by not allowing existing supply to impact the capacity price. The approach, which has been adopted in New England and Colombia, is readily adapted to either a thermal system or a hydro system. (author)

[Established treatment options for male stress urinary incontinence].

Science.gov (United States)

Hampel, C; Gillitzer, R; Wiesner, C; Thüroff, J W

2007-03-01

Nowadays, male stress urinary incontinence is rare and almost always of iatrogenic origin (radiotherapy, pelvic surgery). However, the prognosis of urinary incontinence following surgery is good and can be improved by pelvic floor muscle exercises in combination with biofeedback systems. For the remaining patient cohort with persistent urinary incontinence, several established surgical treatment options are available. Suburothelial injections of bulking agents can easily be performed in an ambulatory setting. However, regardless of the material used, long-term results are disappointing. Moreover, the residual urethral function deteriorates due to cicatrization of the suburothelial plexus with consequent loss of urethral elasticity. The fascial sling procedure in males has to be performed in preoperated areas and is as technically demanding for the surgeon as it is burdening for the patient. Alloplastic material is not used, thus minimizing risks for arrosion or infection. Since the sling tension can neither be standardized nor postoperatively readjusted, the risk of overcorrection is considerable and the success of the procedure is heavily dependent on the surgeon's experience. Despite wear and high revision rates, the technically mature artificial sphincter produces excellent continence results and has become the gold standard in the therapy of male stress urinary incontinence. The circumferential and continuous urethral compression by the cuff is highly effective, but at the price of an almost inevitable urethral atrophy. To overcome this problem, various surgical techniques have been developed (tandem cuff, cuff downsizing, transcorporal cuff placement). However, the expensive artificial sphincter is not a nostrum for every incontinent man, since it requires certain minimal cognitive and manual capabilities. Therefore, the search for less demanding treatment alternatives seems to be necessary, even if one has to accept lower continence rates.

A comparison of Likert scale and visual analogue scales as response options in children's questionnaires

NARCIS (Netherlands)

van Laerhoven, H.; van der Zaag-Loonen, H. J.; Derkx, B. H. F.

2004-01-01

Aim: To examine which response options children prefer and which they find easiest to use, and to study the relative reliability of the different response options. Methods: A consecutive group of unselected children (n = 120) filled out three questionnaires in a paediatric outpatient clinic. Each

Bayesian comparative effectiveness study of four consensus treatment plans for initial management of systemic juvenile idiopathic arthritis: FiRst-Line Options for Systemic juvenile idiopathic arthritis Treatment (FROST).

Science.gov (United States)

Nigrovic, Peter A; Beukelman, Timothy; Tomlinson, George; Feldman, Brian M; Schanberg, Laura E; Kimura, Yukiko

2018-03-01

Systemic juvenile idiopathic arthritis is a rare febrile arthritis of childhood characterized by a potentially severe course, including prolonged glucocorticoid exposure, growth failure, destructive arthritis, and life-threatening macrophage activation syndrome. Early cytokine-blocking biologic therapy may improve long-term outcomes, although some systemic juvenile idiopathic arthritis patients respond well to non-biologic treatment, leaving optimal management undefined. Consequently, treatment of new-onset systemic juvenile idiopathic arthritis by expert clinicians varies widely. To describe a pragmatic, observational comparative effectiveness study that takes advantage of diversity in the management of a rare disease: FiRst-Line Options for Systemic juvenile idiopathic arthritis Treatment (FROST), comparing non-biologic and biologic consensus treatment plans for new-onset systemic juvenile idiopathic arthritis within the 60-center Childhood Arthritis and Rheumatology Research Alliance Registry (CARRA). FiRst-Line Options for Systemic juvenile idiopathic arthritis Treatment (FROST) is a multicenter, prospective, non-randomized study that compares four Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis: (1) glucocorticoids alone, (2) methotrexate, (3) interleukin-1 blockade, and (4) interleukin-6 blockade. Patients consenting to participation in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry are started on one of four Consensus Treatment Plans at the discretion of the treating physician. The outcome of primary interest is clinically inactive disease off glucocorticoids at 9 months, comparing non-biologic (Consensus Treatment Plans 1 + 2) versus biologic (Consensus Treatment Plans 3 + 4) strategies. Bayesian analytic methods will be employed to evaluate response rates, using propensity scoring to balance treatment groups for potential

Construction of Valid and Reliable Test for Assessment of Students

Science.gov (United States)

Osadebe, P. U.

2015-01-01

The study was carried out to construct a valid and reliable test in Economics for secondary school students. Two research questions were drawn to guide the establishment of validity and reliability for the Economics Achievement Test (EAT). It is a multiple choice objective test of five options with 100 items. A sample of 1000 students was randomly…

Professionals' and laypersons' appreciation of various options for Class III surgical correction.

Science.gov (United States)

Fabré, M; Mossaz, C; Christou, P; Kiliaridis, S

2010-08-01

The objectives of this study were to evaluate the assessments of maxillofacial surgeons, orthodontists, and laypersons on the predicted aesthetic outcome of various surgical options in Class III correction and the associations between certain initial cephalometric values and the judges' preferred option. Pre-surgical lateral headfilms and coloured profile photographs of 18 skeletal Class III Caucasian adult patients (10 males and 8 females) with a mean age of 24.5 years were used. The headfilms were hand traced and digitized. Conventional cephalometric analysis was performed. Computerized predictions of three surgical options, mandibular setback, Le Fort I advancement, and bimaxillary surgery, were made. For each case, the pre-surgical profile photograph with the three predictions was presented on a printed page. The questionnaire was sent to 51 maxillofacial surgeons (response rate 45.1 per cent), 78 orthodontists (response rate 71.8 per cent), and 61 laypersons (response rate 100 per cent) to aesthetically evaluate the pre-surgical photographs and the surgical predictions by placing a mark along a 10-graded visual analogue scale (VAS) using a standard profile for calibration. Confidence interval was calculated for each patient. An independent samples t-test was used to detect initial cephalometric values associated with the judges' preferred option and analysis of variance/Tukey's honestly significant differences to evaluate differences between judges. Intra-observer reliability was assessed with a paired t-test. All treatment predictions led to improved scoring of facial aesthetics with the exception of the setback option for three patients. For 14 patients, general agreement for the preferred option existed between the three groups of judges. Laypersons tended to give lower improvement scores than professionals. Overjet, nasofacial, and nasomental angles were important in decision making between the mandibular setback and Le Fort I options (the more negative

Basic science and surgical treatment options for articular cartilage injuries of the knee.

Science.gov (United States)

Tetteh, Elizabeth S; Bajaj, Sarvottam; Ghodadra, Neil S

2012-03-01

The complex structure of articular cartilage allows for diverse knee function throughout range of motion and weight bearing. However, disruption to the structural integrity of the articular surface can cause significant morbidity. Due to an inherently poor regenerative capacity, articular cartilage defects present a treatment challenge for physicians and therapists. For many patients, a trial of nonsurgical treatment options is paramount prior to surgical intervention. In instances of failed conservative treatment, patients can undergo an array of palliative, restorative, or reparative surgical procedures to treat these lesions. Palliative methods include debridement and lavage, while restorative techniques include marrow stimulation. For larger lesions involving subchondral bone, reparative procedures such as osteochondral grafting or autologous chondrocyte implantation are considered. Clinical success not only depends on the surgical techniques but also requires strict adherence to rehabilitation guidelines. The purpose of this article is to review the basic science of articular cartilage and to provide an overview of the procedures currently performed at our institution for patients presenting with symptomatic cartilage lesions.

Comparison of three surgical treatment options for unicameral bone cysts in humerus.

Science.gov (United States)

Mavčič, Blaž; Saraph, Vinay; Gilg, Magdalena M; Bergovec, Marko; Brecelj, Janez; Leithner, Andreas

2018-04-23

Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991-2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting (P=0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level III - therapeutic retrospective comparative study.

Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension

Directory of Open Access Journals (Sweden)

Aiko eOgawa

2015-02-01

Full Text Available In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

Ovarian failure due to cancer treatment and fertility preservation options

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Soheila Aminimoghaddam

2016-04-01

Full Text Available Primary ovarian insufficiency (POI, commonly referred to premature ovarian failure, is defined as ovarian failure before the age of 40 years. It is the loss of ovarian function caused by a process directly affecting ovaries. Cancer therapy which includes surgery, radiotherapy, and chemotherapy influence ovarian function, leading to premature menopause and loss of fertility. POI is idiopathic in most cases (74-90%. The known causes, in addition to anticancer treatment, are other processes like chromosomal abnormalities, autoimmunity, and natural aging can result in secondary ovarian failure, which is detected by an increase in serum gonadotropin levels (FSH and LH. There are evident risks of POI in women treated for cancer. Those who receive anticancer treatments have an increased risk of developing POI. There by, anticancer drugs and radiation therapy are considered as the most common toxins of ovaries. Although cancer incidence rates in women less than 50 years old continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in treatment. Increasing numbers of survivors are now confronted with the long-term consequences of exposure to these treatments. The pool of primordial follicles in the ovary is fixed and any injury to the ovary can potentially reduce this ovarian reserve, effectively advancing the patient’s reproductive age, thus narrowing the window of reproductive opportunity. Ovarian failure occurs in a significant percentage of childhood cancer survivors and many of them will seek care for reproductive dysfunction. Nevertheless, Embryo cryopreservation, oocyte cryopreservation, ovary tissue cryopreservation, ovarian suppression and oophoro-pexy are some options to preserve fertility in these groups. As a result, having foreknowledge of potential treatment related ovarian failure will allow the physician to give a better counsel to patients and their family regarding the importance and

Clinical roundtable monograph: Emerging treatment options for TKI-resistant chronic myelogenous leukemia.

Science.gov (United States)

Cortes, Jorge; Radich, Jerald; Mauro, Michael J

2012-10-01

The development of tyrosine kinase inhibitors (TKIs) that inhibit signaling of the constitutive BCR-ABL protein revolutionized the treatment of chronic myelogenous leukemia (CML). These agents have dramatically changed the treatment landscape for CML, shifting the use of allogeneic stem cell transplantation to selected patients in the salvage setting. Four BCR-ABL TKIs are now commercially available for the treatment of CML: the first-generation TKI imatinib, and the second-generation TKIs dasatinib, nilotinib, and bosutinib. Continuous treatment with these agents induces durable responses in a high proportion of patients with chronic-phase CML. Research is focused on identifying which patients can discontinue therapy without a recurrence of disease. For the group of patients with resistance to TKIs, multiple alternative therapies are being evaluated. The third-generation TKI ponatinib is a BCR-ABL inhibitor that has demonstrated significant activity, including in patients with the TKI resistance mutation T315I. The homoharringtonine derivative omacetaxine mepesuccinate, which inhibits protein synthesis, has also demonstrated clinical activity in CML, including in patients with TKI resistance due to T315I and in patients who have TKI resistance despite no evidence of ABL mutations. It is essential that clinicians implement these new agents with care and change therapies only when appropriate in order to preserve as many options as possible for future use if needed.

Analysis of Parking Reliability Guidance of Urban Parking Variable Message Sign System

OpenAIRE

Zhenyu Mei; Ye Tian; Dongping Li

2012-01-01

Operators of parking guidance and information systems (PGIS) often encounter difficulty in determining when and how to provide reliable car park availability information to drivers. Reliability has become a key factor to ensure the benefits of urban PGIS. The present paper is the first to define the guiding parking reliability of urban parking variable message signs (VMSs). By analyzing the parking choice under guiding and optional parking lots, a guiding parking reliability model was constru...

TISU: Extracorporeal shockwave lithotripsy, as first treatment option, compared with direct progression to ureteroscopic treatment, for ureteric stones: study protocol for a randomised controlled trial.

Science.gov (United States)

McClinton, Samuel; Cameron, Sarah; Starr, Kathryn; Thomas, Ruth; MacLennan, Graeme; McDonald, Alison; Lam, Thomas; N'Dow, James; Kilonzo, Mary; Pickard, Robert; Anson, Ken; Keeley, Frank; Burgess, Neil; Clark, Charles Terry; MacLennan, Sara; Norrie, John

2018-05-22

Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care. However, between one-fifth and one-third of cases require an intervention. The two standard active intervention options are extracorporeal shockwave lithotripsy (ESWL) and ureteroscopic stone retrieval. ESWL and ureteroscopy are effective in terms of stone clearance; however, they differ in terms of invasiveness, anaesthetic requirement, treatment setting, complications, patient-reported outcomes (e.g. pain after intervention, time off work) and cost. There is uncertainty around which is the most clinically effective in terms of stone clearance and the true cost to the NHS and to society (in terms of impact on patient-reported health and economic burden). The aim of this trial is to determine whether, in adults with ureteric stones, judged to require active intervention, ESWL is not inferior and is more cost-effective compared to ureteroscopic treatment as the initial management option. The TISU study is a pragmatic multicentre non-inferiority randomised controlled trial of ESWL as the first treatment option compared with direct progression to ureteroscopic treatment for ureteric stones. Patients aged over 16 years with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) will be randomised to either ESWL or ureteroscopy. The primary clinical outcome is resolution of the stone episode (no further intervention required to facilitate stone clearance) up to six months from randomisation. The primary economic outcome is the incremental cost per quality-adjusted life years (QALYs) gained at six months from

Management options for food production systems affected by a nuclear accident. Task 7: biological treatment of contaminated milk

International Nuclear Information System (INIS)

Nisbet, A.F.; Marchant, J.K.; Woodman, R.F.M.; Wilkins, B.T.; Mercer, J.A.

2003-01-01

In the event of a nuclear accident affecting the UK, regulation of contamination in the foodchain would involve both the Food Standards Agency (FSA) and the Environment Agency (EA). Restrictions would be based on intervention levels imposed by the Council of the European Communities (often referred to as Council Food Intervention Levels, CFILs). FSA would be responsible for preventing commercial foodstuffs with concentrations of radionuclides above the CFILs from entering the foodchain, while EA would regulate the storage and disposal of the waste food. Milk is particularly important in this respect because it is produced continually in large quantities in many parts of the UK. An evaluation of various options for the management of waste foodstuffs has been carried out by NRPB, with support from FSA and its predecessor, the Ministry of Agriculture, Fisheries and Food, and EA. This report describes an evaluation of the practicability of one of those options, namely the biological treatment of contaminated milk. Whole milk has a high content of organic matter and in consequence a high biochemical oxygen demand (BOD) and chemical oxygen demand (COD). If not disposed of properly, releases of whole milk into the environment can have a substantial detrimental effect because of the high BOD. Biological treatments are therefore potentially an attractive management option because the fermentation by bacteria reduces the BOD in the resultant liquid effluent. The objectives of this study were as follows: a. To compile information about the options available for the biological treatment of milk; b. To establish the legal position; c. To assess practicability in terms of technical feasibility, capacity, cost, environmental and radiological impacts and acceptability; d. To assess the radiation doses that might be received by process operators, contractors, farmers and the general public from the biological treatment of contaminated milk. The radionuclides of interest were 131II

Treatment options for active removal of renal stones

NARCIS (Netherlands)

Warmerdam, G.J.J.; Laet, De K.; Wijn, R.P.W.F.; Wijn, P.F.F.

2012-01-01

This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from

Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

NARCIS (Netherlands)

Vierhout, B. P.; Zeebregts, C. J.; van den Dungen, J. J. A. M.; Reijnen, M. M. P. J.

Background: Subclavian artery aneurysms (SAAs) are rare and may cause life- and limb-threatening complications. Therapeutic options greatly differ as do access alternatives. The aim of the study was to assess its clinical presentation, diagnostics and therapeutic options as reported in the

IBS Treatment Options

Science.gov (United States)

... 01 July 2017 Print A short bout of abdominal pain and diarrhea or constipation now and then is not unusual. But long-term or recurring symptoms are not normal. They may signal irritable bowel syndrome (IBS) – and are generally treatable. IBS Treatments Depend ...

Ghana and the nuclear power option

International Nuclear Information System (INIS)

Fletcher, J.J.; Ennison, I.

2000-01-01

For every country, dependable and continuous supply of electricity is a prerequisite for ensuring sustainable development. In Ghana, Ghanaians have currently known the consequences of disrupted and inadequate supply of electricity. Globally too the call of ''Agenda 21'' of the Rio de Janeiro Conference (Earth Summit) to engage in the development and supply of electricity in a sustainable manner imposes on us certain limitations in our choice of energy option to utilise. Taking into account the high economic and population growths with the subsequent increase in demand for electricity in the 21st century, the fact that Ghana has no coal and imports oil which will be in dwindling supply in the 21st century and that the total hydro supply in Ghana will not be sufficient for our electricity demand in the next century, this paper proposes that Ghana starts now to plan for the introduction of the nuclear option so that in the long term we may have in place an environmentally friendly, dependable and reliable supply of energy. The paper also highlights the economic competitiveness of nuclear power over the other energy options in Ghana and addresses the apprehension and misunderstanding surrounding the nuclear power option. (author)

Intra- and interobserver reliability of the Eaton classification for trapeziometacarpal arthritis: a systematic review.

Science.gov (United States)

Berger, Aaron J; Momeni, Arash; Ladd, Amy L

2014-04-01

Trapeziometacarpal, or thumb carpometacarpal (CMC), arthritis is a common problem with a variety of treatment options. Although widely used, the Eaton radiographic staging system for CMC arthritis is of questionable clinical utility, as disease severity does not predictably correlate with symptoms or treatment recommendations. A possible reason for this is that the classification itself may not be reliable, but the literature on this has not, to our knowledge, been systematically reviewed. We therefore performed a systematic review to determine the intra- and interobserver reliability of the Eaton staging system. We systematically reviewed English-language studies published between 1973 and 2013 to assess the degree of intra- and interobserver reliability of the Eaton classification for determining the stage of trapeziometacarpal joint arthritis and pantrapezial arthritis based on plain radiographic imaging. Search engines included: PubMed, Scopus(®), and CINAHL. Four studies, which included a total of 163 patients, met our inclusion criteria and were evaluated. The level of evidence of the studies included in this analysis was determined using the Oxford Centre for Evidence Based Medicine Levels of Evidence Classification by two independent observers. A limited number of studies have been performed to assess intra- and interobserver reliability of the Eaton classification system. The four studies included were determined to be Level 3b. These studies collectively indicate that the Eaton classification demonstrates poor to fair interobserver reliability (kappa values: 0.11-0.56) and fair to moderate intraobserver reliability (kappa values: 0.54-0.657). Review of the literature demonstrates that radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity. Currently, diagnosis and treatment of thumb CMC arthritis are based on the surgeon's qualitative assessment combining history, physical

Interspinous Process Decompression: Expanding Treatment Options for Lumbar Spinal Stenosis

Directory of Open Access Journals (Sweden)

Pierce D. Nunley

2016-01-01

Full Text Available Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy. For the ODI, effect sizes were all very large (>1.0 for Superion and laminectomy at 2, 3, and 4 years. For ZCQ, the 2-year Superion symptom severity (1.26 and physical function (1.29 domains were very large; laminectomy effect sizes were very large (1.07 for symptom severity and large for physical function (0.80. Current projections indicate a marked increase in the number of patients with spinal stenosis. Consequently, there remains a keen interest in minimally invasive treatment options that delay or obviate the need for invasive surgical procedures, such as decompressive laminectomy or fusion. Stand-alone interspinous spacers may fill a currently unmet treatment gap in the continuum of care and help to reduce the burden of this chronic degenerative condition on the health care system.

Alopecia areata: Treatment options

Directory of Open Access Journals (Sweden)

E. Kasumagić-Halilović

2006-02-01

Full Text Available Alopecia areata (AA is a common cause of reversible hair loss afflictingapproximately1-2%ofthegeneralpopulation. It commonly present as round patches of hair loss which can be the firstmanifestationofamoreseverealopecia totalis or universalis. The cause of AA is unknown although most evidence supports the hypothesis that AA is an immunologically mediated disease. Treatment of AA may be divided into four different categories of widely accepted therapeutic modalities: immune inhibitors (steroid or psoralen and UVA light- PUVA, topicalsensitizers (squaric acid dibutylester and diphenylcyclopropenone, non-specificirritants(anthralinandthevasodilatator minoxidil. Improved future treatments may be immunosuppressive or immunomodulatory or they may otherwise protect hair follicles from the injurious effects of inflammation.Theaimofthisarticleistoreviewavailable data on current and potential agents for the treatment of AA.

Biobank participant support of newborn screening for disorders with variable treatment and intervention options.

Science.gov (United States)

Bunnell, Megan E; Tarini, Beth A; Petros, Michael; Goldenberg, Aaron J; Arjunan, Aishwarya; Wicklund, Catherine

2016-10-01

We aimed to better understand biobank participant opinions of the benefits of newborn screening (NBS) for certain disorder types and how terminology used in NBS discourse might impact stakeholder opinion. We conducted a between-subjects randomized survey of 5840 members of the Northwestern University Biobank. The survey contained 12 scenarios, each describing a disorder and its treatment. For each scenario, we varied the terminology used to describe treatment options. One survey version used the term intervention and the other treatment. The outcome measured for each scenario was perceived benefit (for the infant) and importance of testing (for participants). Comparisons were made between participants and between scenarios. Ratings of benefit and importance were not influenced by the use of the term intervention versus treatment within scenarios. Nuances existed in ratings of benefit to the infant and importance to participants amongst scenarios. Participants were most likely to perceive benefit and importance in screening for a disorder if treatment/intervention offered a high chance of improved outcomes. While participants perceived benefit to the infant and importance to themselves in screening for most disorders, nuances in inter-scenario ratings suggest participants weighed availability and type of treatment/intervention in consideration of the benefits of NBS.

Life cycle assessment of wastewater treatment options for small and decentralized communities.

Science.gov (United States)

Machado, A P; Urbano, L; Brito, A G; Janknecht, P; Salas, J J; Nogueira, R

2007-01-01

Sustainability has strong implications on the practice of engineering. Life cycle assessment (LCA) is an appropriate methodology for assessing the sustainability of a wastewater treatment plant design. The present study used a LCA approach for comparing alternative wastewater treatment processes for small and decentralised rural communities. The assessment was focused on two energy-saving systems (constructed wetland and slow rate infiltration) and a conventional one (activated sludge process). The low environmental impact of the energy-saving wastewater treatment plants was demonstrated, the most relevant being the global warming indicator. Options for reduction of life cycle impacts were assessed including materials used in construction and operational lifetime of the systems. A 10% extension of operation lifetime of constructed wetland and slow rate infiltration systems led to a 1% decrease in CO2 emissions, in both systems. The decrease in the abiotic depletion was 5 and 7%, respectively. Also, replacing steel with HDPE in the activated sludge tank resulted in a 1% reduction in CO2 emission and 1% in the abiotic depletion indicator. In the case of the Imhoff tank a 1% reduction in CO2 emissions and 5% in the abiotic depletion indicator were observed when concrete was replaced by HDPE.

Treatment Options in Kleptomania

Directory of Open Access Journals (Sweden)

Lut Tamam

2009-06-01

Full Text Available Kleptomania is a rare disorder with inability or great difficulty in resisting impulses of stealing. People with this disorder are compelled to steal things, generally things of little or no value. This disorder usually begins during puberty and usually last until late adulthood; in some cases lasts throughout the person's life. People with this disorder are likely to have a comorbid conditions like mood disorders. Individuals with the disorder are usually referred for treatment due to the comorbid psychiatric complaints rather than kleptomanic behaviour per se. On the other hand literature lacks of studies about the treatment of kleptomania. A wide variety of therapeutic strategies have been proposed for its treatment, among them psychoanalytic oriented psychotherapy, behavioral therapy and pharmacotherapy. Some medications that are used for people diagnosed with kleptomania are selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists. There is evidence from numerous case studies that a variety of cognitive behavioral therapy techniques are effective in the treatment of kleptomania and it is favored over other approaches such as psychodynamic and psychoanalytic therapies. Studies to date suggest that cognitive behavioral therapy when used in combination with medication, is more effective than medication alone.

Keratosis lichenoides chronica: Case-based review of treatment options.

Science.gov (United States)

Pistoni, Federica; Peroni, Anna; Colato, Chiara; Schena, Donatella; Girolomoni, Giampiero

2016-08-01

Keratosis lichenoides chronica (KLC) is a rare dermatological condition characterized by keratotic papules arranged in a parallel linear or reticular pattern and facial lesions resembling seborrheic dermatitis or rosacea. The clinical, histological and therapeutic information on 71 patients with KLC retrieved through a PubMed search plus one our new case were analyzed. KLC affects patients of all ages, with a modest male predominance. Pediatric cases represent about one quarter of patients. Diagnosis is usually delayed and histologically confirmed. All patients have thick, rough and scaly papules and plaques arranged in a linear or reticular pattern, on limbs (>80%) and trunk (about 60%). Face involvement is described in two-thirds of patients. Lesions are usually asymptomatic or mildly pruritic. Other manifestations, such as palmoplantar keratoderma, mucosal involvement, ocular manifestations, nail dystrophy, are reported in 20-30% of patients. Children present more frequently alopecia. No controlled trials are available. Results from small case series or single case reports show that the best treatment options are phototherapy and systemic retinoids, alone or in combination, with nearly half of patients reaching complete remission. Systemic corticosteroids as well as antibiotics and antimalarials are not effective.

PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

Directory of Open Access Journals (Sweden)

Ralevski E

2014-03-01

Full Text Available Elizabeth Ralevski, Lening A Olivera-Figueroa, Ismene Petrakis Yale University School of Medicine, Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA Background: Although posttraumatic stress disorder (PTSD and alcohol use disorders (AUD frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods: We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results: The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion: There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. Keywords: dual diagnosis, PTSD, AUD, pharmacotherapy

Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia.

Directory of Open Access Journals (Sweden)

Brian Maskery

2016-08-01

Full Text Available Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program.An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1 "No Program," 2 U.S. "Domestic Screening and Treatment," 3 "Overseas Albendazole and Ivermectin" presumptive treatment, and 4 "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs.The "No Program" option is the least expensive ($165,923 per cohort and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort. The "Overseas Albendazole and Ivermectin" option ($418,824 is less expensive than "Domestic Screening and Treatment" ($3,832,572 or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483. According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program".Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as

Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia.

Science.gov (United States)

Maskery, Brian; Coleman, Margaret S; Weinberg, Michelle; Zhou, Weigong; Rotz, Lisa; Klosovsky, Alexander; Cantey, Paul T; Fox, LeAnne M; Cetron, Martin S; Stauffer, William M

2016-08-01

Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program. An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs). The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program". Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic

Expensing options solves nothing.

Science.gov (United States)

Sahlman, William A

2002-12-01

The use of stock options for executive compensation has become a lightning rod for public anger, and it's easy to see why. Many top executives grew hugely rich on the back of the gains they made on their options, profits they've been able to keep even as the value they were supposed to create disappeared. The supposed scam works like this: Current accounting regulations let companies ignore the cost of option grants on their income statements, so they can award valuable option packages without affecting reported earnings. Not charging the cost of the grants supposedly leads to overstated earnings, which purportedly translate into unrealistically high share prices, permitting top executives to realize big gains when they exercise their options. If an accounting anomaly is the problem, then the solution seems obvious: Write off executive share options against the current year's revenues. The trouble is, Sahlman writes, expensing option grants won't give us a more accurate view of earnings, won't add any information not already included in the financial statements, and won't even lead to equal treatment of different forms of executive pay. Far worse, expensing evades the real issue, which is whether compensation (options and other-wise) does what it's supposed to do--namely, help a company recruit, retain, and provide the right people with appropriate performance incentives. Any performance-based compensation system has the potential to encourage cheating. Only ethical management, sensible governance, adequate internal control systems, and comprehensive disclosure will save the investor from disaster. If, Sahlman warns, we pass laws that require the expensing of options, thinking that's fixed the fundamental flaws in corporate America's accounting, we will have missed a golden opportunity to focus on the much more extensive defects in the present system.

Reliability of large superconducting magnets through design

International Nuclear Information System (INIS)

Henning, C.D.

1980-01-01

As superconducting magnet systems grow larger and become the central component of major systems involving fusion, magnetohydrodynamics, and high-energy physics, their reliability must be commensurate with the enormous capital investment in the projects. Although the magnet may represent only 15% of the cost of a large system such as the Mirror Fusion Test Facility, its failure would be catastrophic to the entire investment. Effective quality control during construction is one method of ensuring success. However, if the design is unforgiving, even an inordinate amount of effort expended on quality control may be inadequate. Creative design is the most effective way of ensuring magnet reliability and providing a reasonable limit on the amount of quality control needed. For example, by subjecting the last drawing operation is superconductor manufacture to a stress larger than the magnet design stress, a 100% proof test is achieved; cabled conductors offer mechanical redundancy, as do some methods of conductor joining; ground-plane insulation should be multilayered to prevent arcs, and interturn and interlayer insulation spaced to be compatible with the self-extinguishing of arcs during quench voltages; electrical leads should be thermally protected; and guard vacuum spaces can be incorporated to control helium leaks. Many reliable design options are known to magnet designers. These options need to be documented and organized to produce a design guide. Eventually, standard procedures, safety factors, and design codes can lead to reliability in magnets comparable to that obtained in pressure vessels and other structures. Wihout such reliability, large-scale applications in major systems employing magnetic fusion energy, magnetohydrodynamics, or high-energy physics would present unacceptable economic risks

Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options.

Science.gov (United States)

Patel, Dakshesh B; Emmanuel, Neelmini B; Stevanovic, Milan V; Matcuk, George R; Gottsegen, Christopher J; Forrester, Deborah M; White, Eric A

2014-01-01

Infections of the hand are common, particularly in immunocompromised patients, and can lead to significant morbidity, including amputation, if not treated properly. Hand infection can spread far and wide from the original site of inoculation through interconnections between the synovium-lined and nonsynovial potential spaces. Because surgery is the mainstay of treatment, knowledge of the pertinent anatomy is imperative for accurately describing the presence, location, and extent of infection. The authors review the pertinent anatomy of the spaces of the hand and describe different types of infection-including cellulitis, necrotizing fasciitis, paronychia, felon, pyogenic flexor tenosynovitis, deep space infections, septic arthritis, and osteomyelitis-and common causative organisms of these infections. They also describe various modes of spread; the common radiologic appearances of hand infections, with emphasis on findings at magnetic resonance imaging and ultrasonography; and the role of radiology in the management of these infections, along with a brief overview of treatment options. ©RSNA, 2014.

Physics options in the plasma code VOA

International Nuclear Information System (INIS)

Eltgroth, P.G.

1976-06-01

A two dimensional relativistic plasma physics code has been modified to accomodate general electromagnetic boundary conditions and various approximations of basic physics. The code can treat internal conductors and insulators, imposed electromagnetic fields, the effects of external circuitry and non-equilibrium starting conditions. Particle dynamics options include a full microscopic treatment, fully relaxed electrons, a low frequency electron approximation and a combination of approximations for specified zones. Electromagnetic options include the full wave treatment, an electrostatic approximation and two varieties of magnetohydrodynamic approximations in specified zones

Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

Science.gov (United States)

Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

2018-01-01

Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

Reliability analysis techniques for the design engineer

International Nuclear Information System (INIS)

Corran, E.R.; Witt, H.H.

1982-01-01

This paper describes a fault tree analysis package that eliminates most of the housekeeping tasks involved in proceeding from the initial construction of a fault tree to the final stage of presenting a reliability analysis in a safety report. It is suitable for designers with relatively little training in reliability analysis and computer operation. Users can rapidly investigate the reliability implications of various options at the design stage and evolve a system which meets specified reliability objectives. Later independent review is thus unlikely to reveal major shortcomings necessitating modification and project delays. The package operates interactively, allowing the user to concentrate on the creative task of developing the system fault tree, which may be modified and displayed graphically. For preliminary analysis, system data can be derived automatically from a generic data bank. As the analysis proceeds, improved estimates of critical failure rates and test and maintenance schedules can be inserted. The technique is applied to the reliability analysis of the recently upgraded HIFAR Containment Isolation System. (author)

Human reliability analysis

International Nuclear Information System (INIS)

Dougherty, E.M.; Fragola, J.R.

1988-01-01

The authors present a treatment of human reliability analysis incorporating an introduction to probabilistic risk assessment for nuclear power generating stations. They treat the subject according to the framework established for general systems theory. Draws upon reliability analysis, psychology, human factors engineering, and statistics, integrating elements of these fields within a systems framework. Provides a history of human reliability analysis, and includes examples of the application of the systems approach

Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series

Directory of Open Access Journals (Sweden)

Gerard J Fitzmaurice

2014-01-01

Full Text Available In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment.

Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series.

LENUS (Irish Health Repository)

Fitzmaurice, Gerard J

2014-04-01

In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment.

Improving fMRI reliability in presurgical mapping for brain tumours.

Science.gov (United States)

Stevens, M Tynan R; Clarke, David B; Stroink, Gerhard; Beyea, Steven D; D'Arcy, Ryan Cn

2016-03-01

Functional MRI (fMRI) is becoming increasingly integrated into clinical practice for presurgical mapping. Current efforts are focused on validating data quality, with reliability being a major factor. In this paper, we demonstrate the utility of a recently developed approach that uses receiver operating characteristic-reliability (ROC-r) to: (1) identify reliable versus unreliable data sets; (2) automatically select processing options to enhance data quality; and (3) automatically select individualised thresholds for activation maps. Presurgical fMRI was conducted in 16 patients undergoing surgical treatment for brain tumours. Within-session test-retest fMRI was conducted, and ROC-reliability of the patient group was compared to a previous healthy control cohort. Individually optimised preprocessing pipelines were determined to improve reliability. Spatial correspondence was assessed by comparing the fMRI results to intraoperative cortical stimulation mapping, in terms of the distance to the nearest active fMRI voxel. The average ROC-r reliability for the patients was 0.58±0.03, as compared to 0.72±0.02 in healthy controls. For the patient group, this increased significantly to 0.65±0.02 by adopting optimised preprocessing pipelines. Co-localisation of the fMRI maps with cortical stimulation was significantly better for more reliable versus less reliable data sets (8.3±0.9 vs 29±3 mm, respectively). We demonstrated ROC-r analysis for identifying reliable fMRI data sets, choosing optimal postprocessing pipelines, and selecting patient-specific thresholds. Data sets with higher reliability also showed closer spatial correspondence to cortical stimulation. ROC-r can thus identify poor fMRI data at time of scanning, allowing for repeat scans when necessary. ROC-r analysis provides optimised and automated fMRI processing for improved presurgical mapping. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

Public opinion on water reuse options

International Nuclear Information System (INIS)

Bruvold, W.H.

1988-01-01

Public policy on waste water reuse options must be informed by public opinion because it is the public who must pay the cost of developing the option and who will be served by the option in the future. For public policy on reuse, guidance for innovative reuse is not as simple as first believed. It seems that public opinion regarding actual community reuse options is affected by the linkage of several factors, including water conservation, health protection, treatment and distribution costs, and environmental enhancement. Probability sampling was used in 7 studies to select respondents who were queried regarding their opinions on various reclaimed water uses such as ranging from cooling tower water to full domestic use. These 7 are briefly reviewed

Flexibility and reliability in long-term planning exercises dedicated to the electricity sector

Energy Technology Data Exchange (ETDEWEB)

Maizi, Nadia; Drouineau, Mathilde; Assoumou, Edi; Mazauric, Vincent

2010-09-15

Long-term planning models are useful to build plausible options for future energy systems and must consequently address the technological feasibility and associated cost of these options. This paper focuses on the electricity sector and on problems of flexibility and reliability in power systems in order to improve results provided by long-term planning exercises: flexibility needs are integrated as an additional criterion for new investment decisions and, reliability requirements are assessed through the level of electrical losses they induced and a related cost. These approaches are implemented in a long-term planning model and demonstrated through a study of the Reunion Island.

DIAGNOSTIC AND TREATMENT OPTIONS IN AUTISTIC SPECTRUM DIDORDERS – AN OVERVIEW

Directory of Open Access Journals (Sweden)

Sheffali GULATI

2014-03-01

Full Text Available Goal: To highlight the recent recommenddations and future trends in diagnosing and managing autistic spectrum disorder. Methodology: Comprehensive search was done in the electronic database, journals, reference lists and dissertation related to the field. Results and conclusion: Autistic spectrum disorder is characterized by onset before the age of 3 years, qualitative impairment in social and communication skills along with repetitive behavioural pattern and restricted interests. Multiple pathways involving genetic, structural and environmental factors have been implicated in the etiopathogenesis. Diagnosis is primarily clinical, based on caregiver interview and observing the patient. However, certain biochemical, radiological and electrophysiological investigations are indicated in relevant scenarios. The mainstay of therapy is behavioural intervention with pharmacotherapy indicated for certain behavioural issues. Complementary and alternate treatment, dietary and stem cell therapies are still investigational with some benefits.Various newer therapeutic options are currently being investigated, exploring the molecular and genetic basis of causation.

Immunotoxin – a new treatment option in patients with relapsed and refractory Hodgkin lymphoma

Directory of Open Access Journals (Sweden)

Novakovic Barbara Jezersek

2015-12-01

Full Text Available Background. Even though Hodgkin lymphoma is a highly curable disease, some of the patients have either a refractory disease or experience a relapse following a successful primary therapy. Durable responses and remissions in patients with relapsed or refractory disease may be achieved in approximately one-half with salvage chemotherapy followed by high dose chemotherapy (HDT and autologous hematopoietic cell rescue (SCT. On the other hand, patients who relapse after HDT and autologous SCT or those who have failed at least two prior multi-agent chemotherapy regimens and are not candidates for HDT have limited treatment options.

Vitrification treatment options for disposal of greater-than-Class-C low-level waste in a deep geologic repository

International Nuclear Information System (INIS)

Fullmer, K.S.; Fish, L.W.; Fischer, D.K.

1994-11-01

The Department of Energy (DOE), in keeping with their responsibility under Public Law 99-240, the Low-Level Radioactive Waste Policy Amendments Act of 1985, is investigating several disposal options for greater-than-Class C low-level waste (GTCC LLW), including emplacement in a deep geologic repository. At the present time vitrification, namely borosilicate glass, is the standard waste form assumed for high-level waste accepted into the Civilian Radioactive Waste Management System. This report supports DOE's investigation of the deep geologic disposal option by comparing the vitrification treatments that are able to convert those GTCC LLWs that are inherently migratory into stable waste forms acceptable for disposal in a deep geologic repository. Eight vitrification treatments that utilize glass, glass ceramic, or basalt waste form matrices are identified. Six of these are discussed in detail, stating the advantages and limitations of each relative to their ability to immobilize GTCC LLW. The report concludes that the waste form most likely to provide the best composite of performance characteristics for GTCC process waste is Iron Enriched Basalt 4 (IEB4)

Thermal oxidation of nuclear graphite: A large scale waste treatment option

Science.gov (United States)

Jones, Abbie N.; Marsden, Barry J.

2017-01-01

This study has investigated the laboratory scale thermal oxidation of nuclear graphite, as a proof-of-concept for the treatment and decommissioning of reactor cores on a larger industrial scale. If showed to be effective, this technology could have promising international significance with a considerable impact on the nuclear waste management problem currently facing many countries worldwide. The use of thermal treatment of such graphite waste is seen as advantageous since it will decouple the need for an operational Geological Disposal Facility (GDF). Particulate samples of Magnox Reactor Pile Grade-A (PGA) graphite, were oxidised in both air and 60% O2, over the temperature range 400–1200°C. Oxidation rates were found to increase with temperature, with a particular rise between 700–800°C, suggesting a change in oxidation mechanism. A second increase in oxidation rate was observed between 1000–1200°C and was found to correspond to a large increase in the CO/CO2 ratio, as confirmed through gas analysis. Increasing the oxidant flow rate gave a linear increase in oxidation rate, up to a certain point, and maximum rates of 23.3 and 69.6 mg / min for air and 60% O2 respectively were achieved at a flow of 250 ml / min and temperature of 1000°C. These promising results show that large-scale thermal treatment could be a potential option for the decommissioning of graphite cores, although the design of the plant would need careful consideration in order to achieve optimum efficiency and throughput. PMID:28793326

Thermal oxidation of nuclear graphite: A large scale waste treatment option.

Directory of Open Access Journals (Sweden)

Alex Theodosiou

Full Text Available This study has investigated the laboratory scale thermal oxidation of nuclear graphite, as a proof-of-concept for the treatment and decommissioning of reactor cores on a larger industrial scale. If showed to be effective, this technology could have promising international significance with a considerable impact on the nuclear waste management problem currently facing many countries worldwide. The use of thermal treatment of such graphite waste is seen as advantageous since it will decouple the need for an operational Geological Disposal Facility (GDF. Particulate samples of Magnox Reactor Pile Grade-A (PGA graphite, were oxidised in both air and 60% O2, over the temperature range 400-1200°C. Oxidation rates were found to increase with temperature, with a particular rise between 700-800°C, suggesting a change in oxidation mechanism. A second increase in oxidation rate was observed between 1000-1200°C and was found to correspond to a large increase in the CO/CO2 ratio, as confirmed through gas analysis. Increasing the oxidant flow rate gave a linear increase in oxidation rate, up to a certain point, and maximum rates of 23.3 and 69.6 mg / min for air and 60% O2 respectively were achieved at a flow of 250 ml / min and temperature of 1000°C. These promising results show that large-scale thermal treatment could be a potential option for the decommissioning of graphite cores, although the design of the plant would need careful consideration in order to achieve optimum efficiency and throughput.

A PC-based software package for modeling DOE mixed-waste management options

International Nuclear Information System (INIS)

Abashian, M.S.; Carney, C.; Schum, K.

1995-02-01

The U.S. Department of Energy (DOE) Headquarters and associated contractors have developed an IBM PC-based software package that estimates costs, schedules, and public and occupational health risks for a range of mixed-waste management options. A key application of the software package is the comparison of various waste-treatment options documented in the draft Site Treatment Plans prepared in accordance with the requirements of the Federal Facility Compliance Act of 1992. This automated Systems Analysis Methodology consists of a user interface for configuring complexwide or site-specific waste-management options; calculational algorithms for cost, schedule and risk; and user-selected graphical or tabular output of results. The mixed-waste management activities modeled in the automated Systems Analysis Methodology include waste storage, characterization, handling, transportation, treatment, and disposal. Analyses of treatment options identified in the draft Site Treatment Plans suggest potential cost and schedule savings from consolidation of proposed treatment facilities. This paper presents an overview of the automated Systems Analysis Methodology

AUTOLOGOUS STEM CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA STILL A VALID TREATMENT OPTION, OR IS THE GAME OVER ?

Directory of Open Access Journals (Sweden)

Fabienne McClanahan

2012-01-01

Full Text Available

Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR has been established as the current standard of care for young and fit patients with chronic lymphocytic leukemia (CLL. In the early nineties of the last century, long before the advent of fludarabine or antibody-based strategies, there was realistic hope that myeloablative therapy followed by autologous stem cell transplantation (autoSCT might be an effective and potentially curative front-line treatment option for suitable patients with CLL. Since then, several prospective trials have disenthralled this hope: although autoSCT can prolong event and progression-free survival if used as part of early front-line treatment, it does not improve overall survival, while it is associated with an increased risk of late adverse events such as secondary malignancies. In addition, autoSCT lacks the potential to overcome the negative impact of biomarkers that confer resistance to chemotherapy or early relapse. The role of autoSCT has also been explored in the context of FCR, and it was demonstrated that its effect is inferior to the currently established optimal treatment regimen. In view of ongoing attempts to improve on FCR, promising clinical activity of new substances even in relapsed/ refractory CLL patients, exciting novel cell therapy approaches and advantages in the understanding of the disease and detection of Minimal Residual Disease (MRD, autoSCT has lost its place as a standard treatment option for CLL.

AUTOLOGOUS STEM CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA STILL A VALID TREATMENT OPTION, OR IS THE GAME OVER ?

Directory of Open Access Journals (Sweden)

Fabienne McClanahan

2012-11-01

Full Text Available Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR has been established as the current standard of care for young and fit patients with chronic lymphocytic leukemia (CLL. In the early nineties of the last century, long before the advent of fludarabine or antibody-based strategies, there was realistic hope that myeloablative therapy followed by autologous stem cell transplantation (autoSCT might be an effective and potentially curative front-line treatment option for suitable patients with CLL. Since then, several prospective trials have disenthralled this hope: although autoSCT can prolong event and progression-free survival if used as part of early front-line treatment, it does not improve overall survival, while it is associated with an increased risk of late adverse events such as secondary malignancies. In addition, autoSCT lacks the potential to overcome the negative impact of biomarkers that confer resistance to chemotherapy or early relapse. The role of autoSCT has also been explored in the context of FCR, and it was demonstrated that its effect is inferior to the currently established optimal treatment regimen. In view of ongoing attempts to improve on FCR, promising clinical activity of new substances even in relapsed/ refractory CLL patients, exciting novel cell therapy approaches and advantages in the understanding of the disease and detection of Minimal Residual Disease (MRD, autoSCT has lost its place as a standard treatment option for CLL.

Removing a broken guidewire in the hip joint: treatment options and recommendations for preventing an avoidable surgical catastrophe. A case report

Directory of Open Access Journals (Sweden)

Abhijeet Ashok Salunke

Full Text Available ABSTRACT CONTEXT: Hardware breakage during hip surgery can pose challenging and difficult problems for orthopedic surgeons. Apart from technical difficulties relating to retrieval of the broken hardware, complications such as adjacent joint arthritis and damage to neurovascular structures and major viscera can occur. Complications occurring during the perioperative period must be informed to the patient and proper documentation is essential. The treatment options must be discussed with the patient and relatives and the implant company must be informed about this untoward incident. CASE REPORT: We report a case of complete removal of the implant and then removal of the broken guidewire using a combination of techniques, including a cannulated drill bit, pituitary forceps and Kerrison rongeur. CONCLUSIONS: We suggest some treatment options and recommendations for preventing an avoidable surgical catastrophe.

Engineering Options Assessment Report. Nitrate Salt Waste Stream Processing

Energy Technology Data Exchange (ETDEWEB)

Anast, Kurt Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-11-13

This report examines and assesses the available systems and facilities considered for carrying out remediation activities on remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The assessment includes a review of the waste streams consisting of 60 RNS, 29 above-ground UNS, and 79 candidate below-ground UNS containers that may need remediation. The waste stream characteristics were examined along with the proposed treatment options identified in the Options Assessment Report . Two primary approaches were identified in the five candidate treatment options discussed in the Options Assessment Report: zeolite blending and cementation. Systems that could be used at LANL were examined for housing processing operations to remediate the RNS and UNS containers and for their viability to provide repackaging support for remaining LANL legacy waste.

Engineering Options Assessment Report: Nitrate Salt Waste Stream Processing

Energy Technology Data Exchange (ETDEWEB)

Anast, Kurt Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-11-18

This report examines and assesses the available systems and facilities considered for carrying out remediation activities on remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The assessment includes a review of the waste streams consisting of 60 RNS, 29 aboveground UNS, and 79 candidate belowground UNS containers that may need remediation. The waste stream characteristics were examined along with the proposed treatment options identified in the Options Assessment Report . Two primary approaches were identified in the five candidate treatment options discussed in the Options Assessment Report: zeolite blending and cementation. Systems that could be used at LANL were examined for housing processing operations to remediate the RNS and UNS containers and for their viability to provide repackaging support for remaining LANL legacy waste.

Understanding the Role of Serotonin in Female Hypoactive Sexual Desire Disorder and Treatment Options.

Science.gov (United States)

Croft, Harry A

2017-12-01

The neurobiology of sexual response is driven in part by dopamine and serotonin-the former modulating excitatory pathways and the latter regulating inhibitory pathways. Neurobiological underpinnings of hypoactive sexual desire disorder (HSDD) are seemingly related to overactive serotonin activity that results in underactive dopamine activity. As such, pharmacologic agents that decrease serotonin, increase dopamine, or some combination thereof, have therapeutic potential for HSDD. To review the role of serotonin in female sexual function and the effects of pharmacologic interventions that target the serotonin system in the treatment of HSDD. Searches of the Medline database for articles on serotonin and female sexual function. Relevant articles from the peer-reviewed literature were included. Female sexual response is regulated not only by the sex hormones but also by several neurotransmitters. It is postulated that dopamine, norepinephrine, oxytocin, and melanocortins serve as key neuromodulators for the excitatory pathways, whereas serotonin, opioids, and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Serotonin appears to be a key inhibitory modulator of sexual desire, because it decreases the ability of excitatory systems to be activated by sexual cues. Centrally acting drugs that modulate the excitatory and inhibitory pathways involved in sexual desire (eg, bremelanotide, bupropion, buspirone, flibanserin) have been investigated as treatment options for HSDD. However, only flibanserin, a multifunctional serotonin agonist and antagonist (5-hydroxytryptamine [5-HT] 1A receptor agonist and 5-HT 2A receptor antagonist), is currently approved for the treatment of HSDD. The central serotonin system is 1 biochemical target for medications intended to treat HSDD. This narrative review integrates findings from preclinical studies and clinical trials to elucidate neurobiological underpinnings of HSDD but is limited to 1 neurotransmitter system

Lymphoepithelioma-like carcinoma of the urinary bladder: A case report and review of systemic treatment options

Directory of Open Access Journals (Sweden)

Nicholas M Pantelides

2012-01-01

Full Text Available Lymphoepithelioma-like carcinoma (LELC of the urinary bladder is a rare variant, which can occur in a pure form or in conjunction with transitional cell carcinoma. Owing to the scarcity of reported cases, the optimum treatment is yet to be defined, although the benefits of chemotherapy are increasingly recognised. We present a case of a 64-year-old man with pure LELC, treated with trans-urethral resection of the bladder tumor (TURBT and primary gemcitabine and platinum-based chemotherapy. He remained free of disease at six-month follow-up cystoscopy. The case adds to the growing evidence for the efficacy of chemotherapy, coupled with TUR, as part of a bladder-preserving treatment option for LELC.

Energy options

International Nuclear Information System (INIS)

Hampton, Michael

1999-01-01

This chapter focuses on energy options as a means of managing exposure to energy prices. An intuitive approach to energy options is presented, and traditional definitions of call and put options are given. The relationship between options and swaps, option value and option exercises, commodity options, and option pricing are described. An end-user's guide to energy option strategy is outlined, and straight options, collars, participating swaps and collars, bull and bear spreads, and swaption are examined. Panels explaining the defining of basis risk, and discussing option pricing and the Greeks, delta hedging, managing oil options using the Black-Scholes model, caps, floors and collars, and guidelines on hedging versus speculation with options are included in the paper

A rational approach for evaluation and screening of treatment and disposal options for the solar pond sludges at Rocky Flats

International Nuclear Information System (INIS)

Dickerson, K.S.

1995-01-01

This document consists of information about the treatment options for the sludge that is located in the evaporation ponds at the Rocky Flats Plant. The sludges are mixed low-level radioactive wastes whose composition and character were variable. Sludges similar to these are typically treated prior to ultimate disposal. Disposal of treated sludges includes both on-site and off-site options. The rational approach described in this paper is useful for technology evaluation and screening because it provides a format for developing objectives, listing alternatives, and weighing the alternatives against the objectives and against each other

A Fifth Option for Funding Long-Term Care in Canada - Shift the Resources from Medical Treatment and Universal Pension Entitlements.

Science.gov (United States)

Emery, J C Herbert

2016-01-01

Needs for non-medical residential care services, long-term care (LTC), will increase over the next 30 years as Canada's population ages. Adams and Vanin (2016) explore four options for raising the public and private monies required to meet LTC needs. In this commentary, I raise a fifth option for finding the resources to meet emerging LTC needs. An alternative approach is to divert resources from Canada's well-resourced, but inefficient, medical treatment system. The dividend of provinces pursuing long overdue reforms to medicare is the liberation of public funds to finance emerging priorities for Canadians like LTC.

A rational approach for evaluation and screening of treatment and disposal options for the solar pond sludges at Rocky Flats

Energy Technology Data Exchange (ETDEWEB)

Dickerson, K.S.

1995-12-31

This document consists of information about the treatment options for the sludge that is located in the evaporation ponds at the Rocky Flats Plant. The sludges are mixed low-level radioactive wastes whose composition and character were variable. Sludges similar to these are typically treated prior to ultimate disposal. Disposal of treated sludges includes both on-site and off-site options. The rational approach described in this paper is useful for technology evaluation and screening because it provides a format for developing objectives, listing alternatives, and weighing the alternatives against the objectives and against each other.

The current treatment options for epilepsy

International Nuclear Information System (INIS)

Sykora, P.; Svecova, L.

2014-01-01

Epilepsy is the most prevalent chronic brain disease manifesting with epileptic seizures. Epilepsy itself is not one nosological entity, it rather includes several diseases with various etiology, clinics, course and therapy. Antiepileptic therapy aims seizure freedom without affecting psychical and physical functions. The therapy is in first line pharmacological. The choice of antiepileptic drug depends not only on the seizure phenomenology, but also on the respective type of epilepsy syndrome. Most patients achieve seizure freedom or at least significant seizure frequency reduction. In 20-30% of the patients is the pharmacotherapy ineffective. In these cases of refractory epilepsy therapeutical options include epilepsy surgery, vagal stimulation or ketogenic diet. Despite recent advances in the diagnostics and therapy, epilepsy remains a serious medical and social issue. (author)

Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO): protocol for an educational intervention study.

Science.gov (United States)

Sanchez, Katherine; Eghaneyan, Brittany H; Trivedi, Madhukar H

2016-07-29

Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication (DPC) and resultant sub-optimal use of anti-depressant medications. Stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns about depression treatments among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. The current manuscript presents the study protocol for the Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO) study funded by the Center for Medicare and Medicaid Services (CMS) Grants to Support the Hispanic Health Services Research Grant Program. DESEO will implement universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9)) that is presented through a customized web application and a Depression Education Intervention (DEI) designed to increase disease literacy, and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. This project will be conducted at one community health center whose patient population is majority Hispanic. The target enrollment for recruitment is 350 patients over the 24-month study period. A one-group, pretest-posttest design will be used to asses knowledge of depression and its treatment and related stigma before, immediately after, and one month post intervention. Primary care settings often are the gateway to identifying undiagnosed mental health disorders, particularly for people with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education as an intervention to increase engagement in depression treatment. By participating in the DEI, it is expected that patients will have time to understand treatment

Berg River Textiles - Cleaner Production Option Report

DEFF Research Database (Denmark)

Wenzel, Henrik; Schneider, Zsig

schematics on the various wet treatment operations in the dyehouse, and water and energy balances were made to the extent data allowed. A number of options for saving water, energy and chemicals were identified. The potentials monetary savings and necessary investments were estimated, and a list of priority...... projects including milestone plans for their implementation was made. A saving potential of around 3 mill. R was identified with a pay-back period of around 0.2 years as average of the identified options. The company implemented a large number of the options right away....

Calcific tendinitis of the rotator cuff: management options.

Science.gov (United States)

Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

2014-11-01

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Cimetidine: A Safe Treatment Option for Cutaneous Warts in Pediatric Heart Transplant Recipients

Directory of Open Access Journals (Sweden)

Bibhuti B Das

2018-04-01

Full Text Available Background and Objectives: Immunosuppressed individuals are at particularly increased risk for human papilloma virus-related infections. The primary objective of our study is to determine if there are any adverse effects associated with high-dose cimetidine treatment. A secondary objective is to report our experience with cimetidine in the treatment of cutaneous warts in pediatric heart transplant recipients. Methods and Results: This was a retrospective observational study. A total of 8 pediatric heart transplant recipients diagnosed with multiple recalcitrant warts were the subject of the study. All patients were treated with cimetidine (30–40 mg/kg/day in two divided doses for 3 to 6 month durations. All patients had complete resolution of their lesions except 1 patient who had no clinical improvement. Of these 8 patients, one had recurrence of warts at one year follow-up, which resolved with restarting cimetidine therapy. One patient who had only 3 months of cimetidine therapy had immediate relapse after cimetidine was stopped. None of them had significant change in their tacrolimus trough, serum creatinine, and alanine transaminase levels. No adverse events were reported except one patient experienced mild gynecomastia. Conclusion: Cimetidine can be a safe and alternative treatment option for multiple warts in pediatric heart transplant recipients.

Excited delirium syndrome (ExDS): treatment options and considerations.

Science.gov (United States)

Vilke, Gary M; Bozeman, William P; Dawes, Donald M; Demers, Gerard; Wilson, Michael P

2012-04-01

and initiate appropriate stabilizing treatment. ExDS patients will generally require transfer to an emergency department (ED) for further management, evaluation, and definitive care. In this paper, we present a typical ExDS case and then review existing literature for current treatment options. Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Puget Sound area electric reliability plan: Draft Environmental Impact Statement

International Nuclear Information System (INIS)

1992-04-01

The purpose of this appendix to the draft environmental impact statement (EIS) report is to provide an update of the latest study work done on transmission system options for the Puget Sound Area Electric Reliability Plan. Also included in the attachments to the EIS are 2 reports analyzing the voltage stability of the Puget Sound transmission system and a review by Power Technologies, Inc. of the BPA voltage stability analysis and reactive options. Five transmission line options and several reactive options are presently being considered as possible solutions to the PSAFRP by the Transmission Team. The first two line options would be built on new rights-of way adjacent (as much as possible) to existing corridors. The reactive options would optimize the existing transmission system capability by adding new stations for series capacitors and/or switchgear. The other three line options are rebuilds or upgrades of existing cross mountain transmission lines. These options are listed below and include a preliminary assessment of the additional transmission system reinforcement required to integrate the new facilities into the existing transmission system. Plans were designed to provide at least 500 MVAR reactive margin

Breaking the Mold: A Review of Mucormycosis and Current Pharmacological Treatment Options.

Science.gov (United States)

Riley, Treavor T; Muzny, Christina A; Swiatlo, Edwin; Legendre, Davey P

2016-09-01

To review the current literature for the pathogenesis of mucormycosis, discuss diagnostic strategies, and evaluate the efficacy of polyenes, triazoles, and echinocandins as pharmacological treatment options. An electronic literature search was conducted in PubMed using the MESH terms Rhizopus, zygomycetes, zygomycosis, Mucorales and mucormycosis, with search terms amphotericin B, micafungin, anidulafungin, caspofungin, extended infusion amphotericin B, liposomal amphotericin B, combination therapy, triazole, posaconazole, isavuconazole, diagnosis, and clinical manifestations. Studies written in the English language from January 1960 to March 2016 were considered for this review article. All search results were reviewed, and the relevance of each article was determined by the authors independently. Mucormycosis is a rare invasive fungal infection with an exceedingly high mortality and few therapeutic options. It has a distinct predilection for invasion of endothelial cells in the vascular system, which is likely important in dissemination of disease from a primary focus of infection. Six distinct clinical syndromes can occur in susceptible hosts, including rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated, and miscellaneous infection. Diagnosis of mucormycosis is typically difficult to make based on imaging studies, sputum culture, bronchoalveolar lavage culture, or needle aspirate. Surgical debridement prior to dissemination of infection improves clinical outcomes. Surgery combined with early, high-dose systemic antifungal therapy yields greater than a 1.5-fold increase in survival rates. The Mucorales are inherently resistant to most widely used antifungal agents. Amphotericin B is appropriate for empirical therapy, whereas posaconazole and isavuconazole are best reserved for de-escalation, refractory cases, or patients intolerant to amphotericin B. © The Author(s) 2016.

Reliability testing of two classification systems for osteoarthritis and post-traumatic arthritis of the elbow.

Science.gov (United States)

Amini, Michael H; Sykes, Joshua B; Olson, Stephen T; Smith, Richard A; Mauck, Benjamin M; Azar, Frederick M; Throckmorton, Thomas W

2015-03-01

The severity of elbow arthritis is one of many factors that surgeons must evaluate when considering treatment options for a given patient. Elbow surgeons have historically used the Broberg and Morrey (BM) and Hastings and Rettig (HR) classification systems to radiographically stage the severity of post-traumatic arthritis (PTA) and primary osteoarthritis (OA). We proposed to compare the intraobserver and interobserver reliability between systems for patients with either PTA or OA. The radiographs of 45 patients were evaluated at least 2 weeks apart by 6 evaluators of different levels of training. Intraobserver and interobserver reliability were calculated by Spearman correlation coefficients with 95% confidence intervals. Agreement was considered almost perfect for coefficients >0.80 and substantial for coefficients of 0.61 to 0.80. In patients with both PTA and OA, intraobserver reliability and interobserver reliability were substantial, with no difference between classification systems. There were no significant differences in intraobserver or interobserver reliability between attending physicians and trainees for either classification system (all P > .10). The presence of fracture implants did not affect reliability in the BM system but did substantially worsen reliability in the HR system (intraobserver P = .04 and interobserver P = .001). The BM and HR classifications both showed substantial intraobserver and interobserver reliability for PTA and OA. Training level differences did not affect reliability for either system. Both trainees and fellowship-trained surgeons may easily and reliably apply each classification system to the evaluation of primary elbow OA and PTA, although the HR system was less reliable in the presence of fracture implants. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options.

Science.gov (United States)

Lamb, Ruth; Rohrer, Jonathan D; Lees, Andrew J; Morris, Huw R

2016-09-01

There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specifically bradykinesia and rigidity) in PSP and CBD; however, evidence is conflicting and where present, benefits are often negligible and short lived. In fact, "poor" response to levodopa forms part of the NINDS-SPSP criteria for the diagnosis of PSP and consensus criteria for the diagnosis of CBD (Lang Mov Disord. 20 Suppl 1:S83-91, 2005; Litvan et al. Neurology. 48:119-25, 1997; Armstrong et al. Neurology. 80(5):496-503, 2013). There is some evidence that intrasalivery gland botulinum toxin is useful in managing problematic sialorrhea and that intramuscular botulinum toxin and baclofen are helpful in reducing dystonia, including blepharospasm. Benzodiazepines may also be useful in managing dystonia. Myoclonus may be managed using levetiracetam and benzodiazepines. Pharmacological agents licensed for Alzheimer's disease (such as acetylcholinesterase inhibitors and N-Methyl-D-aspartate receptor antagonists) have been used off-label in PSP, CBD, and other tauopathies with the aim of improving cognition; however, there is limited evidence that they are effective and risk of adverse effects may outweigh benefits. The use of atypical antipsychotics for behavioural symptoms is not recommended in the elderly or those with demetia associated conditions and most antipsychotics will worsen Parkinsonism. Antidepressants may be useful for behavioral symptoms and depression but are often poorly tolerated due to adverse effects. In the absence of an effective drug treatment to target the underlying cause of

48 CFR 552.217-71 - Notice Regarding Option(s).

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Notice Regarding Option(s... Notice Regarding Option(s). As prescribed in 517.208(b), insert the following provision: Notice Regarding Option(s) (NOV 1992) The General Services Administration (GSA) has included an option to [Insert...

A Proposed Solution for the Chicken-Egg Dilemma in Pricing Currency Options

Directory of Open Access Journals (Sweden)

Ariful Hoque

2013-06-01

Full Text Available The implied volatility (IV estimation process suffers from an obvious chicken-egg dilemma: obtaining an unbiased IV requires the options to be priced correctly and calculating an accurate option price (OP requires an unbiased IV. We address this critical issue in two steps. First, the Granger causality test is employed, whichconfirms the chicken-and-egg problem in the IV computing process. Secondly, the concept of “moneyness volatility (MV” is introduced as an alternative to IV. MV is modelled based on an option’s moneyness (OM during the life of the option’s contract. The F-test, Granger-Newbold test and Diebold-Mariano test results consistently show that MV outperforms IV in estimating the exchange rate volatility for pricing options. Further, these series of tests across six major currency options substantiate the validity as well as the reliability of the results. We posit that MV offers a unique solution for pricing currency options accurately.

Automotive turbogenerator design options

Energy Technology Data Exchange (ETDEWEB)

Rodgers, C. [ITC, San Diego, CA (United States); McDonald, C. [McDonald Thermal Engineering, La Jolla, CA (United States)

1998-12-31

For the small turbogenerator to find reception in the hybrid electric automotive market its major features must be dominated by the following considerations, low cost, high performance, low emissions, compact size and high reliability. Not meeting the first two criteria has been the nemesis of earlier attempts to introduce the small gas turbine for automotive service. With emphasis on the design for low cost and high performance, this paper presents several turbogenerator design flowpath configuration options for the major engine components. The projected evolution from today`s state-of-the-art all metallic engines, to advanced technology ceramic units for service in the early decade of the 21st century, is the major topic of this paper. (author)

Energy options. Preparing for an uncertain future

International Nuclear Information System (INIS)

Andrews, H.R.; Harvey, M.

1988-02-01

We must begin now to plan to replace fossil fuels as a major energy source. Few energy sources are capable of supplying the vast amount of energy required. The only options that can play a major role are coal, hydro-electricity, and nuclear. The soft energy options are not reliable: we cannot control the blowing of the wind or the shining of the sun; biomass is susceptible to disease. If we were to become too dependent on these we would be surrendering our energy system to the vagaries of nature. A strong electrical system is a cornerstone of energy security. Surplus capacity is often criticized, but a shortfall in supply will cause industrial chaos. Nuclear power is based on a sustainable resource supply, uses a proven technology, is economically competitive, and causes minimal harm to human populations and the environment

Reliability impact of RF tube technology for the NPB

International Nuclear Information System (INIS)

Bueck, J.C.

1989-01-01

Two reliability options, redundancy and operating margin, are examined to determine their effect on power system configurations using RF tube technology (klystron and klystrode) powered Neutral Particle Beam weapons. Redundance is addressed by providing an additional identical RF tube to the tubes required to power an accelerator RF element (DTL section, RFQ, or CCL). RF elements do not share RF power with other RF elements. Operating margin provides increased reliability by sizing the RF tubes such that tube operating levels may be increased compensate for the loss of a tube. It is shown that power system mass is affected by the choice of reliability measures, that higher power tubes coupled with higher power RF elements may mitigate mass increases, and that redundancy appears preferable to operating margin as a method of improving RF system reliability

Incontinence Treatment: Biofeedback

Science.gov (United States)

... Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding ... Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding ...

Stereotactic body radiotherapy: a promising treatment option for the boost of oropharyngeal cancers not suitable for brachytherapy: a single-institutional experience.

NARCIS (Netherlands)

Al-Mamgani, A.; Tans, L.; Teguh, D.N.; Rooij, P. van; Zwijnenburg, E.M.; Levendag, P.C.

2012-01-01

PURPOSE: To prospectively assess the outcome and toxicity of frameless stereotactic body radiotherapy (SBRT) as a treatment option for boosting primary oropharyngeal cancers (OPC) in patients who not suitable for the standard brachytherapy boost (BTB). METHODS AND MATERIALS: Between 2005 and 2010,

Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options

Science.gov (United States)

Lee, Chang-Ro; Lee, Jung Hun; Park, Moonhee; Park, Kwang Seung; Bae, Il Kwon; Kim, Young Bae; Cha, Chang-Jun; Jeong, Byeong Chul; Lee, Sang Hee

2017-01-01

Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized. PMID:28348979

Natural Products as New Treatment Options for Trichomoniasis: A Molecular Docking Investigation

Directory of Open Access Journals (Sweden)

Mary Snow Setzer

2017-01-01

Full Text Available Trichomoniasis, caused by the parasitic protozoan Trichomonas vaginalis, is the most common non-viral sexually-transmitted disease, and there can be severe complications from trichomoniasis. Antibiotic resistance in T. vaginalis is increasing, but there are currently no alternatives treatment options. There is a need to discover and develop new chemotherapeutic alternatives. Plant-derived natural products have long served as sources for new medicinal agents, as well as new leads for drug discovery and development. In this work, we have carried out an in silico screening of 952 antiprotozoal phytochemicals with specific protein drug targets of T. vaginalis. A total of 42 compounds showed remarkable docking properties to T. vaginalis methionine gamma-lyase (TvMGL and to T. vaginalis purine nucleoside phosphorylase (TvPNP. The most promising ligands were polyphenolic compounds, and several of these showed docking properties superior to either co-crystallized ligands or synthetic enzyme inhibitors.

An investigation of storage and treatment options for radioactive wastes prepared for sea disposal

International Nuclear Information System (INIS)

Wakerley, M.W.; Woodfine, B.C.

1986-07-01

A sea disposal of 3500 t of packaged waste using a specially converted ship was planned for 1983, but did not take place. The major part of this waste is currently stored at two UKAEA sites. The waste packages were made with the intention that they would be disposed of within about 18 months of packaging. It was not intended that they would be stored for long periods. All wastes are packaged in mild steel drums and the wastes are temporarily stored within buildings. The conditions under which the packages are stored and their present condition are described and possible storage and treatment options are investigated having regard to available disposal routes. (author)

SGLT-2 Inhibitors: Are They a Promising Treatment Option in T2DM Patients with NAFLD?

Directory of Open Access Journals (Sweden)

Dimitrios Patoulias

2018-04-01

Full Text Available Sodium glucose co-transporter type 2 inhibitors (SGLT-2 inhibitors are a class of antidiabetics, recently approved for the treatment of patients with T2DM. They feature cardioprotective and renoprotective action, while they exert beneficial effects on metabolic parameters. Non-alcoholic fatty liver disease (NAFLD is a frequent co-morbidity in diabetic patients. Its prevalence reaches up to 70%. Since there is no specific treatment approved for NAFLD, both experimental and clinical studies have been recently conducted highlighting the efficacy and safety of SGLT-2 inhibitors mainly in animal models and secondarily in patients with T2DM and NAFLD. This class of antidiabetics seems very attractive, improving both glycemic control and liver function tests, while inhibiting NAFLD progression. However, further investigation is required to establish them as a first-line treatment option in T2DM patients with NAFLD, after thorough assessment of their efficacy and safety in clinical practice.

The rationale for B lymphocyte depletion in Graves' disease. Monoclonal anti-CD20 antibody therapy as a novel treatment option

DEFF Research Database (Denmark)

El Fassi, Daniel; Nielsen, Claus H; Hasselbalch, Hans K

2006-01-01

We have reviewed the immunology of thyroid autoimmunity with special reference to the importance of B lymphocytes (B cells) in thyroidal and extrathyroidal Graves' disease (GD), thus providing a framework for the hypothesis that B cell depletion may be beneficial in GD. Additionally, after...... reviewing the efficacy and safety in other autoimmune diseases, we propose that treatment with the B cell-depleting agent Rituximab may become a clinically relevant treatment option in selected cases of GD, particularly when complicated with thyroid-associated ophthalmopathy....

Estimating the option value of a non-firm electricity tariff

International Nuclear Information System (INIS)

Moore, J.; Horii, B.; Price, S.; Olson, A.; Woo, C.K.

2010-01-01

We estimate the option value of a non-firm electricity tariff commonly used by a local distribution company (LDC) in its electricity demand response program. This option value captures the benefit that a LDC enjoys from not serving an end-use load during high-price hours in a wholesale electricity market. It is conservative in that it does not include the cost savings in meeting the LDC's resource adequacy requirement or deferring transmission and distribution (T and D) investments necessary for delivering reliable service. Illustrated by a Northern California example, our two-pronged approach entails (a) a set of summer monthly market price regressions to forecast daily spot price distributions that incorporate uncertainty in natural gas price and weather; and (b) a simulation exercise to quantify the tariff's value under a specific design. The results indicate that a non-firm service tariff can have varying option value estimates that are highly sensitive to the tariff's design, and that an incentive payment based on the option value alone is likely insufficient to attract customer participation in a non-firm service program. (author)

Systems engineering study: tank 241-C-103 organic skimming,storage, treatment and disposal options

Energy Technology Data Exchange (ETDEWEB)

Klem, M.J.

1996-10-23

This report evaluates alternatives for pumping, storing, treating and disposing of the separable phase organic layer in Hanford Site Tank 241-C-103. The report provides safety and technology based preferences and recommendations. Two major options and several varations of these options were identified. The major options were: 1) transfer both the organic and pumpable aqueous layers to a double-shell tank as part of interim stabilization using existing salt well pumping equipment or 2) skim the organic to an above ground before interim stabilization of Tank 241-C-103. Other options to remove the organic were considered but rejected following preliminary evaluation.

Treatment Option Overview (Chronic Myelogenous Leukemia)

Science.gov (United States)

... ALL Treatment Childhood AML Treatment Research Chronic Myelogenous Leukemia Treatment (PDQ®)–Patient Version General Information About Chronic Myelogenous Leukemia Go to Health Professional Version Key Points Chronic ...

Successful treatment of bullous lichen planus with acitretin monotherapy. Review of treatment options for bullous lichen planus and case report.

Science.gov (United States)

Rallis, Efstathios; Liakopoulou, Angeliki; Christodoulopoulos, Constantinos; Katoulis, Alexandros

2016-12-31

Bullous lichen planus (BLP) is a rare variant of lichen planus, characterized by the development of vesicular and bullous lesions, of skin, nails, hair and/or mucosa. We present a case of 63-year-old woman with BLP, unresponsive to previous therapies with topical corticosteroids, topical calcipotriol, antihistamines and oral cyclosporine (4 mg/kg/day for 4 months). She was already receiving treatment for arterial hypertension, hyperlipidemia, atrial fibrillation and uncontrolled diabetes mellitus. Acitretin was administered for 5 months with complete remission of BLP lesions and no major side effects. This is probably the first reported case of BLP treated with acitretin monotherapy. In this case acitretin was an efficacious and well-tolerated therapeutic option for BLP.

Reliability and validity of a treatment fidelity assessment for motivational interviewing targeting sexual risk behaviors in people living with HIV/AIDS.

Science.gov (United States)

Seng, Elizabeth K; Lovejoy, Travis I

2013-12-01

This study psychometrically evaluates the Motivational Interviewing Treatment Integrity Code (MITI) to assess fidelity to motivational interviewing to reduce sexual risk behaviors in people living with HIV/AIDS. 74 sessions from a pilot randomized controlled trial of motivational interviewing to reduce sexual risk behaviors in people living with HIV were coded with the MITI. Participants reported sexual behavior at baseline, 3-month, and 6-months. Regarding reliability, excellent inter-rater reliability was achieved for measures of behavior frequency across the 12 sessions coded by both coders; global scales demonstrated poor intraclass correlations, but adequate percent agreement. Regarding validity, principle components analyses indicated that a two-factor model accounted for an adequate amount of variance in the data. These factors were associated with decreases in sexual risk behaviors after treatment. The MITI is a reliable and valid measurement of treatment fidelity for motivational interviewing targeting sexual risk behaviors in people living with HIV/AIDS.

Reasoning with Inductive Argument Test: A Study of Validity and Reliability

Directory of Open Access Journals (Sweden)

Mehmet Emrah Karadere

2013-11-01

Full Text Available Reasoning with Inductive Argument Test:A Study of Validity and Reliability Objective: The aim of our study is to research reliability and validity and to evaluate the usability of Turkish version of Reasoning with Inductive Argument Test (RIAT in Turkish healty population. Method: 51 healty volunteers who work in Ankara Dıskapi Yildirim Beyazit Research and Training Hospital participated in this study. Reasoning with Inductive Argument Test (RIAT was translated into Turkish by three clinical good knowledge of English. Participants were given a sociodemographic data form, and RIAT were performed by clinicians. To test the reliability of the Turkish version of RIAT, Cronbach’s alpha coefficient was calculated and the halving method was used for the test. Results: The internal consistency of the Reasoning with Inductive Argument Test (RIAT items, Cronbach’s alpha internal consistency coefficient measurements of 0.73 was found to be statistically significant. Spearman-Brown coefficient that determines the reliability of the whole test r=0.74 was found. Kurtosis values of all the items was below 1.5 and the percentages in the second evaluation were mainly lower. At the same time, both change in belief between self produced RIAT options and given RIAT options (p=0.02, z=-2296 as well as changes in beliefs between related and unrelated items for Obsessive Compulsive Disorder (OCD difference (p=0.03, z=-2.199 were significant. Conclusion: The preliminary data obtained from the study of reliability and validity of the scale shows that ‘Reasoning with Inductive Argument Test’ supports reliability and validity in Turkish population.

Puget Sound Area Electric Reliability Plan : Appendix E, Transmission Reinforcement Analysis.

Energy Technology Data Exchange (ETDEWEB)

United States. Bonneville Power Administration.

1992-04-01

The purpose of this appendix to the draft environmental impact statement (EIS) report is to provide an update of the latest study work done on transmission system options for the Puget Sound Area Electric Reliability Plan. Also included in the attachments to the EIS are 2 reports analyzing the voltage stability of the Puget Sound transmission system and a review by Power Technologies, Inc. of the BPA voltage stability analysis and reactive options. Five transmission line options and several reactive options are presently being considered as possible solutions to the PSAFRP by the Transmission Team. The first two line options would be built on new rights-of way adjacent (as much as possible) to existing corridors. The reactive options would optimize the existing transmission system capability by adding new stations for series capacitors and/or switchgear. The other three line options are rebuilds or upgrades of existing cross mountain transmission lines. These options are listed below and include a preliminary assessment of the additional transmission system reinforcement required to integrate the new facilities into the existing transmission system. Plans were designed to provide at least 500 MVAR reactive margin.

A qualitative assessment of climate adaptation options and some estimates of adaptation costs

International Nuclear Information System (INIS)

Van Ierland, E.C.; De Bruin, K.; Dellink, R.B.; Ruijs, A.

2007-02-01

The Routeplanner project aims to provide a 'systematic assessment' of potential adaptation options to respond to climate change in the Netherlands in connection to spatial planning. The study is the result of a policy oriented project that took place between May and September 2006. The aim of the current study is to provide a 'qualitative assessment' of the direct and indirect effects of adaptation options and to provide an assessment of some of the costs and benefits of adaptation options. The present report presents and summarizes the results of all phases of the study: an inventory of adaptation options, a qualitative assessment of the effects of the adaptation options for the Netherlands in the long run, a database which allows to rank the various options according to a set of criteria and a relative ranking on the basis of these criteria. Finally, the report also contains the best available information on costs and benefits of various adaptation options. However, while conducting the study the project team observed that reliable information in this respect is in many cases still lacking and an urgent need exists for more detailed studies on costs and benefits of adaptation options and the design of the best options to cope with climate change

Electrical Performance and Reliability Improvement of Amorphous-Indium-Gallium-Zinc-Oxide Thin-Film Transistors with HfO₂ Gate Dielectrics by CF₄ Plasma Treatment.

Science.gov (United States)

Fan, Ching-Lin; Tseng, Fan-Ping; Tseng, Chiao-Yuan

2018-05-17

In this work, amorphous indium-gallium-zinc oxide thin-film transistors (a-IGZO TFTs) with a HfO₂ gate insulator and CF₄ plasma treatment was demonstrated for the first time. Through the plasma treatment, both the electrical performance and reliability of the a-IGZO TFT with HfO₂ gate dielectric were improved. The carrier mobility significantly increased by 80.8%, from 30.2 cm²/V∙s (without treatment) to 54.6 cm²/V∙s (with CF₄ plasma treatment), which is due to the incorporated fluorine not only providing an extra electron to the IGZO, but also passivating the interface trap density. In addition, the reliability of the a-IGZO TFT with HfO₂ gate dielectric has also been improved by the CF₄ plasma treatment. By applying the CF₄ plasma treatment to the a-IGZO TFT, the hysteresis effect of the device has been improved and the device's immunity against moisture from the ambient atmosphere has been enhanced. It is believed that the CF₄ plasma treatment not only significantly improves the electrical performance of a-IGZO TFT with HfO₂ gate dielectric, but also enhances the device's reliability.

Options for reducing oil content of sludge from a petroleum wastewater treatment plant.

Science.gov (United States)

Kwon, Tae-Soon; Lee, Jae-Young

2015-10-01

Wastewater treatment plants at petroleum refineries often produce substantial quantities of sludge with relatively high concentrations of oil. Disposal of this waste is costly, in part because the high oil content requires use of secure disposal methods akin to handling of hazardous wastes. This article examines the properties of oily sludge and evaluates optional methods for reducing the oil content of this sludge to enable use of lower cost disposal methods. To reduce the oil content or break the structure of oily sludge, preliminary lab-scale experiments involving mechanical treatment, surfactant extraction, and oxidation are conducted. By applying surfactants, approximately 36% to 45% of oils are extracted from oily sludge. Of this, about 33% of oils are rapidly oxidised via radiation by an electron beam within 10 s of exposure. The Fenton reaction is effective for destruction of oily sludge. It is also found that 56% of oils were removed by reacting oily sludge with water containing ozone of 0.5 mg l(-1) over a period of 24 h. Oxidation using ozone thus can also be effectively used as a pretreatment for oily sludge. © The Author(s) 2015.

Energy exotic options

International Nuclear Information System (INIS)

Kaminski, V.; Gibner, S.; Pinnamaneni, K.

1999-01-01

This chapter with 88 references focuses on the use of exotic options to control exposure to energy prices. Exotic options are defined, and the conversion of a standard option into an exotic option and pricing models are examined. Pricing and hedging exotic options, path-dependent options, multi-commodity options, options on the minimum-or-maximum of two commodities, compound options, digital options, hybrid and complex structures, and natural gas daily options are described. Formulas for option pricing for vanilla, barrier, compound, options on minimum or maximum of two assets, and look back options are given in an appendix

Regulatory analysis for the resolution of Generic Issue 115, enhancement of the reliability of the Westinghouse Solid State Protection System

International Nuclear Information System (INIS)

Basdekas, D.L.

1989-05-01

Generic Issue 115 addresses a concern related to the reliability of the Westinghouse reactor protection system for plants using the Westinghouse Solid State Protection System (SSPS). Several options for improving the reliability of the Westinghouse reactor trip function for these plants and their effect on core damage frequency (CDF) and overall risk were evaluated. This regulatory analysis includes a quantitative assessment of the costs and benefits associated with the various options for enhancing the reliability of the Westinghouse SSPS and provides insights for consideration and industry initiatives. No new regulatory requirements are proposed. 25 refs., 11 tabs

GARCH Option Valuation: Theory and Evidence

DEFF Research Database (Denmark)

Christoffersen, Peter; Jacobs, Kris; Ornthanalai, Chayawat

We survey the theory and empirical evidence on GARCH option valuation models. Our treatment includes the range of functional forms available for the volatility dynamic, multifactor models, nonnormal shock distributions as well as style of pricing kernels typically used. Various strategies...... for empirical implementation are laid out and we also discuss the links between GARCH and stochastic volatility models. In the appendix we provide Matlab computer code for option pricing via Monte Carlo simulation for nonaffine models as well as Fourier inversion for affine models....

Hand Eczema: Treatment options

DEFF Research Database (Denmark)

Lund, Tamara Theresia; Agner, Tove

2017-01-01

Hand eczema is a common disease, it affects young people, is often work-related, and the burden of the disease is significant for the individual as well as for society. Factors to be considered when choosing a treatment strategy are, among others, whether the eczema is acute or chronic, the sever...

Primary intestinal lymphangiectasia in children: is octreotide an effective and safe option in the treatment?

Science.gov (United States)

Sari, Sinan; Baris, Zeren; Dalgic, Buket

2010-10-01

Octreotide has been suggested as a medical treatment option in refractory cases of primary intestinal lymphangiectasia (IL). There are few data about the long-term effect and safety of octreotide for IL in the literature. In the present article we analyzed pediatric cases of primary IL with long-term octreotide treatment and discussed its safety profile. Between 1999 and 2008, 13 children were diagnosed in our clinic as having IL. Six patients with primary IL were followed up, receiving octreotide therapy. The clinical data of the patients and duration of therapy, dose, and side effects of octreotide were evaluated. Octreotide, 15 to 20 μg per body weight 2 times daily subcutaneously, was given to all of the patients. Duration of the octreotide treatment changed between 3 and 37 months. Stool frequency decreased in all of the patients after starting octreotide treatment. Serum albumin could be maintained at normal levels in 3 patients. The requirement of albumin infusions decreased in all of the patients. Acute pancreatitis was observed as a side effect of octreotide in 1 patient. Octreotide may help to maintain serum albumin levels, improve clinical findings, and decrease the requirement of albumin infusions in refractory cases of primary IL.

Evaluation of nasal and oropharyngeal flora in patients with acne vulgaris according to treatment options.

Science.gov (United States)

Ozuguz, Pınar; Callioglu, Elif E; Tulaci, Kamil G; Kacar, Seval D; Balta, Ilknur; Asik, Gulsah; Karatas, Serap; Karaca, Semsettin

2014-11-01

The aim of this study was to evaluate changes in nasal and oropharyngeal flora in patients with acne during treatments with tetracycline and isotretinoin. Swab specimens were taken from the right and left nasal cavities and oropharynx of 55 patients with acne and 20 healthy volunteers who were admitted to the dermatology department (Etlik Educational and Research Hospital, Ankara, Turkey) before the administration of treatment and in the third month of treatment. Study participants were divided into four groups as follows: patients with acne on topical treatment only, systemic isotretinoin, and systemic tetracycline, and the control group. Of 55 patients with acne, 18 were male and 37 were female. The mean age of the patients and the control group was 22.21 ± 4.22 and 21.95 ± 7.64, respectively. Staphylococcus aureus was isolated from the nasal flora of five patients, normal flora was suppressed in the oropharyngeal cultures of seven patients, and normal flora grew in the cultures of the other 20 patients who were on tetracycline treatment. On the other hand, normal flora grew in the nasal and oropharyngeal cultures of all the patients who were on isotretinoin treatment. Treatment options and follow-up procedures for acne vulgaris may lead to the development of bacterial resistance and damage to flora. In particular, systemic tetracycline treatment leads to changes in flora of the nose and throat in patients with acne with an increased carriage of S. aureus. Therefore, careful attention should be paid to the duration of tetracycline treatment in order to not increase the risk of disturbance of microbial flora. © 2014 The International Society of Dermatology.

The safety of available treatment options for iron-deficiency anemia.

Science.gov (United States)

Muñoz, Manuel; Gómez-Ramírez, Susana; Bhandari, Sunil

2018-02-01

Iron deficiency (ID), with or without anemia, is highly prevalent worldwide and has clinical consequences. The prevention and treatment of ID is a major public health goal. Accurate diagnosis, selection of the appropriate iron replacement therapy and addressing the underlying cause, remain as the main challenges in ID management. Areas covered: This review aims to provide a narrative review of current available evidence on iron supplementation options regularly used to treat ID, including oral and intravenous (IV) iron formulations, with emphasis on safety issues. Analyzed safety concerns include gastrointestinal side effects (oral iron) and risks of hypotension, anaphylaxis, infection, hypophosphatemia, oxidative stress and mortality (IV iron). Expert opinion: Low-to-moderate doses of oral iron supplementation remains as first line therapy for uncomplicated ID, but it has been scarcely discussed in the setting of inflammation. Confirmatory studies on the efficacy of newer oral iron formulations in this setting are needed. Compared with oral iron, short-term IV iron administration is more efficacious in ID correction, without significant safety concerns. However, long-term safety of IV iron maintenance therapy, head to head comparisons of IV iron preparations, pharmacological modulation of hepcidin and HIF, and extra-erythropoietic effects of iron are among the important areas of research.

New options for uveitis treatment

OpenAIRE

He, Yu; Jia, Song-Bai; Zhang, Wei; Shi, Jing-Ming

2013-01-01

Uveitis is one of the most important causes of blindness worldwide. Its etiology and pathogenesis are complicated and have not been well understood. The treatment for uveitis is predominantly based on steroids and immunosuppressants. However, systemic side effects limit their clinical application. With the advancement of molecular biology, some intravitreal implants and biologic agents have been used for the treatment of uveitis. Additionally, novel techniques such as gene therapy and RNA int...

Arsenic contaminated groundwater and its treatment options in Bangladesh.

Science.gov (United States)

Jiang, Jia-Qian; Ashekuzzaman, S M; Jiang, Anlun; Sharifuzzaman, S M; Chowdhury, Sayedur Rahman

2012-12-20

Arsenic (As) causes health concerns due to its significant toxicity and worldwide presence in drinking water and groundwater. The major sources of As pollution may be natural process such as dissolution of As-containing minerals and anthropogenic activities such as percolation of water from mines, etc. The maximum contaminant level for total As in potable water has been established as 10 µg/L. Among the countries facing As contamination problems, Bangladesh is the most affected. Up to 77 million people in Bangladesh have been exposed to toxic levels of arsenic from drinking water. Therefore, it has become an urgent need to provide As-free drinking water in rural households throughout Bangladesh. This paper provides a comprehensive overview on the recent data on arsenic contamination status, its sources and reasons of mobilization and the exposure pathways in Bangladesh. Very little literature has focused on the removal of As from groundwaters in developing countries and thus this paper aims to review the As removal technologies and be a useful resource for researchers or policy makers to help identify and investigate useful treatment options. While a number of technological developments in arsenic removal have taken place, we must consider variations in sources and quality characteristics of As polluted water and differences in the socio-economic and literacy conditions of people, and then aim at improving effectiveness in arsenic removal, reducing the cost of the system, making the technology user friendly, overcoming maintenance problems and resolving sludge management issues.

Arsenic Contaminated Groundwater and Its Treatment Options in Bangladesh

Science.gov (United States)

Jiang, Jia-Qian; Ashekuzzaman, S. M.; Jiang, Anlun; Sharifuzzaman, S. M.; Chowdhury, Sayedur Rahman

2012-01-01

Arsenic (As) causes health concerns due to its significant toxicity and worldwide presence in drinking water and groundwater. The major sources of As pollution may be natural process such as dissolution of As-containing minerals and anthropogenic activities such as percolation of water from mines, etc. The maximum contaminant level for total As in potable water has been established as 10 µg/L. Among the countries facing As contamination problems, Bangladesh is the most affected. Up to 77 million people in Bangladesh have been exposed to toxic levels of arsenic from drinking water. Therefore, it has become an urgent need to provide As-free drinking water in rural households throughout Bangladesh. This paper provides a comprehensive overview on the recent data on arsenic contamination status, its sources and reasons of mobilization and the exposure pathways in Bangladesh. Very little literature has focused on the removal of As from groundwaters in developing countries and thus this paper aims to review the As removal technologies and be a useful resource for researchers or policy makers to help identify and investigate useful treatment options. While a number of technological developments in arsenic removal have taken place, we must consider variations in sources and quality characteristics of As polluted water and differences in the socio-economic and literacy conditions of people, and then aim at improving effectiveness in arsenic removal, reducing the cost of the system, making the technology user friendly, overcoming maintenance problems and resolving sludge management issues. PMID:23343979

Radiotherapy of splenomegaly. A palliative treatment option for a benign phenomenon in malignant diseases

International Nuclear Information System (INIS)

Kriz, Jan; Mueller, Rolf-Peter; Eich, Hans Theodor

2011-01-01

Purpose: Since the 20 th century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT. Material and Methods: Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects. Results: From 1989-2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with 60 Co gamma rays or 5-15MV photons. The fraction size ranged from 10-200 cGy and the total dose per treatment course from 30-1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II . Conclusion: The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten. (orig.)

Radiotherapy of splenomegaly. A palliative treatment option for a benign phenomenon in malignant diseases

Energy Technology Data Exchange (ETDEWEB)

Kriz, Jan; Mueller, Rolf-Peter; Eich, Hans Theodor [Koeln Univ. (Germany). Dept. of Radiation Oncology; Micke, Oliver [St. Franziskus Hospital, Bielefeld (Germany). Dept. of Radiation Oncology; Bruns, Frank [Medical School Hannover (Germany). Dept. of Radiation Oncology; Haverkamp, Uwe [Clemens Hospital, Muenster (Germany). Dept. of Radiation and Radiation Oncology; Muecke, Ralph; Schaefer, Ulrich [Hospital Lippe (Germany). Dept. of Radiation Oncology; Seegenschmiedt, Heinrich [Center of Radiotherapy, Hamburg (Germany)

2011-04-15

Purpose: Since the 20{sup th} century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT. Material and Methods: Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects. Results: From 1989-2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with {sup 60}Co gamma rays or 5-15MV photons. The fraction size ranged from 10-200 cGy and the total dose per treatment course from 30-1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II . Conclusion: The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten. (orig.)

Current Nondopaminergic Therapeutic Options for Motor Symptoms of Parkinson's Disease

Institute of Scientific and Technical Information of China (English)

Juan-Juan Du; Sheng-Di Chen

2017-01-01

Objective:The aim of this study was to summarize recent studies on nondopaminergic options for the treatment of motor symptoms in Parkinson's disease (PD).Data Sources:Papers in English published in PubMed,Cochrane,and Ovid Nursing databases between January 1988 and November 2016 were searched using the following keywords:PD,nondopaminergic therapy,adenosine,glutamatergic,adrenergic,serotoninergic,histaminic,and iron chelator.We also reviewed the ongoing clinical trials in the website of clinicaltrials.gov.Study Selection:Articles related to the nondopaminergic treatment of motor symptoms in PD were selected for this review.Results:PD is conventionally treated with dopamine replacement strategies,which are effective in the early stages of PD.Long-term use oflevodopa could result in motor complications.Recent studies revealed that nondopaminergic systems such as adenosine,glutamatergic,adrenergic,serotoninergic,histaminic,and iron chelator pathways could include potential therapeutic targets for motor symptoms,including motor fluctuations,levodopa-induced dyskinesia,and gait disorders.Some nondopaminergic drugs,such as istradefylline and amantadine,are currently used clinically,while most such drugs are in preclinical testing stages.Transitioning of these agents into clinically beneficial strategies requires reliable evaluation since several agents have failed to show consistent results despite positive findings at the preclinical level.Conclusions:Targeting nondopaminergic transmission could improve some motor symptoms in PD,especially the discomfort ofdyskinesia.Although nondopaminergic treatments show great potential in PD treatment as an adjunct therapy to levodopa,further investigation is required to ensure their success.

The Reliability of a Novel Mobile 3-dimensional Wound Measurement Device.

Science.gov (United States)

Anghel, Ersilia L; Kumar, Anagha; Bigham, Thomas E; Maselli, Kathryn M; Steinberg, John S; Evans, Karen K; Kim, Paul J; Attinger, Christopher E

2016-11-01

Objective assessment of wound dimensions is essential for tracking progression and determining treatment effectiveness. A reliability study was designed to establish intrarater and interrater reliability of a novel mobile 3-dimensional wound measurement (3DWM) device. Forty-five wounds were assessed by 2 raters using a 3DWM device to obtain length, width, area, depth, and volume measurements. Wounds were also measured manually, using a disposable ruler and digital planimetry. The intraclass correlation coefficient (ICC) was used to establish intrarater and interrater reliability. High levels of intrarater and interrater agreement were observed for area, length, and width; ICC = 0.998, 0.977, 0.955 and 0.999, 0.997, 0.995, respectively. Moderate levels of intrarater (ICC = 0.888) and interrater (ICC = 0.696) agreement were observed for volume. Lastly, depth yielded an intrarater ICC of 0.360 and an interrater ICC of 0.649. Measures from the 3DWM device were highly correlated with those obtained from scaled photography for length, width, and area (ρ = 0.997, 0.988, 0.997, P device yielded correlations of ρ = 0.990, 0.987, 0.996 with P device was found to be highly reliable for measuring wound areas for a range of wound sizes and types as compared to manual measurement and digital planimetry. The depth and therefore volume measurement using the 3DWM device was found to have a lower ICC, but volume ICC alone was moderate. Overall, this device offers a mobile option for objective wound measurement in the clinical setting.

Problems of reliability and economy work of thermal power plants water treatment based on baromembrane technologies

Science.gov (United States)

Chichirova, N. D.; Chichirov, A. A.; Saitov, S. R.

2017-11-01

The introduction of baromembrane water treatment technologies for water desalination at Russian thermal power plants was beganed more than 25 years ago. These technologies have demonstrated their definite advantage over the traditional technologies of additional water treatment for steam boilers. However, there are problems associated with the reliability and economy of their work. The first problem is a large volume of waste water (up to 60% of the initial water). The second problem a expensive and unique chemical reagents complex (biocides, antiscalants, washing compositions) is required for units stable and troublefree operation. Each manufacturer develops his own chemical composition for a certain membrane type. This leads to a significant increase in reagents cost, as well as creates dependence of the technology consumer on the certain supplier. The third problem is that the reliability of the baromembrane units depends directly on the water preliminary treatment. The popular pre-cleaning technology with coagulation of aluminum oxychloride proves to be unacceptable during seasonal changes in the quality of the source water at a number of stations. As a result, pollution, poisoning and lesion of the membrane structure or deterioration of their mechanical properties are observed. The report presents ways to solve these problems.

78 FR 8060 - Treatment of Grantor of an Option on a Partnership Interest

Science.gov (United States)

2013-02-05

... noncompensatory option as a partner would result in a substantial reduction in the present value of the partners... reduction of the present value of the aggregate Federal tax liabilities of the partners and the... noncompensatory option that has as a principal purpose the substantial reduction of the present value of the...

Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences.

Science.gov (United States)

Scalia, Peter; Durand, Marie-Anne; Kremer, Jan; Faber, Marjan; Elwyn, Glyn

2018-01-01

Randomized trials have shown that patient decision aids can modify users' preferred healthcare options, but research has yet to identify the attributes embedded in these tools that cause preferences to shift. The aim of this study was to investigate people's preferences as they used decision aids for 5 health decisions and, for each of the following: 1) determine if using the interactive Option Grid led to a pre-post shift in preferences; 2) determine which frequently asked questions (FAQs) led to preference shifts; 3) determine the FAQs that were rated as the most important as users compared options. Interactive Option Grid decision aids enable users to view attributes of available treatment or screening options, rate their importance, and specify their preferred options before and after decision aid use. The McNemar-Bowker paired test was used to compare stated pre-post preferences. Multinomial logistic regressions were conducted to investigate possible associations between covariates and preference shifts. Overall, 626 users completed the 5 most-used tools: 1) Amniocentesis test: yes or no? ( n = 73); 2) Angina: treatment options ( n = 88); 3) Breast cancer: surgical options ( n = 265); 4) Prostate Specific Antigen (PSA) test: yes or no? ( n = 82); 5) Statins for heart disease risk: yes or no? ( n = 118). The breast cancer, PSA, and statins Option Grid decision aids generated significant preference shifts. Generally, users shifted their preference when presented with the description of the available treatment options, and the risk associated with each option. The use of decision aids for some, but not all health decisions, was accompanied by a shift in user preferences. Users typically valued information associated with risks, and chose more risk averse options after completing the interactive tool.

20 CFR 416.2035 - Optional supplementation: Additional State options.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Optional supplementation: Additional State options. 416.2035 Section 416.2035 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... § 416.2035 Optional supplementation: Additional State options. (a) Residency requirement. A State or...

Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis.

Science.gov (United States)

van Rijn, Dafne; van den Akker-Scheek, Inge; Steunebrink, Mirjam; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk

2017-10-10

Currently, no treatments exist for patellar tendinopathy (PT) that guarantee quick and full recovery. Our objective was to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments. A secondary analysis was performed on the combined databases of 3 previously performed double-blind randomized controlled trials. In total, 138 patients with PT were included in the analysis. Participants were divided into 5 groups, based on the treatment they received: Extracorporeal shockwave therapy (ESWT) (n = 31), ESWT plus eccentric training (n = 43), eccentric training (n = 17), topical glyceryl trinitrate patch plus eccentric training (n = 16), and placebo treatment (n = 31). Clinical improvement (increase of ≥13 points on the Victorian Institute of Sport Assessment-Patella score) after 3 months of treatment. Fifty-two patients (37.7%) improved clinically after 3 months of treatment. Odds ratios (ORs) for clinical improvement were significantly higher in the eccentric training group (OR 6.68, P = 0.009) and the ESWT plus eccentric training group (OR 5.42, P = 0.015) compared with the other groups. We found evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance). Our study confirmed the importance of exercise, and eccentric training in particular, in the management of PT. The role of ESWT remains uncertain. Further research focusing on the identified prognostic factors is needed to be able to design patient-specific treatment protocols for the management of PT.

Methane and nitrous oxide: Methods in national emissions inventories and options for control

Energy Technology Data Exchange (ETDEWEB)

Van Amstel, A.R. (ed.)

1993-07-01

The UN Framework Convention on Climate Change signed in Rio de Janeiro, Brazil, calls for the return of anthropogenic emissions of greenhouse gases to their 1990 levels by the year 2000 in industrialized countries. It also calls for a monitoring of the emissions of greenhouse gases. It is important that reliable and scientifically credible national inventories are available for the international negotiations. Therefore a consistent methodology and a transparent reporting format is needed. The title workshop had two main objectives: (1) to support the development a methodology and format for national emissions inventories of greenhouse gases by mid 1993, as coordinated by the Science Working Group of the IPCC and the OECD; and (2) the development of technical options for reduction of greenhouse gases and the assessment of the socio-economic feasibility of these options. The workshop consisted of key note overview presentations, and two rounds of working group sessions, each covering five parallel sessions on selected sources. In the first round of each working group session the literature, existing methods for methane and nitrous oxide inventories, and the OECD/IPCC guidelines have been addressed. Then, in the second round, options for emission reductions have been discussed, as well as their socio-economic implications. The methane sources discussed concern oil and gas, coal mining, ruminants, animal waste, landfills and sewage treatment, combustion and industry, rice production and wetlands, biomass burning. The nitrous oxide sources discussed are agricultural soils and combustion and industry. The proceedings on methane comprise 16 introductory papers and 7 papers on the results of the working groups, while in part two four introductory papers and two papers on the results of working groups on nitrous oxide are presented. In part three future emission reduction policy options are discussed. Finally, 16 poster contributions are included

Analysis of Options Contract, Option Pricing in Agricultural Products

Directory of Open Access Journals (Sweden)

H. Tamidy

2016-03-01

Full Text Available Introduction: Risk is an essential component in the production and sale of agricultural products. Due to the nature of agricultural products, the people who act in this area including farmers and businesspersons encounter unpredictable fluctuations of prices. On the other hand, the firms that process agricultural products also face fluctuation of price of agricultural inputs. Given that the Canola is considered as one of the inputs of product processing factories, control of unpredictable fluctuations of the price of this product would increase the possibility of correct decision making for farmers and managers of food processing industries. The best available tool for control and management of the price risk is the use of future markets and options. It is evident that the pricing is the main pillar in every trade. Therefore, offering a fair price for the options will be very important. In fact, options trading in the options market create cost insurance stopped. In this way, which can reduce the risks of deflation created in the future, if the person entitled to the benefits of the price increase occurs in the future. Unlike the futures, market where the seller had to deliver the product on time, in the options market, there is no such compulsion. In addition, this is one of the strengths of this option contract, because if there is not enough product for delivery to the futures market as result of chilling, in due course, the farmers suffer, but in the options market there will be a loss. In this study, the setup options of rape, as a product, as well as inputs has been paid for industry. Materials and Methods: In this section. The selection criteria of the disposal of asset base for valuation of European put options and call option is been introduced. That for obtain this purpose, some characteristics of the goods must considered: 1-Unpredictable fluctuations price of underlying asset 2 -large underlying asset cash market 3- The possibility

MIDLINE DIASTEMA: TREATMENT OPTIONS

OpenAIRE

Sunil Kumar; Pradnya; Varsha; Sumeet; Fareedi

2012-01-01

ABSTRACT : Maxillary midline diastema is a common esthetic problem in mixed and permanent dentition. The space can occur either as a transient malocclusion or created by developmental, pathological or iatrogenic factors. Many innovative therapies are available from restorative procedures such as composite build-up to surgery (fr enectomies) and Orthodontics is available. Treatment depends upon the correct diagnosis of its etiology and early intervention relevant ...

Occurrence of otitis media in children and assessment of treatment options.

Science.gov (United States)

Nwokoye, N N; Egwari, L O; Olubi, O O

2015-08-01

Otitis media is a more frequent occurrence in children, and the disease may progress from an acute to chronic state if appropriate and timely intervention is not initiated. A total of 212 children aged 6 months to 10 years were examined and treated for otitis media, in a 13-month hospital-based study. Acute otitis media was diagnosed in 130 (61.3 per cent) of the patients. There were 82 (38.7 per cent) chronic suppurative otitis media cases. The incidence of acute otitis media and chronic suppurative otitis media in the first year of life was 54.6 per cent and 45.1 per cent respectively. Chronic suppurative otitis media patients were assigned to one of three treatment groups. Recovery occurred in 70.4 per cent of amoxicillin-treated patients, in 88.9 per cent of amoxicillin-clavulanic acid treated patients and in 96.4 per cent of culture and antibiotic sensitivity test patients. Relapses were seen only in the amoxicillin (five cases) and amoxicillin-clavulanic acid (two cases) groups. The success rate in patients treated with antibiotics makes this option mandatory for an established diagnosis.

Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur?

Science.gov (United States)

Sevelda, Florian; Waldstein, Wenzel; Panotopoulos, Joannis; Kaider, Alexandra; Funovics, Philipp Theodor; Windhager, Reinhard

2018-05-01

The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup. The most common primary disease was breast cancer. In general, during this period, our indications for this procedure were extensive metastatic disease precluding internal fixation or isolated proximal or distal femur replacement, and an anticipated lifespan exceeding 6 months. Our contraindication for this procedure during this time was expected lifespan less than 6 months. Patient survival was assessed by Kaplan-Meier analysis; implant survival free from revision surgery and amputation were assessed by competing risk analysis. Function was determined preoperatively and 6 to 12 weeks postoperatively with the Musculoskeletal Tumor Society (MSTS) score normalized to a 100-point scale, with higher scores representing better function from a longitudinally maintained institutional database. Eleven patients died at a median of 5 months (range, 1-31 months) after surgery. One-year revision-free and limb survival were 82% (95% CI, 51%-98%) and 91% (95% CI, 61%-99%), respectively. Reasons for reoperation were hip dislocation, infection and local recurrence in one patient each. The

Alternative disposal options for transuranic waste

International Nuclear Information System (INIS)

Loomis, G.G.

1994-01-01

Three alternative concepts are proposed for the final disposal of stored and retrieved buried transuranic waste. These proposed options answer criticisms of the existing U.S. Department of Energy strategy of directly disposing of stored transuranic waste in deep, geological salt formations at the Waste Isolation Pilot Plant (WIPP) in Carlsbad, New Mexico. The first option involves enhanced stabilization of stored waste by thermal treatment followed by convoy transportation and internment in the existing WIPP facility. This concept could also be extended to retrieved buried waste with proper permitting. The second option involves in-state, in situ internment using an encapsulating lens around the waste. This concept applies only to previously buried transuranic waste. The third option involves sending stored and retrieved waste to the Nevada Test Site and configuring the waste around a thermonuclear device from the U.S. or Russian arsenal in a specially designed underground chamber. The thermonuclear explosion would transmute plutonium and disassociate hazardous materials while entombing the waste in a national sacrifice area

Reliability analysis of grid connected small wind turbine power electronics

International Nuclear Information System (INIS)

Arifujjaman, Md.; Iqbal, M.T.; Quaicoe, J.E.

2009-01-01

Grid connection of small permanent magnet generator (PMG) based wind turbines requires a power conditioning system comprising a bridge rectifier, a dc-dc converter and a grid-tie inverter. This work presents a reliability analysis and an identification of the least reliable component of the power conditioning system of such grid connection arrangements. Reliability of the configuration is analyzed for the worst case scenario of maximum conversion losses at a particular wind speed. The analysis reveals that the reliability of the power conditioning system of such PMG based wind turbines is fairly low and it reduces to 84% of initial value within one year. The investigation is further enhanced by identifying the least reliable component within the power conditioning system and found that the inverter has the dominant effect on the system reliability, while the dc-dc converter has the least significant effect. The reliability analysis demonstrates that a permanent magnet generator based wind energy conversion system is not the best option from the point of view of power conditioning system reliability. The analysis also reveals that new research is required to determine a robust power electronics configuration for small wind turbine conversion systems.

Assessing mental health clinicians' intentions to adopt evidence-based treatments: reliability and validity testing of the evidence-based treatment intentions scale.

Science.gov (United States)

Williams, Nathaniel J

2016-05-05

Intentions play a central role in numerous empirically supported theories of behavior and behavior change and have been identified as a potentially important antecedent to successful evidence-based treatment (EBT) implementation. Despite this, few measures of mental health clinicians' EBT intentions exist and available measures have not been subject to thorough psychometric evaluation or testing. This paper evaluates the psychometric properties of the evidence-based treatment intentions (EBTI) scale, a new measure of mental health clinicians' intentions to adopt EBTs. The study evaluates the reliability and validity of inferences made with the EBTI using multi-method, multi-informant criterion variables collected over 12 months from a sample of 197 mental health clinicians delivering services in 13 mental health agencies. Structural, predictive, and discriminant validity evidence is assessed. Findings support the EBTI's factor structure (χ (2) = 3.96, df = 5, p = .556) and internal consistency reliability (α = .80). Predictive validity evidence was provided by robust and significant associations between EBTI scores and clinicians' observer-reported attendance at a voluntary EBT workshop at a 1-month follow-up (OR = 1.92, p adoption at a 12-month follow-up (R (2) = .17, p adopt EBTs. Discussion focuses on research and practice applications.

Treatment Options for Extrahepatic Bile Duct Cancer

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... Treatment Liver Cancer Prevention Liver Cancer Screening Research Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®)–Patient Version Treatment ... are different types of treatment for patients with bile duct cancer. Different types of treatments are available ...

Treatment Option Overview (Extrahepatic Bile Duct Cancer)

Science.gov (United States)

... Treatment Liver Cancer Prevention Liver Cancer Screening Research Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®)–Patient Version Treatment ... are different types of treatment for patients with bile duct cancer. Different types of treatments are available ...

Treatment Option Overview (Renal Cell Cancer)

Science.gov (United States)

... Tumors Treatment Genetics of Kidney Cancer Research Renal Cell Cancer Treatment (PDQ®)–Patient Version General Information About Renal Cell Cancer Go to Health Professional Version Key Points Renal ...

Eating Disorder Treatment: Know Your Options

Science.gov (United States)

... of the American Dietetic Association. 2011:111:1236. Gabbard GO, ed. Evidence-based psychological treatments for eating disorders. In: Gabbard's Treatments of Psychiatric Disorders. 5th ed. Arlington, Va.: ...

Arsenic Contaminated Groundwater and Its Treatment Options in Bangladesh

Directory of Open Access Journals (Sweden)

Sayedur Rahman Chowdhury

2012-12-01

Full Text Available Arsenic (As causes health concerns due to its significant toxicity and worldwide presence in drinking water and groundwater. The major sources of As pollution may be natural process such as dissolution of As-containing minerals and anthropogenic activities such as percolation of water from mines, etc. The maximum contaminant level for total As in potable water has been established as 10 µg/L. Among the countries facing As contamination problems, Bangladesh is the most affected. Up to 77 million people in Bangladesh have been exposed to toxic levels of arsenic from drinking water. Therefore, it has become an urgent need to provide As-free drinking water in rural households throughout Bangladesh. This paper provides a comprehensive overview on the recent data on arsenic contamination status, its sources and reasons of mobilization and the exposure pathways in Bangladesh. Very little literature has focused on the removal of As from groundwaters in developing countries and thus this paper aims to review the As removal technologies and be a useful resource for researchers or policy makers to help identify and investigate useful treatment options. While a number of technological developments in arsenic removal have taken place, we must consider variations in sources and quality characteristics of As polluted water and differences in the socio-economic and literacy conditions of people, and then aim at improving effectiveness in arsenic removal, reducing the cost of the system, making the technology user friendly, overcoming maintenance problems and resolving sludge management issues.

Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

Directory of Open Access Journals (Sweden)

Dolan Kate A

2005-06-01

Full Text Available Abstract In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%, opium (32% and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55% reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed.

Using the Reliability Theory for Assessing the Decision Confidence Probability for Comparative Life Cycle Assessments.

Science.gov (United States)

Wei, Wei; Larrey-Lassalle, Pyrène; Faure, Thierry; Dumoulin, Nicolas; Roux, Philippe; Mathias, Jean-Denis

2016-03-01

Comparative decision making process is widely used to identify which option (system, product, service, etc.) has smaller environmental footprints and for providing recommendations that help stakeholders take future decisions. However, the uncertainty problem complicates the comparison and the decision making. Probability-based decision support in LCA is a way to help stakeholders in their decision-making process. It calculates the decision confidence probability which expresses the probability of a option to have a smaller environmental impact than the one of another option. Here we apply the reliability theory to approximate the decision confidence probability. We compare the traditional Monte Carlo method with a reliability method called FORM method. The Monte Carlo method needs high computational time to calculate the decision confidence probability. The FORM method enables us to approximate the decision confidence probability with fewer simulations than the Monte Carlo method by approximating the response surface. Moreover, the FORM method calculates the associated importance factors that correspond to a sensitivity analysis in relation to the probability. The importance factors allow stakeholders to determine which factors influence their decision. Our results clearly show that the reliability method provides additional useful information to stakeholders as well as it reduces the computational time.

Emerging therapeutic options for sporadic inclusion body myositis

Directory of Open Access Journals (Sweden)

Alfano LN

2015-09-01

Full Text Available Lindsay N Alfano, Linda P Lowes Nationwide Children’s Hospital, Center for Gene Therapy, Columbus, OH, USA Abstract: Sporadic inclusion body myositis is the most common inflammatory muscle disorder preferentially affecting males over the age of 40 years. Progressive muscle weakness of the finger flexors and quadriceps muscles results in loss of independence with activities of daily living and eventual wheelchair dependence. Initial signs of disease are often overlooked and can lead to mis- or delayed diagnosis. The underlying cause of disease is unknown, and disease progression appears refractory to available treatment options. This review discusses the clinical presentation of inclusion body myositis and the current efforts in diagnosis, and focuses on the current state of research for both nonpharmacological and pharmacological treatment options for this patient group. Keywords: myositis, inclusion body myositis, inflammatory myopathy, treatment, function, outcomes

DISPOSITION PATHS FOR ROCKY FLATS GLOVEBOXES: EVALUATING OPTIONS

International Nuclear Information System (INIS)

Lobdell, D.; Geimer, R.; Larsen, P.; Loveland, K.

2003-01-01

The Kaiser-Hill Company, LLC has the responsibility for closure activities at the Rocky Flats Environmental Technology Site (RFETS). One of the challenges faced for closure is the disposition of radiologically contaminated gloveboxes. Evaluation of the disposition options for gloveboxes included a detailed analysis of available treatment capabilities, disposal facilities, and lifecycle costs. The Kaiser-Hill Company, LLC followed several processes in determining how the gloveboxes would be managed for disposition. Currently, multiple disposition paths have been chosen to accommodate the needs of the varying styles and conditions of the gloveboxes, meet the needs of the decommissioning team, and to best manage lifecycle costs. Several challenges associated with developing a disposition path that addresses both the radiological and RCRA concerns as well as offering the most cost-effective solution were encountered. These challenges included meeting the radiological waste acceptance criteria of available disposal facilities, making a RCRA determination, evaluating treatment options and costs, addressing void requirements associated with disposal, and identifying packaging and transportation options. The varying disposal facility requirements affected disposition choices. Facility conditions that impacted decisions included radiological and chemical waste acceptance criteria, physical requirements, and measurement for payment options. The facility requirements also impacted onsite activities including management strategies, decontamination activities, and life-cycle cost

The Effect of Heat Treatment on the Pull-off Strength of Optionally Varnished Surfaces of Five Wood Materials

Directory of Open Access Journals (Sweden)

Musa Atar

2015-09-01

Full Text Available This study investigated the effects of heat treatment, following optional treatment with synthetic, water-based, and alkyd varnishes, on the pull-off strength of wooden materials sampled from oriental beech (Fagus orientalis L., oak (Quercus petraea Liebl., black poplar (Populus nigra L., pine (Pinus sylvestris L., and fir (Abies bornmulleriana M.. The test samples were subjected to heat treatment at temperatures of 165 °C and 175 °C for periods of 2 and 4 h with a total of 4 variations. With respect to the wood type, the samples of beech wood yielded the highest results for pull-off strength, while fir wood yielded the lowest. With respect to the varnish types, the highest pull-off strength was found in the samples of synthetic varnished beech (5,452 with a 37.2% improvement at 175 °C heat treatment for 4 h, while the lowest results were obtained in the samples of fir (0.991 with a 48.5% decrease at 175 °C heat treatment for 4 h. In conclusion, heat treatment significantly decreased the pull-off strength of the woods.

Treatment Options for Intraocular (Uveal) Melanoma

Science.gov (United States)

... A to Z List of Cancer Drugs Complementary & Alternative Medicine (CAM) Questions to Ask about Your Treatment Research ... Treatment Side Effects Clinical Trials Cancer Drugs Complementary & Alternative Medicine Coping Feelings & Cancer Adjusting to Cancer Self Image & ...

Treatment Option Overview (Intraocular [Uveal] Melanoma)

Science.gov (United States)

... A to Z List of Cancer Drugs Complementary & Alternative Medicine (CAM) Questions to Ask about Your Treatment Research ... Treatment Side Effects Clinical Trials Cancer Drugs Complementary & Alternative Medicine Coping Feelings & Cancer Adjusting to Cancer Self Image & ...

Signal Quality Outage Analysis for Ultra-Reliable Communications in Cellular Networks

DEFF Research Database (Denmark)

Gerardino, Guillermo Andrés Pocovi; Alvarez, Beatriz Soret; Lauridsen, Mads

2015-01-01

Ultra-reliable communications over wireless will open the possibility for a wide range of novel use cases and applications. In cellular networks, achieving reliable communication is challenging due to many factors, particularly the fading of the desired signal and the interference. In this regard......, we investigate the potential of several techniques to combat these main threats. The analysis shows that traditional microscopic multiple-input multiple-output schemes with 2x2 or 4x4 antenna configurations are not enough to fulfil stringent reliability requirements. It is revealed how such antenna...... schemes must be complemented with macroscopic diversity as well as interference management techniques in order to ensure the necessary SINR outage performance. Based on the obtained performance results, it is discussed which of the feasible options fulfilling the ultra-reliable criteria are most promising...

A review of methodologies applied in Australian practice to evaluate long-term coastal adaptation options

Directory of Open Access Journals (Sweden)

Timothy David Ramm

2017-01-01

Full Text Available Rising sea levels have the potential to alter coastal flooding regimes around the world and local governments are beginning to consider how to manage uncertain coastal change. In doing so, there is increasing recognition that such change is deeply uncertain and unable to be reliably described with probabilities or a small number of scenarios. Characteristics of methodologies applied in Australian practice to evaluate long-term coastal adaptation options are reviewed and benchmarked against two state-of-the-art international methods suited for conditions of uncertainty (Robust Decision Making and Dynamic Adaptive Policy Pathways. Seven out of the ten Australian case studies assumed the uncertain parameters, such as sea level rise, could be described deterministically or stochastically when identifying risk and evaluating adaptation options across multi-decadal periods. This basis is not considered sophisticated enough for long-term decision-making, implying that Australian practice needs to increase the use of scenarios to explore a much larger uncertainty space when assessing the performance of adaptation options. Two Australian case studies mapped flexible adaptation pathways to manage uncertainty, and there remains an opportunity to incorporate quantitative methodologies to support the identification of risk thresholds. The contextual framing of risk, including the approach taken to identify risk (top-down or bottom-up and treatment of uncertain parameters, were found to be fundamental characteristics that influenced the methodology selected to evaluate adaptation options. The small sample of case studies available suggests that long-term coastal adaptation in Australian is in its infancy and there is a timely opportunity to guide local government towards robust methodologies for developing long-term coastal adaptation plans.

Current classification, treatment options, and new perspectives in the management of adipocytic sarcomas

Directory of Open Access Journals (Sweden)

De Vita A

2016-10-01

Full Text Available Alessandro De Vita,1 Laura Mercatali,1 Federica Recine,1 Federica Pieri,2 Nada Riva,1 Alberto Bongiovanni,1 Chiara Liverani,1 Chiara Spadazzi,1 Giacomo Miserocchi,1 Dino Amadori,1 Toni Ibrahim1 1Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST IRCCS, Meldola, FC, 2Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy Abstract: Sarcomas are a heterogeneous group of mesenchymal tumors arising from soft tissue or bone, with an uncertain etiology and difficult classification. Soft tissue sarcomas (STSs account for around 1% of all adult cancers. Till date, more than 50 histologic subtypes have been identified. Adipocyte sarcoma or liposarcoma (LPS is one of the most common STS subtypes, accounting for 15% of all sarcomas, with an incidence of 24% of all extremity STSs and 45% of all retroperitoneal STSs. The new World Health Organization classification system has divided LPS into four different subgroups: atypical lipomatous tumor/well-differentiated LPS, dedifferentiated LPS, myxoid LPS, and pleomorphic LPS. These lesions can develop at any location and exhibit different aggressive potentials reflecting their morphologic diversity and clinical behavior. Patients affected by LPS should be managed in specialized multidisciplinary cancer centers. Whereas surgical resection is the mainstay of treatment for localized disease, the benefits of adjuvant and neoadjuvant chemotherapy are still unclear. Systemic treatment, particularly chemotherapy, is still limited in metastatic disease. Despite the efforts toward a better understanding of the biology of LPS, the outcome of advanced and metastatic patients remains poor. The advent of targeted therapies may lead to an improvement of treatment options and clinical outcomes. A larger patient enrollment into translational and clinical studies will help increase the knowledge of the biological behavior of LPSs, test new drugs, and introduce new

Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.

Science.gov (United States)

Silver, Julie K; Baima, Jennifer

2013-08-01

Cancer prehabilitation, a process on the continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment, includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient's health to reduce the incidence and the severity of current and future impairments. There is a growing body of scientific evidence that supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments. This is the first review of cancer prehabilitation, and the purpose was to describe early studies in the noncancer population and then the historical focus in cancer patients on aerobic conditioning and building strength and stamina through an appropriate exercise regimen. More recent research shows that opportunities exist to use other unimodal or multimodal prehabilitation interventions to decrease morbidity, improve physical and psychological health outcomes, increase the number of potential treatment options, decrease hospital readmissions, and reduce both direct and indirect healthcare costs attributed to cancer. Future research may demonstrate increased compliance with acute cancer treatment protocols and, therefore, improved survival outcomes. New studies suggest that a multimodal approach that incorporates both physical and psychological prehabilitation interventions may be more effective than a unimodal approach that addresses just one or the other. In an impairment-driven cancer rehabilitation model, identifying current and anticipating future impairments are the critical first steps in improving healthcare outcomes and decreasing costs. More research is urgently needed to evaluate the most effective prehabilitation interventions, and combinations thereof, for survivors of all types of cancer.

Resilience and reliability of compact vertical-flow treatment wetlands designed for tropical climates.

Science.gov (United States)

Lombard-Latune, R; Pelus, L; Fina, N; L'Etang, F; Le Guennec, B; Molle, P

2018-06-10

Most of the tropical areas have sanitation problems to contend with. The French system of vertical-flow treatment wetlands (FS-VFTW) fed with raw wastewater could be a good water and sludge management solution. The purpose-adapted tropical design can reduce area requirement to below 1 m 2 /population equivalents (p.e.). The Taupinière FS-VFTW on Martinique Island was built according to this design, with one stage but with a saturated layer at the bottom of the filter and a simplified trickling filter (TF) added for further treatment to meet the high performances targeted. Unsaturated/saturated vertical-flow filters (US/S FS-VFTW) have shown improved performances on total nitrogen, carbon and suspended solids removal in temperate climates, but the performances in tropical conditions remain unknown. Here, we report on real-world-operation in the French Overseas Territories (FOT), the reliability and performances of this VFCW tropical-design. The system experienced loading conditions ranging from 30% to 165% of nominal carbonaceous biological oxygen demand (BOD 5 ), as well as tropical rainstorms that brought over 7 times the nominal hydraulic load. Over a period of 3 years, 29 campaigns collected 24-h flow-proportional samples at each treatment stage (raw wastewater, FS-VFTW outlet, TF outlet). When applied loads were close to nominal values, the US/S FS-VFTW itself guarantees 85/90/60/50% removal and 125/25/40/50 mg/L at the outlet for chemical oxygen demand (COD)/total suspended solids (TSS)/total Kjeldahl nitrogen (TKN)/total nitrogen (TN), respectively. By comparison with US/S systems in mainland France, it appears that the warmer tropical-climate temperatures facilitate both nitrification and denitrification kinetics. Performances in overload conditions confirm that the US/S FS-VFTW remains robust and reliable although COD and TKN removal are impacted, especially after strong tropical rain events. By adding a simple compact trickling filter to a US/S FS

Essure a novel option for the treatment of hydrosalpinx: a case series and literature review.

Science.gov (United States)

Lorente González, Juan; Ríos Castillo, José Enrique; Pomares Toro, Elvira; Romero Nieto, María Inmaculada; Castelo-Branco, Camil; Arjona Berral, José Eduardo

2016-01-01

The aim of this study is to evaluate the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx (HS)-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following IVF-ICSI treatment with those patients having had laparoscopic tubal occlusion (LTO). From 2008 to 2014 a total of 50 patients were diagnosed with unilateral or bilateral hydrosalpinges: 29 patients had laparoscopic contraindications and were treated hysteroscopically and 21 patients were treated with laparoscopical salpingectomy. Of the 29 patients who underwent treatment with Essure(®), 21 began a cycle of in vitro fertilization (IVF), and 13 finished in embryo transfer that resulted in seven clinical pregnancies. Furthermore, in the group of women treated with salpingectomy, 17 started an IVF cycle that resulted in 12 clinical pregnancies. The clinical pregnancy rate per patient with an IVF cycle started was 33.3% and 70.6%, the live-birth rate per patient was 14.3% and 52.9%, the miscarriage rate was 57.1% and 18.2%, and the implantation rate was 16.3% and 34.1% for hysteroscopy and laparoscopy, respectively. Essure(®) placement is an alternative method for occlusion of hydrosalpinges before IVF. Monitoring the live-birth rate confirms that this option may be considered when laparoscopy is impossible or contraindicated.

Reliability of assessment of adherence to an antimicrobial treatment guideline

NARCIS (Netherlands)

Mol, PGM; Gans, ROB; Panday, PVN; Degener, JE; Laseur, M; Haaijer-Ruskamp, FM

Assessment procedures for adherence to a guideline must be reliable and credible. The aim of this study was to explore the reliability of assessment of adherence, taking account of the professional backgrounds of the observers. A secondary analysis explored the impact of case characteristics on

Reliability and Validity of a Treatment Barriers Scale for Individuals With Alcohol Use Disorder.

Science.gov (United States)

Possemato, Kyle; Funderburk, Jennifer; Spinola, Suzanne; Hutchison, Dezarie; Maisto, Stephen A; Lantinga, Larry J; Oslin, David W

2016-01-01

Few studies have measured addiction-specific barriers to treatment. A measurement of barriers with psychometric support that has been tested in diverse samples and that assesses multiple components of addiction treatment barriers is needed to inform providers and treatment programs. This paper aims to provide an initial psychometric investigation of a measure of barriers to seeking addictions treatment. Data were collected from 196 Veterans Affairs primary care patients with Alcohol Use Disorder that participated in a randomized clinical trial. A Principal Components Analysis revealed that the 32-item Treatment Barriers Scale (TBS) can be reduced to 14 items, measuring 4 factors: stigma, dislike of the treatment process, alcohol problem identification, and logistical concerns. Acceptable internal consistent reliability (α = .64-.76) and excellent precision of alpha (α = 0.001-0.009) was found for each subscale. Support for the measure's concurrent validity was found, for example, participants who reported more motivation to reduce their drinking perceived significantly fewer barriers to care. Support for the measure's predictive validity was also found, including that more barriers were related to future drinking among all participants and less mental health and addictions treatment visits among participants in one treatment condition. Conclusions/ Importance: Our results provide initial support for the utility of the TBS-14 among primary care patients with Alcohol Use Disorder. Use of the TBS-14 could enable healthcare providers to better understand patient-specific treatment barriers, provide corrective information on treatment misconceptions, and inform individualized treatment plans that increase patient engagement in addiction services.

Assessment of the technological reliability of a hybrid constructed wetland for wastewater treatment in a mountain eco-tourist farm in Poland.

Science.gov (United States)

Jucherski, Andrzej; Nastawny, Maria; Walczowski, Andrzej; Jóźwiakowski, Krzysztof; Gajewska, Magdalena

2017-06-01

The aim of the present study was to assess the technological reliability of a domestic hybrid wastewater treatment installation consisting of a classic three-chambered (volume 6 m 3 ) septic tank, a vertical flow trickling bed filled with granules of a calcinated clay material (KERAMZYT), a special wetland bed constructed on a slope, and a permeable pond used as a receiver. The test treatment plant was located at a mountain eco-tourist farm on the periphery of the spa municipality of Krynica-Zdrój, Poland. The plant's operational reliability in reducing the concentration of organic matter, measured as biochemical oxygen demand (BOD 5 ) and chemical oxygen demand (COD), was 100% when modelled by both the Weibull and the lognormal distributions. The respective reliability values for total nitrogen removal were 76.8% and 77.0%, total suspended solids - 99.5% and 92.6%, and PO 4 -P - 98.2% and 95.2%, with the differences being negligible. The installation was characterized by a very high level of technological reliability when compared with other solutions of this type. The Weibull method employed for statistical evaluation of technological reliability can also be used for comparison purposes. From the ecological perspective, the facility presented in the study has proven to be an effective tool for protecting local aquifer areas.

Remediation options and treatment for Tebuthiuron at an upstream oil and gas site

Energy Technology Data Exchange (ETDEWEB)

Lin, F. [EBA Engineering Consultants Ltd., Edmonton, AB (Canada)

2009-07-01

Sterilants are strong herbicides that contain teburithion, a substance of concern in remediation and reclamation activities. Tebuthiuron has very high to low mobility in soils, and its sorption capacity increases in relation to clay and organic matter content. There is currently no soil benchmark for sterilants. Remedial options for tebuthiuron include adsorption with amendments, thermal desorption, and soil flushing with injected solutions. A recent pilot plant successfully used thermal desorption to treat soil contaminated with tebuthiuron and bromacil to below laboratory detection limits. Surface soils at the site were contaminated to a depth of 4 m. A temperature ramping study was performed to determine optimal treatment temperatures. A total of 15,136 tonnes of soil were treated and then used as backfill on-site. Water at the site was monitored and treated with charcoal filters. Hydrocarbon-contaminated soil at the site was also successfully treated using the thermal desorption process. tabs., figs.

Hazardous landfill management, control options

International Nuclear Information System (INIS)

Corbin, M.H.; Lederman, P.B.

1982-01-01

The land disposal of hazardous wastes has been a common practice over the last half century. The industrial and environmental communities, as well as the public, have an immediate challenge to control the contaminants that may be released from waste land disposal facilities. At the same time, land disposal continues to be, in many cases, the only available disposal technique that can be utilized in the next five years. Thus, it is extremely important that environmentally sound landfill management and control techniques be utilized, both for inactive and active sites. There are a number of key steps in developing a sound management and control plan. These include problem definition, personnel safety, characterization, evaluation of control options, cost-effectiveness analysis and development of an integrated control plan. A number of control options, including diversion, regrading, sealing, and leachate treatment are available and more cost effective in most cases than waste removal. These and other options, as well as the methodology to develop an integrated control plan, are discussed, together with examples. (Auth.)

Direct lymphangiography as treatment option of lymphatic leakage: Indications, outcomes and role in patient's management

Energy Technology Data Exchange (ETDEWEB)

Gruber-Rouh, Tatjana, E-mail: tgruberrouh@googlemail.com [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Naguib, Nagy N.N. [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria (Egypt); Lehnert, Thomas; Harth, Marc; Thalhammer, Axel; Beeres, Martin [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Tsaur, Igor [Department of Urology, Johann Wolfgang Goethe University Frankfurt, Frankfurt am Main (Germany); Hammersting, Renate; Wichmann, Julian L.; Vogl, Thomas J.; Jacobi, Volkmar [Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany)

2014-12-15

Background: To evaluate the effectiveness of lymphography as a minimally invasive treatment option of lymphatic leakage in terms of local control and to investigate which parameters influence the success rate. Method: This retrospective study protocol was approved by the ethic committee. Patient history, imaging data, therapeutic options and follow-up were recorded and retrospectively analyzed. Between June 1998 and February 2013, 71 patients (m:w = 42:29, mean age, 52.4; range 42–75 years) with lymphatic leakage in form of lymphatic fistulas (n = 37), lymphocele (n = 11), chylothorax (n = 13) and chylous ascites (n = 10) underwent lymphography. Sixty-four patients (90.1%) underwent successful lymphography while lymphography failed in 7 cases. Therapeutic success was evaluated and correlated to the volume of lymphatic leakage and to the volume of the applied iodized oil. Result: Signs of leakage or contrast extravasation were directly detected in 64 patients. Of 64 patients, 45 patients (70.3%) were treated and cured after lymphography. Based on the lymphography findings, 19 patients (29.7%) underwent surgical intervention with a completely occlusion of lymphatic leakage. The lymphatic leak could be completely occluded in 96.8% of patients when the lymphatic drainage volume was less than 200 mL/day (n = 33). Even when lymphatic drainage was higher than 200 mL/day (n = 31), therapeutic lymphography was still successful in 58.1% of the patients. Conclusion: Lymphography is an effective, minimally invasive method in the detection and treatment of lymphatic leakage. The volume of lymphatic drainage per day is a significant predictor of the therapeutic success rate.

Evaluation of transcranial surgical decompression of the optic canal as a treatment option for traumatic optic neuropathy.

Science.gov (United States)

He, Zhenhua; Li, Qiang; Yuan, Jingmin; Zhang, Xinding; Gao, Ruiping; Han, Yanming; Yang, Wenzhen; Shi, Xuefeng; Lan, Zhengbo

2015-07-01

Traumatic optic neuropathy (TON) is a serious complication of head trauma, with the incidence rate ranging from 0.5% to 5%. The two treatment options widely practiced for TON are: (i) high-dose corticosteroid therapy and (ii) surgical decompression. However, till date, there is no consensus on the treatment protocol. This study aimed to evaluate the therapeutic efficacy of transcranial decompression of optic canal in TON patients. A total of 39 patients with visual loss resulting from TON between January 2005 and June 2013 were retrospectively reviewed for preoperative vision, preoperative image, visual evoked potential (VEP), surgical approach, postoperative visual acuity, complications, and follow-up results. All these patients underwent transcranial decompression of optic canal. During the three-month follow-up period, among the 39 patients, 21 showed an improvement in their eyesight, 6 recovered to standard logarithmic visual acuity chart "visible," 10 could count fingers, 2 could see hand movement, and 3 regained light sensation. Visual evoked potential could be used as an important preoperative and prognostic evaluation parameter for TON patients. Once TON was diagnosed, surgery is a promising therapeutic option, especially when a VEP wave is detected, irrespective of the HRCT scan findings. Operative time between trauma and operation is not necessary reference to assess the therapeutic effect of surgical decompression. The poor results of this procedure may be related to the severity of optic nerve injury. The patient's age is an important factor affecting the surgical outcomes. Copyright © 2015 Elsevier B.V. All rights reserved.

Direct lymphangiography as treatment option of lymphatic leakage: Indications, outcomes and role in patient's management

International Nuclear Information System (INIS)

Gruber-Rouh, Tatjana; Naguib, Nagy N.N.; Lehnert, Thomas; Harth, Marc; Thalhammer, Axel; Beeres, Martin; Tsaur, Igor; Hammersting, Renate; Wichmann, Julian L.; Vogl, Thomas J.; Jacobi, Volkmar

2014-01-01

Background: To evaluate the effectiveness of lymphography as a minimally invasive treatment option of lymphatic leakage in terms of local control and to investigate which parameters influence the success rate. Method: This retrospective study protocol was approved by the ethic committee. Patient history, imaging data, therapeutic options and follow-up were recorded and retrospectively analyzed. Between June 1998 and February 2013, 71 patients (m:w = 42:29, mean age, 52.4; range 42–75 years) with lymphatic leakage in form of lymphatic fistulas (n = 37), lymphocele (n = 11), chylothorax (n = 13) and chylous ascites (n = 10) underwent lymphography. Sixty-four patients (90.1%) underwent successful lymphography while lymphography failed in 7 cases. Therapeutic success was evaluated and correlated to the volume of lymphatic leakage and to the volume of the applied iodized oil. Result: Signs of leakage or contrast extravasation were directly detected in 64 patients. Of 64 patients, 45 patients (70.3%) were treated and cured after lymphography. Based on the lymphography findings, 19 patients (29.7%) underwent surgical intervention with a completely occlusion of lymphatic leakage. The lymphatic leak could be completely occluded in 96.8% of patients when the lymphatic drainage volume was less than 200 mL/day (n = 33). Even when lymphatic drainage was higher than 200 mL/day (n = 31), therapeutic lymphography was still successful in 58.1% of the patients. Conclusion: Lymphography is an effective, minimally invasive method in the detection and treatment of lymphatic leakage. The volume of lymphatic drainage per day is a significant predictor of the therapeutic success rate

Polymyxins: Antimicrobial susceptibility concerns and therapeutic options

Directory of Open Access Journals (Sweden)

V Balaji

2011-01-01

Full Text Available The increasing prevalence of multidrug-resistant nosocomial pathogens such as Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae poses a great challenge to the treating physicians. The paucity of newer effective antimicrobials has led to renewed interest in the polymyxin group of drugs, as a last resort for treatment of gram-negative bacterial infections. There is a dearth of information on the pharmacological properties of colistin, leading to difficulties in selecting the right dose, dosing interval, and route of administration for treatment, especially in critically-ill patients. The increasing use of colistin over the last few years necessitates the need for accurate and reliable in vitro susceptibility testing methods. Development of heteroresistant strains as a result of colistin monotherapy is also a growing concern. There is a compelling need from the clinicians to provide options for probable and possible colistin combination therapy for multidrug-resistant bacterial infections in the ICU setting. Newer combination drug synergy determination tests are being developed and reported. There are no standardized recommendations from antimicrobial susceptibility testing reference agencies for the testing and interpretation of these drug combinations. Comparison and analysis of these reported methodologies may help to understand and assist the microbiologist to choose the best method that produces accurate results at the earliest. This will help clinicians to select the appropriate combination therapy. In this era of multidrug resistance it is important for the microbiology laboratory to be prepared, by default, to provide timely synergistic susceptibility results in addition to routine susceptibility, if warranted. Not as a favour or at request, but as a responsibility.

Locally advanced and metastatic basal cell carcinoma: molecular pathways, treatment options and new targeted therapies.

Science.gov (United States)

Ruiz Salas, Veronica; Alegre, Marta; Garcés, Joan Ramón; Puig, Lluis

2014-06-01

The hedgehog (Hh) signaling pathway has been identified as important to normal embryonic development in living organisms and it is implicated in processes including cell proliferation, differentiation and tissue patterning. Aberrant Hh pathway has been involved in the pathogenesis and chemotherapy resistance of different solid and hematologic malignancies. Basal cell carcinoma (BCC) and medulloblastoma are two well-recognized cancers with mutations in components of the Hh pathway. Vismodegib has recently approved as the first inhibitor of one of the components of the Hh pathway (smoothened). This review attempts to provide current data on the molecular pathways involved in the development of BCC and the therapeutic options available for the treatment of locally advanced and metastatic BCC, and the new targeted therapies in development.

Evidence-based treatment strategies for treatment-resistant bipolar depression: a systematic review

NARCIS (Netherlands)

Sienaert, P.; Lambrichts, L.; Dols, A.; De Fruyt, J.

2013-01-01

Objectives: Treatment resistance in bipolar depression is a common clinical problem that constitutes a major challenge for the treating clinician as there is a paucity of treatment options. The objective of this paper was to review the evidence for treatment options in treatment-resistant bipolar

Treatment options and outcomes for glioblastoma in the elderly patient

Directory of Open Access Journals (Sweden)

Arvold ND

2014-02-01

options include best supportive care, TMZ alone, hypofractionated RT alone, or whole brain RT for symptomatic patients needing to start treatment urgently. Given the balance between short survival and quality of life in this patient population, optimal management of elderly GBM patients must be made individually according to patient age, MGMT methylation status, performance score, and patient preferences. Keywords: glioblastoma, elderly, radiotherapy, hypofractionated, temozolomide, MGMT

Analysis of Parking Reliability Guidance of Urban Parking Variable Message Sign System

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Zhenyu Mei

2012-01-01

Full Text Available Operators of parking guidance and information systems (PGIS often encounter difficulty in determining when and how to provide reliable car park availability information to drivers. Reliability has become a key factor to ensure the benefits of urban PGIS. The present paper is the first to define the guiding parking reliability of urban parking variable message signs (VMSs. By analyzing the parking choice under guiding and optional parking lots, a guiding parking reliability model was constructed. A mathematical program was formulated to determine the guiding parking reliability of VMS. The procedures were applied to a numerical example, and the factors that affect guiding reliability were analyzed. The quantitative changes of the parking berths and the display conditions of VMS were found to be the most important factors influencing guiding reliability. The parking guiding VMS achieved the best benefit when the parking supply was close to or was less than the demand. The combination of a guiding parking reliability model and parking choice behavior offers potential for PGIS operators to reduce traffic congestion in central city areas.

Treatment Option Overview (Parathyroid Cancer)

Science.gov (United States)

... the following rare disorders that are inherited (passed down from parent to child): Familial isolated hyperparathyroidism (FIHP). Multiple endocrine neoplasia type 1 (MEN1) syndrome . Treatment with radiation therapy may increase the risk of ...

Treatment Option Overview (Bladder Cancer)

Science.gov (United States)

... above the waist. Tiny tubules in the kidneys filter and clean the blood . They take out waste ... to bladder cancer. Being exposed to paints, dyes, metals, or petroleum products in the workplace. Past treatment ...

Reliability analysis techniques for the design engineer

International Nuclear Information System (INIS)

Corran, E.R.; Witt, H.H.

1980-01-01

A fault tree analysis package is described that eliminates most of the housekeeping tasks involved in proceeding from the initial construction of a fault tree to the final stage of presenting a reliability analysis in a safety report. It is suitable for designers with relatively little training in reliability analysis and computer operation. Users can rapidly investigate the reliability implications of various options at the design stage, and evolve a system which meets specified reliability objectives. Later independent review is thus unlikely to reveal major shortcomings necessitating modification and projects delays. The package operates interactively allowing the user to concentrate on the creative task of developing the system fault tree, which may be modified and displayed graphically. For preliminary analysis system data can be derived automatically from a generic data bank. As the analysis procedes improved estimates of critical failure rates and test and maintenance schedules can be inserted. The computations are standard, - identification of minimal cut-sets, estimation of reliability parameters, and ranking of the effect of the individual component failure modes and system failure modes on these parameters. The user can vary the fault trees and data on-line, and print selected data for preferred systems in a form suitable for inclusion in safety reports. A case history is given - that of HIFAR containment isolation system. (author)

Options for the disposal of high-level radioactive waste

International Nuclear Information System (INIS)

Mitchell, N.T.; Laughton, A.S.; Webb, G.A.M.

1977-01-01

The management of radioactive waste within the fuel cycle, especially the high-level wastes from reprocessing of nuclear fuel, is currently a matter of particular concern. In the short term (meaning a timescale of tens of years) management by engineered storage is considered to provide a satisfactory solution. Beyond this, however, the two main alternative options which are considered in the paper are: (a) disposal by burial into geologic formations on land; and (b) disposal by emplacement into or onto the seabed. Status of our present knowledge on the land and seabed disposal options is reviewed together with an assessment of the extent to which their reliability and safety can be judged on presently available information. Further information is needed on the environmental behaviour of radioactivity in the form of solidified waste in both situations in order to provide a more complete, scientific assessment. Work done so far has clarified the areas where further research is most needed - for instance modelling of the environmental transfer processes associated with the seabed option. This is discussed together with an indication of the research programmes which are now being pursued

Comparison of duloxetine and SSRI as a treatment option of painful physical symptoms associated with major depressive disorder

Directory of Open Access Journals (Sweden)

Haider M

2017-10-01

Full Text Available Miqdad Haider,1 Muhammad Nabeel Shafqat2 1Department of Medicine, Fatima Memorial Hospital, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan; 2Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC, Villa Clara, CubaWe would like to write about the recently published article “An observational study of duloxetine versus selective serotonin reuptake inhibitors (SSRIs monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis” by Kuga et al, which we read with great interest.1 The study is a good step toward finding the best treatment option for painful physical symptoms (PPSs in patients with major depressive disorder (MDD.View the original paper by Kuga and colleagues. 

Electrical Performance and Reliability Improvement of Amorphous-Indium-Gallium-Zinc-Oxide Thin-Film Transistors with HfO2 Gate Dielectrics by CF4 Plasma Treatment

Science.gov (United States)

Fan, Ching-Lin; Tseng, Fan-Ping; Tseng, Chiao-Yuan

2018-01-01

In this work, amorphous indium-gallium-zinc oxide thin-film transistors (a-IGZO TFTs) with a HfO2 gate insulator and CF4 plasma treatment was demonstrated for the first time. Through the plasma treatment, both the electrical performance and reliability of the a-IGZO TFT with HfO2 gate dielectric were improved. The carrier mobility significantly increased by 80.8%, from 30.2 cm2/V∙s (without treatment) to 54.6 cm2/V∙s (with CF4 plasma treatment), which is due to the incorporated fluorine not only providing an extra electron to the IGZO, but also passivating the interface trap density. In addition, the reliability of the a-IGZO TFT with HfO2 gate dielectric has also been improved by the CF4 plasma treatment. By applying the CF4 plasma treatment to the a-IGZO TFT, the hysteresis effect of the device has been improved and the device’s immunity against moisture from the ambient atmosphere has been enhanced. It is believed that the CF4 plasma treatment not only significantly improves the electrical performance of a-IGZO TFT with HfO2 gate dielectric, but also enhances the device’s reliability. PMID:29772767

Electrical Performance and Reliability Improvement of Amorphous-Indium-Gallium-Zinc-Oxide Thin-Film Transistors with HfO2 Gate Dielectrics by CF4 Plasma Treatment

Directory of Open Access Journals (Sweden)

Ching-Lin Fan

2018-05-01

Full Text Available In this work, amorphous indium-gallium-zinc oxide thin-film transistors (a-IGZO TFTs with a HfO2 gate insulator and CF4 plasma treatment was demonstrated for the first time. Through the plasma treatment, both the electrical performance and reliability of the a-IGZO TFT with HfO2 gate dielectric were improved. The carrier mobility significantly increased by 80.8%, from 30.2 cm2/V∙s (without treatment to 54.6 cm2/V∙s (with CF4 plasma treatment, which is due to the incorporated fluorine not only providing an extra electron to the IGZO, but also passivating the interface trap density. In addition, the reliability of the a-IGZO TFT with HfO2 gate dielectric has also been improved by the CF4 plasma treatment. By applying the CF4 plasma treatment to the a-IGZO TFT, the hysteresis effect of the device has been improved and the device’s immunity against moisture from the ambient atmosphere has been enhanced. It is believed that the CF4 plasma treatment not only significantly improves the electrical performance of a-IGZO TFT with HfO2 gate dielectric, but also enhances the device’s reliability.

Toxin-Based Drug May Be New Option for Rare Leukemia

Science.gov (United States)

In patients with hairy cell leukemia, the toxin-based treatment moxetumomab pasudotox may be an effective new treatment option. As this Cancer Currents post explains, the drug looked to be highly effective in a large clinical trial.

Reliability improvement through alternative designs-A case study

International Nuclear Information System (INIS)

Kumar, Saurabh; Chattopadhyay, Gopi; Kumar, Uday

2007-01-01

In today's competitive world, reliability of equipment is extremely important to maintain quality and delivery deadlines. This is achieved by using proper maintenance and design changes for unreliable subsystems and components of a complex system. It is significant to develop a strategy for maintenance, replacement and design changes related to those subsystems and components. An analysis of down time along with causes is essential to identify the unreliable components and subsystems. This paper presents an analysis of failure data of solenoid coils of automatic internal grinding machine used in a bearing manufacturing plant. It analyses various replacement and change of design options such as introduction of pneumatic system in place of electromagnetic solenoids for improvement of reliability of the plunger movement mechanism

Vessel co-option in primary human tumors and metastases: an obstacle to effective anti-angiogenic treatment?

Science.gov (United States)

Donnem, Tom; Hu, Jiangting; Ferguson, Mary; Adighibe, Omanma; Snell, Cameron; Harris, Adrian L; Gatter, Kevin C; Pezzella, Francesco

2013-08-01

Angiogenesis has been regarded as essential for tumor growth and progression. Studies of many human tumors, however, suggest that their microcirculation may be provided by nonsprouting vessels and that a variety of tumors can grow and metastasize without angiogenesis. Vessel co-option, where tumor cells migrate along the preexisting vessels of the host organ, is regarded as an alternative tumor blood supply. Vessel co-option may occur in many malignancies, but so far mostly reported in highly vascularized tissues such as brain, lung, and liver. In primary and metastatic lung cancer and liver metastasis from different primary origins, as much as 10-30% of the tumors are reported to use this alternative blood supply. In addition, vessel co-option is introduced as a potential explanation of antiangiogenic drug resistance, although the impact of vessel co-option in this clinical setting is still to be further explored. In this review we discuss tumor vessel co-option with specific examples of vessel co-option in primary and secondary tumors and a consideration of the clinical implications of this alternative tumor blood supply.

Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V.

Science.gov (United States)

Andrews, Gavin; Hobbs, Megan J; Borkovec, Thomas D; Beesdo, Katja; Craske, Michelle G; Heimberg, Richard G; Rapee, Ronald M; Ruscio, Ayelet Meron; Stanley, Melinda A

2010-02-01

Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM-III. The majority of these revisions have been in response to its poor inter-rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM-IV GAD criteria for DSM-V. First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM-III-R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM-IV criteria for GAD was examined. The review presents a number of options to be considered for DSM-V. One option is for GAD to be re-labeled in DSM-V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM-V validity tests and field trials.