Guidelines for social support to child play

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Mitranić Nevena N.

2016-01-01

Full Text Available Play is a precious aspect of living and irreplaceable importance for not only child well-being and development but for adults and communities, too. Complex current living conditions often minimize the importance of child play and it becomes even more necessary that educational policies support it. The subject of the research is based on the role child play has in educational policy and the aim is formulation of measures and actions which can support child play in educational policy. We examined measures and actions of official educational policies and non government organizations of the United Kingdom of England and Northern Ireland, the Republic of Ireland and Republic of Serbia. The results show that the problem is deeper than current nonexistence of systemic support to play in Serbia and open the question on which paradigm official educational policy in Serbia approaches to education, and the question of how to bring to awareness the importance of play in order to support it. Relaying on the frameworks of play support policy in the United Kingdom and Republic of Ireland we suggest some guidelines for social support of child play which might prove sensible and feasible in Serbia.

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion.

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Echlin, Paul Sean; Tator, Charles H; Cusimano, Michael D; Cantu, Robert C; Taunton, Jack E; Upshur, Ross E G; Czarnota, Michael; Hall, Craig R; Johnson, Andrew M; Forwell, Lorie A; Driediger, Molly; Skopelja, Elaine N

2010-11-01

The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16-21-year-old) ice hockey players during a regular season. The authors conducted a prospective cohort study during 1 junior regular season (2009-2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16-21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7-29 days); the mean number of physician office visits

Australian Football League concussion guidelines: what do community players think?

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White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua

2016-01-01

Background Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players’ views on following the Australian Football League's (AFL) concussion guidelines. Methods 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Results Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players’ rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players’ desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Conclusions Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport. PMID:28890801

Can Competitive Athletes Return to High-Level Play After Osteochondral Allograft Transplantation of the Knee?

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McCarthy, Mark A; Meyer, Maximilian A; Weber, Alexander E; Levy, David M; Tilton, Annemarie K; Yanke, Adam B; Cole, Brian J

2017-09-01

To investigate functional outcomes among competitive athletes undergoing osteochondral allograft (OCA) transplantation of the knee, including rates of return to play (RTP), and factors preventing RTP. A retrospective review identified all competitive athletes (high school, intercollegiate, professional) undergoing isolated femoral condyle OCA from 2004 to 2013. Patient-reported outcome (PRO) questionnaires (Lysholm, International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMasters Universities Arthritis Index [WOMAC], 12-Item Short Form Health Survey [SF-12], Tegner, and Marx) and custom RTP surveys were administered. All subsequent reoperations were documented. Thirteen athletes (4 intercollegiate, 9 high-school) were identified with an average follow-up of 5.9 ± 2.5 years. Seven athletes (54%) returned to competitive sport at an average of 7.9 ± 3.5 months, 5 of whom returned to preinjury functional levels. Of the 8 athletes who either did not return to competitive sport or failed to sustain their high level of play, the most common reasons cited were graduation from high school or college (4 patients, 50%) or fear of reinjury (3 patients, 38%). All 4 patients citing graduation as the primary factor preventing return to preinjury level of competitive sport resumed recreational sport without limitations, yielding an adjusted RTP rate of 10 patients (77%) who either returned to competitive play or believed they could return if they had not graduated. At final follow-up, athletes reported significant improvements in all PRO scores except for KOOS-Sport, WOMAC-Stiffness, and SF-12 Mental subscales. There were 3 reoperations at an average of 3.8 ± 3.3 years after the index OCA. There were no instances of graft failure. OCAs provide an adjusted RTP rate of 77% for high-level adolescent athletes. Social factors may be more likely than persistent pain to prevent return to sport. Level IV

Femoroacetabular Impingement in Professional Football Players: Return to Play and Predictors of Career Length After Hip Arthroscopy.

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Menge, Travis J; Bhatia, Sanjeev; McNamara, Shannen C; Briggs, Karen K; Philippon, Marc J

2017-07-01

Previous studies have shown hip arthroscopy to be a highly effective treatment for symptomatic femoroacetabular impingement (FAI) in a wide range of athletes; however, the rate of return to play and length of career after hip arthroscopy in professional football players are unknown. To determine how many athletes returned to professional football and the number of seasons they played after surgery. Case series; Level of evidence, 4. Fifty-one professional football players (60 hips) underwent hip arthroscopy for FAI between 2000 and 2014 by a single surgeon. Return to play was defined as competing in a preseason or regular season professional football game after surgery. Data were retrospectively obtained for each player from NFL.com , ESPN.com , individual team websites, and/or CFL.ca . We found that 87% (52/60) of the arthroscopic procedures allowed professional football players to return to play in a preseason or regular season game. Athletes who returned played an average of 38 games during 3.2 seasons after arthroscopy, with an average total career length of 7.4 seasons. Ninety-two percent (48/52) of players who returned had a minimum total career length of 3 years. When participants were analyzed by position, linemen were less likely to return after hip arthroscopy compared with other players (odds ratio 5.6; 95% CI, 1.1-35; P = .04). All quarterbacks and tight ends returned to play after surgery. No significant difference in return to play rate was found between athletes who underwent microfracture and those who did not (25% vs 38%, P = .698). Hip arthroscopy for treatment of FAI and associated pathologic abnormalities in professional football players resulted in a high rate of return to play. The study's findings demonstrate that 87% of the arthroscopic procedures allowed professional football players to return to play, linemen were less likely to return compared with other positions, and the presence of microfracture did not significantly affect the return

Educational Intervention Improves Compliance With AAN Guidelines for Return Epilepsy Visits: A Quality Improvement Project.

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Nelson, Gary R; Filloux, Francis M; Kerr, Lynne M

2016-10-01

In 2011, the American Academy of Neurology (AAN) released guidelines for return seizure visits detailing 8 points that should be addressed during such visits. These guidelines are designed to improve routine follow-up care for epilepsy patients. The authors performed a quality improvement project aimed at increasing compliance with these guidelines after educating providers about them. The authors performed a chart review before and after an intervention which included: education regarding the guidelines, providing materials to remind providers of the guidelines, and templates to facilitate compliance. The authors reviewed charts at 2 and 6 months after the intervention. Significant improvement in documentation of 4 of the 8 measures was observed after this educational intervention. This suggests that simple educational interventions may help providers change practice and can improve compliance with new guidelines while requiring minimal time and resources to implement. © The Author(s) 2016.

Professional Athletes' Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.

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Trofa, David P; Miller, J Chance; Jang, Eugene S; Woode, Denzel R; Greisberg, Justin K; Vosseller, J Turner

2017-10-01

Most Achilles tendon ruptures are sports related. However, few studies have examined and compared the effect of surgical repair for complete ruptures on return to play (RTP), play time, and performance across multiple sports. To examine RTP and performance among professional athletes after Achilles tendon repair and compare pre- versus postoperative functional outcomes of professional athletes from different major leagues in the United States. Cohort study; Level of evidence, 3. National Basketball Association (NBA), National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2013 were identified via public injury reports and press releases. Demographic information and performance-related statistics were recorded for 2 seasons before and after surgery and compared with matched controls. Statistical analyses were used to assess differences in recorded metrics. Of 86 athletes screened, 62 met inclusion criteria including 25 NBA, 32 NFL, and 5 MLB players. Nineteen (30.6%) professional athletes with an isolated Achilles tendon rupture treated surgically were unable to return to play. Among athletes who successfully returned to play, game participation averaged 75.4% ( P .05). When individual sports were compared, NBA players were most significantly affected, experiencing significant decreases in games played, play time, and performance. An Achilles tendon rupture is a devastating injury that prevents RTP for 30.6% of professional players. Athletes who do return play in fewer games, have less play time, and perform at a lower level than their preinjury status. However, these functional deficits are seen only at 1 year after surgery compared with matched controls, such that players who return to play can expect to perform at a level commensurate with uninjured controls 2 years postoperatively.

Use of the stepwise progression return-to-play protocol following concussion among practicing athletic trainers

Directory of Open Access Journals (Sweden)

Jessica Wallace

2018-04-01

Full Text Available Purpose: The purpose of this study was to determine whether practicing athletic trainers (ATs were using the stepwise progression to make return-to-play (RTP decisions after concussion and to determine what factors influenced their decision to use the stepwise progression. Methods: A total of 166 ATs (response rate = 16.6% completed a 21-item questionnaire that evaluated participant demographics, methods of concussion management, and RTP decision-making using the stepwise progression. Descriptive statistics and a logistic regression were completed to analyze data. Results: Factors such as education level (p = 0.05 and number of concussions treated (p = 0.05 predicted use of the stepwise progression, whereas sex (p = 0.17, employment setting (p = 0.17, state law (p = 0.86, and years practicing (p = 0.17 did not predict whether ATs were following the stepwise progression. Conclusion: The majority of the ATs from this study are employing the stepwise progression to safely return athletes to play after sustaining a concussion. This demonstrates that ATs are providing a standard of care for concussed athletes across various athletic training settings; however, having a graduate degree and treating more concussions per year are predictors of whether an AT follows all steps of the stepwise progression. Keywords: Athletic trainers, Concussion, Concussion management, Graduate degree, Return to play, Sports medicine, Stepwise progression

Return to Play After Shoulder Surgery in Throwers.

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Thorsness, Robert; Alland, Jeremy A; McCulloch, Colin B; Romeo, Anthony

2016-10-01

The throwing athlete's shoulder is a unique, complex entity with challenges in diagnosis and management. The shoulders in these athletes possess unique biomechanics and pathologic conditions. Unfortunately, return to play outcomes are often poor when specifically evaluating overhead athletes, especially with regard to SLAP repair. It is imperative for the surgeon to be cautious when indicating these athletes for surgery, because although they may demonstrate improvements in pain and general function, subtle changes in accuracy or velocity as a result of surgery can significantly affect the success of an overhead throwing athlete at the competitive level. Copyright © 2016 Elsevier Inc. All rights reserved.

Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play

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Chu, Samuel K.; Rho, Monica E.

2016-01-01

Hamstring injuries are very common in athletes. Acute hamstring strains can occur with high-speed running or with excessive hamstring lengthening. Athletes with proximal hamstring tendinopathy often do not report a specific inciting event; instead they develop the pathology from chronic overuse. A thorough history and examination is important to determine the appropriate diagnosis and rule out other causes of posterior thigh pain. Conservative management of hamstring strains involves a rehabilitation protocol that gradually increases intensity, range of motion and progresses to sport-specific and neuromuscular control exercises. Eccentric strengthening exercises are used for management of proximal hamstring tendinopathy. Studies investigating corticosteroid and platelet-rich plasma injections have mixed results. MRI and ultrasound are effective for identification of hamstring strains and tendinopathy, but have not demonstrated correlation with return to play. The article focuses on diagnosis, treatment and return to play considerations for acute hamstring strains and proximal hamstring tendinopathy in the athlete. PMID:27172083

Recurrent stingers in an adolescent American football player: dilemmas of return to play. A case report and review of the literature.

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Zaremski, Jason L; Horodyski, MaryBeth; Herman, Daniel C

2017-01-01

We present the case of a 16-year-old football linebacker with a history of recurrent stingers. Initial physical examination was normal as were cervical spine radiographs. MRI of the cervical spine revealed relative stenosis. Electrodiagnostic testing revealed chronic bilateral neurogenic changes of the superior trunk of the brachial plexus. A Kerr Collar was obtained to minimize head acceleration and force transmission through the neck. While there are return-to-play guidelines for recurrent stingers, there are inconsistencies with those recommendations. Our case highlights the challenges in contact sport athletes with recurrent stingers.

Adherence to active play and electronic media guidelines in preschool children: gender and parental education considerations.

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Loprinzi, Paul D; Schary, David P; Cardinal, Bradley J

2013-01-01

The primary purpose of the present study was to examine adherence to current active play and electronic media use guidelines in a sample of US preschool-aged children and to examine whether differences occurred across gender and parental education. 164 parents completed an on-line survey to estimate preschool children's active play and sedentary behaviors. For weekdays, 50% of the sample met the active play guideline with this increasing to 65% during the weekend. With respect to electronic media use, 90% of the sample met guidelines during the week, with the percentage meeting guidelines dropping to 78% during the weekend. A greater percentage of preschool children from high parental education families (83.4 ± 3.3) met electronic media use guidelines on the weekends, compared to preschool children from low parental education families (59.4 ± 8.1) (p = 0.002). Our findings indicate that a substantial portion of preschool children are not meeting active play guidelines and that adherence to active play and electronic media use guidelines may be influenced by parental education.

Return to Play and Performance After Jones Fracture in National Basketball Association Athletes

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Begly, John P.; Guss, Michael; Ramme, Austin J.; Karia, Raj; Meislin, Robert J.

2015-01-01

Background: Basketball players are at risk for foot injuries, including Jones fractures. It is unknown how this injury affects the future play and performance of athletes. Hypothesis: National Basketball Association (NBA) players who sustain Jones fractures of the base of the fifth metatarsal have high rates of return to play and do not experience a decrease in performance on return to competition when compared with preinjury and with control-matched peers. Study Design: Retrospective cohort study. Level of Evidence: Level 5. Methods: Data on 26 elite basketball players with Jones fractures over 19 NBA seasons (1994-1995 to 2012-2013) were obtained from injury reports, press releases, player profiles, and online public databases. Variables included age, body mass index (BMI), player position, experience, and surgical treatment. Individual season statistics pre- and postinjury were collected. Twenty-six controls were identified by matched player position, age, and performance statistics. Results: The mean age at the time of injury was 24.8 years, mean BMI was 24.7 kg/m2, and the mean experience prior to injury was 4.1 NBA seasons. Return to previous level of competition was achieved by 85% of athletes. There was no change in player efficiency rating (PER) when pre- and postinjury performance was compared. When compared with controls, no decline in PER measured performance was identified. Conclusion: The majority of NBA players sustaining a Jones fracture return to their preinjury level of competition. These elite athletes demonstrate no decrease in performance on their return to play. Clinical Relevance: Jones fractures are well-studied injuries in terms of etiology, diagnosis, and management. However, the effect of these injuries on future performance of athletes is unknown. Using the findings of our study, orthopaedic surgeons may be better prepared to counsel and educate elite athletes who sustain a Jones fracture. PMID:26627111

Return to Play and Performance After Jones Fracture in National Basketball Association Athletes.

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Begly, John P; Guss, Michael; Ramme, Austin J; Karia, Raj; Meislin, Robert J

2016-07-01

Basketball players are at risk for foot injuries, including Jones fractures. It is unknown how this injury affects the future play and performance of athletes. National Basketball Association (NBA) players who sustain Jones fractures of the base of the fifth metatarsal have high rates of return to play and do not experience a decrease in performance on return to competition when compared with preinjury and with control-matched peers. Retrospective cohort study. Level 5. Data on 26 elite basketball players with Jones fractures over 19 NBA seasons (1994-1995 to 2012-2013) were obtained from injury reports, press releases, player profiles, and online public databases. Variables included age, body mass index (BMI), player position, experience, and surgical treatment. Individual season statistics pre- and postinjury were collected. Twenty-six controls were identified by matched player position, age, and performance statistics. The mean age at the time of injury was 24.8 years, mean BMI was 24.7 kg/m(2), and the mean experience prior to injury was 4.1 NBA seasons. Return to previous level of competition was achieved by 85% of athletes. There was no change in player efficiency rating (PER) when pre- and postinjury performance was compared. When compared with controls, no decline in PER measured performance was identified. The majority of NBA players sustaining a Jones fracture return to their preinjury level of competition. These elite athletes demonstrate no decrease in performance on their return to play. Jones fractures are well-studied injuries in terms of etiology, diagnosis, and management. However, the effect of these injuries on future performance of athletes is unknown. Using the findings of our study, orthopaedic surgeons may be better prepared to counsel and educate elite athletes who sustain a Jones fracture. © 2015 The Author(s).

Return to Golf After Lumbar Fusion.

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Shifflett, Grant D; Hellman, Michael D; Louie, Philip K; Mikhail, Christopher; Park, Kevin U; Phillips, Frank M

Spinal fusion surgery is being increasingly performed, yet few studies have focused on return to recreational sports after lumbar fusion and none have specifically analyzed return to golf. Most golfers successfully return to sport after lumbar fusion surgery. Case series. Level 4. All patients who underwent 1- or 2-level primary lumbar fusion surgery for degenerative pathologies performed by a single surgeon between January 2008 and October 2012 and had at least 1-year follow-up were included. Patients completed a specifically designed golf survey. Surveys were mailed, given during follow-up clinic, or answered during telephone contact. A total of 353 patients met the inclusion and exclusion criteria, with 200 responses (57%) to the questionnaire producing 34 golfers. The average age of golfers was 57 years (range, 32-79 years). In 79% of golfers, preoperative back and/or leg pain significantly affected their ability to play golf. Within 1 year from surgery, 65% of patients returned to practice and 52% returned to course play. Only 29% of patients stated that continued back/leg pain limited their play. Twenty-five patients (77%) were able to play the same amount of golf or more than before fusion surgery. Of those providing handicaps, 12 (80%) reported the same or an improved handicap. More than 50% of golfers return to on-course play within 1 year of lumbar fusion surgery. The majority of golfers can return to preoperative levels in terms of performance (handicap) and frequency of play. This investigation offers insight into when golfers return to sport after lumbar fusion surgery and provides surgeons with information to set realistic expectations postoperatively.

Complete avulsion of the adductor longus in a semi-professional football player: Rapid return to play with nonoperative treatment

Directory of Open Access Journals (Sweden)

Vince W Lands

2016-01-01

Full Text Available The adductor longus has become recognized as one of the more commonly injured muscles in the medial compartment. Acute complete rupture injuries occurring at the proximal aspect of the muscle are less common. Limited data exist regarding management of the injuries in athletes required for return to play and functioning. The current data favors operative management; however, nonoperative treatment may be a viable option. Nonoperative management of avulsion injuries of the proximal adductor longus tendon may prove equal results to surgical repair in return to play and functioning. A semi-professional football player sustained a left groin injury while participating in the play. Due to continued pain, swelling, and suspicion of injury, a magnetic resonance imaging was performed diagnosing a complete tear of proximal adductor longus tendon. Physical examination, strength, and range of motion were recorded until the patient was able to function normally without strength deficit, the range of motion loss, and the return of speed. The player was treated nonoperatively and was eventually allowed to return to play. The time of return to play was 6 weeks. Strength deficit was not appreciated or loss of motion and player was able to return to baseline function. Nonoperative management of complete avulsion injuries of the proximal adductor longus tendon result in faster return to play than operative management even if significant retraction is present.

Athletic pubalgia: Return to play after targeted surgery.

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Kajetanek, C; Benoît, O; Granger, B; Menegaux, F; Chereau, N; Pascal-Mousselard, H; Khiami, F

2018-03-13

Surgery for athletic pubalgia usually consists in abdominal wall repair combined with routine bilateral adductor tenotomy. We currently confine the surgical procedure to the injured structure(s) (abdominal wall only, adductor tendon only, or both) to limit morbidity and expedite recovery. Outcomes of this à la carte approach are unclear. The objectives of this retrospective study were to determine the return to play (RTP) time, evaluate the potential influence of injury location, and assess the frequency of recurrence or contralateral involvement. À la carte surgery for athletic pubalgia is associated with similar RTP times as the conventional procedure and is not followed by recurrence. Consecutive adults younger than 40 years of age who underwent surgery for athletic pubalgia with injury to the abdominal wall and/or adductor attachment sites between 2009 and 2015 were included. Patients with intra-articular hip disorders, isolated pubic symphysis involvement, or herniation were not eligible. The diagnosis was established clinically then confirmed by at least one imaging technique (ultrasonography plus either a radiograph of the pelvis or magnetic resonance imaging of the pelvis). The criterion for performing surgery was failure of appropriate conservative therapy followed for at least 3 months. Of the 27 included patients, eight had abdominal wall involvement only, seven adductor tendon involvement only, and 12 both. Overall, 25 (92.6%) patients returned to play at their previous level, after a mean of 112±38 days (range, 53-223 days), and experienced no recurrence during the 1-year follow-up. Mean RTP time was significantly shorter in the group with abdominal wall injury only (91.1±21.0 days) compared to the groups with adductor tendon injury only (101.7±42.0 days) or combined injuries (132.5±39.0) (p=0.02). In patients with athletic pubalgia, à la carte surgery confined to the injured structure(s) produces excellent RTP outcomes. RTP time is shortest in

Variable reporting of functional outcomes and return to play in superior labrum anterior and posterior tear.

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Steinhaus, Michael E; Makhni, Eric C; Lieber, Adam C; Kahlenberg, Cynthia A; Gulotta, Lawrence V; Romeo, Anthony A; Verma, Nikhil N

2016-11-01

Outcomes assessments after superior labrum anterior and posterior (SLAP) tear/repair are highly varied, making it difficult to draw comparisons across the literature. This study examined the inconsistency in outcomes reporting in the SLAP tear literature. We hypothesize that there is significant variability in outcomes reporting and that although most studies may report return to play, time to return reporting will be highly variable. The PubMed, Medline, Scopus, and Embase databases were systematically reviewed for studies from January 2000 to December 2014 reporting outcomes after SLAP tear/repair. Two reviewers assessed each study, and those meeting inclusion criteria were examined for pertinent data. Outcomes included objective (range of motion, strength, clinical examinations, and imaging) and subjective (patient-reported outcomes, satisfaction, activities of daily living, and return to play) measures. Of the 56 included studies, 43% documented range of motion, 14% reported strength, and 16% noted postoperative imaging. There was significant variation in use of patient-reported outcomes measures, with the 3 most commonly noted measures reported in 20% to 55% of studies. Return to play was noted in 75% of studies, and 23% reported time to return, with greater rates in elite athletes. Eleven studies (20%) did not report follow-up or noted data with <12 months of follow-up. The SLAP literature is characterized by substantial variability in outcomes reporting, with time to return to play noted in few studies. Efforts to standardize outcomes reporting would facilitate comparisons across the literature and improve our understanding of the prognosis of this injury. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Concussion Incidence and Return-to-Play Time in National Basketball Association Players: Results From 2006 to 2014.

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Padaki, Ajay S; Cole, Brian J; Ahmad, Christopher S

2016-09-01

Various research efforts have studied concussions in the National Football League, Major League Baseball, and the National Hockey League. However, no study has investigated the incidence and return-to-play trends in the National Basketball Association (NBA), which this study aims to do. Increased media scrutiny and public awareness, in addition to the institution of a league-wide concussion protocol, may have resulted in more conservative return-to-play practices. Descriptive epidemiology study. All concussions to NBA players that were publicly reported in the media from the beginning of the 2006 NBA season to the end of the 2014 season were included. The incidence and return-to-play statistics were generated by synthesizing information from publicly available records. There were 134 publicly reported concussions to NBA players from the beginning of the 2006 season to the conclusion of the 2014 season, resulting in an average of 14.9 concussions per season. The incidence has not changed significantly during this time span. The average games missed after a concussion from 2006 to 2010 was 1.6, significantly less than the 5.0 games missed from 2011 to 2014, following the institution of the NBA concussion protocol (P = .023). Although the incidence of publicly reported concussions in the NBA has not changed appreciably over the past 9 seasons, the time missed after a concussion has. While players often returned in the same game in the 2006 season, the combination of implemented policy, national coverage, medical staff awareness, and player education may have contributed to players now missing an average of 4 to 6 games after a concussion. A multitude of factors has resulted in more conservative return-to-play practices for NBA players after concussions. © 2016 The Author(s).

Connective tissue injury in calf muscle tears and return to play: MRI correlation.

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Prakash, Ashutosh; Entwisle, Tom; Schneider, Michal; Brukner, Peter; Connell, David

2017-10-26

The aim of our study was to assess a group of patients with calf muscle tears and evaluate the integrity of the connective tissue boundaries and interfaces. Further, we propose a novel MRI grading system based on integrity of the connective tissue and assess any correlation between the grading score and time to return to play. We have also reviewed the anatomy of the calf muscles. We retrospectively evaluated 100 consecutive patients with clinical suspicion and MRI confirmation of calf muscle injury. We evaluated each calf muscle tear with MRI for the particular muscle injured, location of injury within the muscle and integrity of the connective tissue structure at the interface. The muscle tears were graded 0-3 depending on the degree of muscle and connective tissue injury. The time to return to play for each patient and each injury was found from the injury records and respective sports doctors. In 100 patients, 114 injuries were detected. Connective tissue involvement was observed in 63 out of 100 patients and failure (grade 3 injury) in 18. Mean time to return to play with grade 0 injuries was 8 days, grade 1 tears was 17 days, grade 2 tears was 25 days and grade 3 tears was 48 days (pmuscle tears. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Return to Play and Decreased Performance After Anterior Cruciate Ligament Reconstruction in National Football League Defensive Players.

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Read, Connor R; Aune, Kyle T; Cain, E Lyle; Fleisig, Glenn S

2017-07-01

Anterior cruciate ligament (ACL) injuries occur commonly in football. Recent work has reported ACL reconstruction (ACLR) as one of several orthopaedic procedures with unfavorable outcomes for professional athletes. The performance impact to defensive players after surgery has not been quantified. To quantify the effect of ACLR on the performance of defensive players by comparing them to a cohort of matched controls as well as to measure the effect of ACLR on athletes' career length in the National Football League (NFL). Case-control and cohort study; Level of evidence, 3. Thirty-eight NFL defensive players with a history of ACLR from 2006 to 2012 were identified. For each injured player, a matched control player was identified. Demographic and performance statistics were collected from the online NFL player database. Players who returned after ACLR (n = 23) were compared with players who did not return (n = 15) using t tests and chi-squared analyses. Similarly, players who returned after ACLR (n = 23) were compared with their matched controls with t tests and chi-squared analyses. Two-way repeated-measures analysis of variance was utilized to test for significant differences between performance before and after the season of the injury for the players in the ACLR group who returned (n = 23) and for their matched controls. Kaplan-Meier analysis was performed to test for differences in the rate of retirement between the groups. For all analyses, P values <.05 were considered significant. Approximately 74% (28/38) of athletes who underwent ACLR returned to play at least 1 NFL game, and 61% (23/38) successfully returned to play at least half a season (ie, 8 games). Athletes in the ACLR group who returned retired from the NFL significantly sooner and more often after surgery than their matched controls. In the seasons leading up to their injury, athletes who successfully returned to play started a greater percentage of their games (81%) and made more solo tackles per

Effectiveness of guideline-based care by occupational physicians on the return-to-work of workers with common mental disorders: design of a cluster-randomised controlled trial.

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van Beurden, Karlijn M; Brouwers, Evelien P M; Joosen, Margot C W; Terluin, Berend; van der Klink, Jac J L; van Weeghel, Jaap

2013-03-06

Sickness absence due to common mental disorders (such as depression, anxiety disorder, adjustment disorder) is a problem in many Western countries. Long-term sickness absence leads to substantial societal and financial costs. In workers with common mental disorders, sickness absence costs are much higher than medical costs. In the Netherlands, a practice guideline was developed that promotes an activating approach of the occupational physician to establish faster return-to-work by enhancing the problem-solving capacity of workers, especially in relation to their work environment. Studies on this guideline indicate a promising association between guideline adherence and a shortened sick leave duration, but also minimal adherence to the guideline by occupational physicians. Therefore, this study evaluates the effect of guideline-based care on the full return-to-work of workers who are sick listed due to common mental disorders. This is a two-armed cluster-randomised controlled trial with randomisation at the occupational physician level. During one year, occupational physicians in the intervention group receive innovative training to improve their guideline-based care whereas occupational physicians in the control group provide care as usual. A total of 232 workers, sick listed due to common mental disorders and counselled by participating occupational physicians, will be included. Data are collected via the registration system of the occupational health service, and by questionnaires at baseline and at 3, 6 and 12 months. The primary outcome is time to full return-to-work. Secondary outcomes are partial return-to-work, total number of sick leave days, symptoms, and workability. Personal and work characteristics are the prognostic measures. Additional measures are coping, self-efficacy, remoralization, personal experiences, satisfaction with consultations with the occupational physician and with contact with the supervisor, experiences and behaviour of the supervisor

Return to Play After Shoulder Instability Surgery in National Collegiate Athletic Association Division I Intercollegiate Football Athletes.

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Robins, R Judd; Daruwalla, Jimmy H; Gamradt, Seth C; McCarty, Eric C; Dragoo, Jason L; Hancock, Robert E; Guy, Jeffrey A; Cotsonis, George A; Xerogeanes, John W; Tuman, Jeffrey M; Tibone, James E; Javernick, Matthew A; Yochem, Eric M; Boden, Stephanie A; Pilato, Alexis; Miley, Jennifer H; Greis, Patrick E

2017-08-01

Recent attention has focused on the optimal surgical treatment for recurrent shoulder instability in young athletes. Collision athletes are at a higher risk for recurrent instability after surgery. To evaluate variables affecting return-to-play (RTP) rates in Division I intercollegiate football athletes after shoulder instability surgery. Case series; Level of evidence, 4. Invitations to participate were made to select sports medicine programs that care for athletes in Division I football conferences (Pac-12 Conference, Southeastern Conference [SEC], Atlantic Coast Conference [ACC]). After gaining institutional review board approval, 7 programs qualified and participated. Data on direction of instability, type of surgery, time to resume participation, and quality and level of play before and after surgery were collected. There were 168 of 177 procedures that were arthroscopic surgery, with a mean 3.3-year follow-up. Overall, 85.4% of players who underwent arthroscopic surgery without concomitant procedures returned to play. Moreover, 15.6% of athletes who returned to play sustained subsequent shoulder injuries, and 10.3% sustained recurrent instability, resulting in reduction/revision surgery. No differences were noted in RTP rates in athletes who underwent anterior labral repair (82.4%), posterior labral repair (92.9%), combined anterior-posterior repair (84.8%; P = .2945), or open repair (88.9%; P = .9362). Also, 93.3% of starters, 95.4% of utilized players, and 75.7% of rarely used players returned to play. The percentage of games played before the injury was 49.9% and rose to 71.5% after surgery ( P surgery. Scholarship status significantly correlated with RTP after surgery ( P = .0003). The majority of surgical interventions were isolated arthroscopic stabilization procedures, with no statistically significant difference in RTP rates when concomitant arthroscopic procedures or open stabilization procedures were performed. Athletes who returned to play often

Return to Play and Future ACL Injury Risk Following ACL Reconstruction In Soccer Athletes From the MOON Group

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Brophy, Robert H.; Schmitz, Leah; Wright, Rick W.; Dunn, Warren R.; Parker, Richard D.; Andrish, Jack T.; McCarty, Eric C.; Spindler, Kurt P.

2013-01-01

Background There is limited information on outcomes and return to play (RTP) after ACL reconstruction (ACLR) in soccer athletes. Hypothesis The purpose of this study was to (i) test the hypotheses that player sex, side of injury and graft choice do not influence RTP, and (ii) define the risk for future ACL injury in soccer players after ACLR. Study design Retrospective cohort study, Level II. Methods Soccer players in a prospective cohort were contacted to determine RTP following ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant) and incidence of subsequent ACL surgery was recorded. Results Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACL reconstruction returned to soccer. At average follow up of 7.0 years, 36% were still playing, a significant decrease compared to initial RTP (psoccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% v. 5.5%, p=0.03). Soccer athletes who underwent ACLR on their non-dominant limb had a higher future rate of contra-lateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (p=0.03). Conclusion Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer following ACLR declines over time. PMID:23002201

Systematic review of prognosis and return to play after sport concussion: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.

Science.gov (United States)

Cancelliere, Carol; Hincapié, Cesar A; Keightley, Michelle; Godbolt, Alison K; Côté, Pierre; Kristman, Vicki L; Stålnacke, Britt-Marie; Carroll, Linda J; Hung, Ryan; Borg, Jörgen; Nygren-de Boussard, Catharina; Coronado, Victor G; Donovan, James; Cassidy, J David

2014-03-01

To synthesize the best available evidence on prognosis after sport concussion. MEDLINE and other databases were searched (2001-2012) with terms including "craniocerebral trauma" and "sports." Reference lists of eligible articles were also searched. Randomized controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 concussion cases. Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables. Evidence was synthesized qualitatively according to modified SIGN criteria, and studies were categorized as exploratory or confirmatory based on the strength of their design and evidence. After 77,914 records were screened, 52 articles were eligible for this review, and 24 articles (representing 19 studies) with a low risk of bias were accepted. Our findings are based on exploratory studies of predominantly male football players at the high school, collegiate, and professional levels. Most athletes recover within days to a few weeks, and American and Australian professional football players return to play quickly after mild traumatic brain injury. Delayed recovery appears more likely in high school athletes, in those with a history of previous concussion, and in those with a higher number and duration of postconcussion symptoms. The evidence concerning sports concussion course and prognosis is very preliminary, and there is no evidence on the effect of return-to-play guidelines on prognosis. Our findings have implications for further research. Well-designed, confirmatory studies are urgently needed to understand the consequences of sport concussion, including recurrent concussion, across different athletic populations and sports. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights

Return to play after hamstring injuries in football (soccer) : A worldwide Delphi procedure regarding definition, medical criteria and decision-making

NARCIS (Netherlands)

Van Der Horst, Nick; Backx, F. J.G.; Goedhart, Edwin A.; Huisstede, Bionka M.A.

2017-01-01

There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify

Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return-to-play decision-making.

Science.gov (United States)

Shrier, Ian

2015-10-01

The sport medicine clinician is faced with return-to-play (RTP) decisions for every patient who wants to return to activity. The complex interaction of factors related to history, physical examination, testing, activity and baseline characteristics can make RTP decision-making challenging. Further, when reasoning is not explicit, unnecessary conflict can arise among clinicians themselves, or among clinicians and patients. This conflict can have negative health consequences for the patient. In 2010, a transparent framework for RTP decisions was proposed. However, some have identified limitations to the framework and found difficulties in its implementation. This paper presents a revised framework that addresses the limitations, and provides concrete examples of how to apply it in simple and complex cases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Play for All Guidelines: Planning, Design and Management of Outdoor Play Settings for All Children. Second Edition.

Science.gov (United States)

Moore, Robin C., Ed.; Goltsman, Susan M., Ed.; Iacofano, Daniel S., Ed.

These guidelines assist professional designers, park and recreation managers, and community groups when making decisions about the planning, design, and ongoing management of children's public play environments. The guidelines are updated to meet or exceed the requirements of the Americans with Disabilities Act Guidelines (July 26, 1991) and the…

Return to Play After Hamstring Injuries: A Qualitative Systematic Review of Definitions and Criteria

NARCIS (Netherlands)

N. van der Horst (Nick); S. van de Hoef (Sander); G. Reurink (Gustaaf); B.M.A. Huisstede (Bionka); F.J.G. Backx (Frank)

2016-01-01

textabstractBackground: More than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to

Social support from the athletic trainer and symptoms of depression and anxiety at return to play.

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Yang, Jingzhen; Schaefer, Julie T; Zhang, Ni; Covassin, Tracey; Ding, Kele; Heiden, Erin

2014-01-01

Few empirical studies have examined social support from athletic trainers (ATs) and its buffering effect during injury recovery. To examine the effect of social support received from ATs during injury recovery on reported symptoms of depression and anxiety at return to play among a cohort of collegiate athletes. Cohort study. Two Big 10 Conference universities. A total of 594 injuries sustained by 387 collegiate athletes (397 injuries by 256 males, 197 injuries by 131 females) on 9 sports teams. Data were collected during the 2007-2011 seasons. Social support was measured using the 6-item Social Support Questionnaire. Symptoms of depression were assessed using the Center for Epidemiological Studies Depression Scale. Anxiety was measured by the State-Trait Anxiety Inventory. We used generalized estimation equation regression models to examine the effect of the social support from ATs on the odds of symptoms of depression and anxiety at return to play. In 84.3% (n = 501) of injury events, injured athletes received social support from ATs during their recovery. Of these, 264 (53.1%) athletes reported being very satisfied with this social support. Whether or not athletes received social support from ATs during recovery did not affect the symptoms of depression or anxiety experienced at return to play. However, compared with athletes who were dissatisfied with the social support received from ATs, athletes who were very satisfied or satisfied with this social support were 87% (95% confidence interval = 0.06, 0.30) and 70% (95% confidence interval = 0.13, 0.70) less likely to report symptoms of depression at return to play, respectively. Similar results were observed for anxiety. Our findings support the buffering effect of social support from ATs and have important implications for successful recovery in both the physical and psychological aspects for injured athletes.

Return to Play After Hamstring Injuries : A Qualitative Systematic Review of Definitions and Criteria

NARCIS (Netherlands)

van der Horst, Nick; van de Hoef, Sander; Reurink, Gustaaf; Huisstede, Bionka; Backx, Frank

BACKGROUND: More than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to determine when

Determinants of Return to Play After the Nonoperative Management of Hamstring Injuries in Athletes: A Systematic Review.

Science.gov (United States)

Fournier-Farley, Camille; Lamontagne, Martin; Gendron, Patrick; Gagnon, Dany H

2016-08-01

It is important for clinicians to rely on suitable prognosis factors after hamstring injuries because of the high incidence of these injuries and time away from athletic activities. To summarize the current literature on factors that influence return to play after a hamstring injury in athletes. Systematic review. A computer-assisted literature search of CINAHL, MEDLINE, Embase, and EBM Reviews databases (and a manual search of the reference lists of all selected articles) was conducted using keywords related to hamstring injuries and return to play. The literature review criteria included (1) patients with an acute hamstring or posterior thigh injury; (2) a randomized controlled trial, cohort study, case-control study, case series, or prospective or retrospective design; (3) information on rehabilitation, physical therapy, clinical assessment, imaging techniques, and return to play; and (4) studies written in English or French. The search strategy identified 914 potential articles, of which 24 met the inclusion criteria. In terms of the clinical assessment, the following factors were associated with a longer recovery time: stretching-type injuries, recreational-level sports, structural versus functional injuries, greater range of motion deficit with the hip flexed at 90°, time to first consultation >1 week, increased pain on the visual analog scale, and >1 day to be able to walk pain free after the injury. As for magnetic resonance imaging studies, the following factors correlated with a longer recovery time: positive findings; higher grade of injury; muscle involvement >75%; complete transection; retraction; central tendon disruption of the biceps femoris; proximal tendon involvement; shorter distance to the ischial tuberosity; length of the hamstring injury; and depth, volume, and large cross-sectional area. With respect to ultrasound studies, the following factors were associated with a poor prognosis: large cross-sectional area, injury outside the

Active release technique in hamstrings strain: Rehabilitation and return to play – a case study

Directory of Open Access Journals (Sweden)

Hariharasudhan Ravichandran

2017-01-01

Full Text Available Hamstring injuries and its rehabilitation in competitive events such as football targets safe and early return to play. This is because hamstring injuries are more related to prolonged recovery time and high rate of re-injury. In this case study, Zakeer Mundampara, 26-year-old footballer of Chennaiyin FC team (Indian super league tournament, who was rehabilitated for Grade 2 hamstring strain was briefed. To describe the importance of conservative rehabilitation in hamstring injuries and report on player's rehabilitation program and clinical outcome. Zakeer Mundampara was conservatively treated with active release technique for 2 weeks duration. Data collected includes passive knee extension test range of motion and verbal rating score. After 2 weeks of rehabilitation, Zakeer Mundampara had nearly full range of pain-free movement, normal gait and trained to run safely. By the 3rd week, he started to perform all sports specific drills. He was rehabilitated and set fit to play after 4 weeks from the date of injury. Active release technique is effective in hamstring injuries. In this case study, rehabilitation program with an emphasis on active release technique is found to be effective in returning the footballer back to play.

A Functional Return-to-Play Progression After Exertional Heat Stroke in a High School Football Player.

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Lopez, Rebecca M; Tanner, Patrick; Irani, Sarah; Mularoni, P Patrick

2018-03-01

  To present a functional return-to-play (RTP) progression after exertional heat stroke (EHS) in a 17-year-old high school football defensive end (height = 185 cm, mass = 145.5 kg).   The patient had no pertinent medical history but moved to a warm climate several days before the EHS occurred. After completing an off-season conditioning test (14- × 110-yd [12.6- × 99.0-m] sprints) on a warm afternoon (temperature = approximately 34°C [93°F], relative humidity = 53%), the patient collapsed. An athletic trainer (AT) was called to the field, where he found the patient conscious but exhibiting central nervous system dysfunction. Emergency medical services were summoned and immediately transported the patient to the hospital.   Exertional heat stroke, heat exhaustion, exertional sickling, rhabdomyolysis, and cardiac arrhythmia.   The patient was immediately transported to a hospital, where his oral temperature was 39.6°C (103.3°F). He was transferred to a children's hospital and treated for rhabdomyolysis, transaminitis, and renal failure. He was hospitalized for 11 days. After a physician's clearance once the laboratory results normalized, an RTP progression was completed. The protocol began with light activity and progressed over 3 weeks to full football practice. During activity, an AT monitored the patient's gastrointestinal temperature, heart rate, rating of perceived exertion, fluid consumption, and sweat losses.   Documentation of RTP guidelines for young athletes is lacking. We used a protocol intended for the football setting to ensure the athlete was heat tolerant, had adequate physical fitness, and could safely RTP. Despite his EHS, he recovered fully, with no lasting effects, and successfully returned to compete in the final 5 games of the season.   Using a gradual RTP progression and close monitoring, a high school defensive end successfully returned to football practice and games after EHS. This case demonstrates the feasibility of

Development of guidelines to assist organisations to support employees returning to work after an episode of anxiety, depression or a related disorder: a Delphi consensus study with Australian professionals and consumers

Directory of Open Access Journals (Sweden)

Reavley Nicola J

2012-09-01

Full Text Available Abstract Background Mental disorders are a significant cause of disability and loss of workplace productivity. The scientific evidence for how organisations should best support those returning to work after common mental disorders is relatively limited. Therefore a Delphi expert consensus study was carried out with professional and consumer experts. Methods A systematic review of websites, books and journal articles was conducted to develop a 387 item survey containing strategies that organisations might use to support those returning to work after common mental disorders. Three panels of Australian experts (66 health professionals, 30 employers and 80 consumers were recruited and independently rated the items over three rounds, with strategies reaching consensus on importance written into the guidelines. Results The participation rate across all three rounds was 60.2% (57.6% health professionals, 76.7% employers, 56.3% consumers. 308 strategies were endorsed as essential or important by at least 80% of all three panels. The endorsed strategies provided information on policy and procedures, the roles of supervisors, employees and colleagues in managing absence and return to work, and provision of mental health information and training. Conclusions The guidelines outline strategies for organisations supporting those returning to work after common mental disorders. It is hoped that they may be used to inform policy and practice in a variety of workplaces.

Return to play and performance after anterior cruciate ligament reconstruction in the National Basketball Association: surgeon case series and literature review.

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Nwachukwu, Benedict U; Anthony, Shawn G; Lin, Kenneth M; Wang, Tim; Altchek, David W; Allen, Answorth A

2017-09-01

To investigate return to play (RTP) and functional performance after anterior cruciate ligament reconstruction (ACLR) in National Basketball Association (NBA) players and to perform a systematic review of the literature to understand RTP after ACLR in professional basketball. NBA players undergoing ACLR between 2008 and 2014 by two surgeons were identified. RTP and performance were assessed based on a review of publically available statistics. A systematic review of the literature was performed using the MEDLINE database. Inclusion criteria were: English language, ACL surgery outcome, professional basketball and RTP outcome. We reviewed studies for RTP rates and RTP performance. Our study included 12 professional basketball players with NBA level experience. Eleven of the 12 players returned to their prior level of play. Eight of the 9 (88.9%) players actively playing in the NBA returned to play in the NBA at a mean 9.8 months. Among players returning to NBA play, during RTP season 1, mean per game statistics decreased for the following: minutes, points, rebounds, assists, steals, blocks, turnovers and personal fouls - none of these changes reached statistical significance. Player efficiency ratings significantly declined from pre-injury (12.5) to the first RTP season (7.6) (p = 0.05). By RTP season 2, player performance metrics approximated pre-injury levels and were not significantly different. Six studies met inclusion criteria; reported RTP rates ranged from 78-86%. Identified studies similarly found a decline in functional performance after RTP. There is a high rate (89%) of return to NBA play for NBA players undergoing ACLR. After RTP, however, there is a quantitative decline in initial season 1 RTP statistics with a significant decrease in player efficiency rating. By RTP season 2, performance metrics demonstrated an improvement compared to RTP season 1 but did not reach pre-injury functional performance, though performance metrics are not significantly

Return to Sport After Rotator Cuff Tear Repair: A Systematic Review and Meta-analysis.

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Klouche, Shahnaz; Lefevre, Nicolas; Herman, Serge; Gerometta, Antoine; Bohu, Yoann

2016-07-01

One of the most frequent demands from athletes after rotator cuff tear repair is to return to sport, if possible at the same level of play. The main goal of this study was to determine the rate of return to sport after treatment of rotator cuff tears. Meta-analysis and systematic review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature, as well as for the presentation of results. A search of the literature was performed on the electronic databases MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Inclusion criteria were studies in English evaluating return to sport after treatment of traumatic, degenerative, partial or full-thickness rotator cuff tears in patients practicing a sport regularly, whatever the level, all ages and sports included. The main judgment criterion was the number of patients who returned to a sports activity after treatment of a rotator cuff tear. The criterion was analyzed in 2 ways: return to sport (yes/no) and the level of play (identical or higher/lower level). Twenty-five studies were reviewed, including 859 patients (683 athletes), all treated surgically after a mean follow-up of 3.4 years (range, 0.3-13.4 years). The level of sports was recorded in 23 studies or 635 (93%) athletes and included 286 competitive or professional athletes and 349 recreational athletes. The most commonly practiced sports were baseball (224 participants), tennis (104 participants), and golf (54 participants). The overall rate of return to sport was 84.7% (95% CI, 77.6%-89.8%), including 65.9% (95% CI, 54.9%-75.4%) at an equivalent level of play, after 4 to 17 months. Of the professional and competitive athletes, 49.9% (95% CI, 35.3-64.6%) returned to the same level of play. Most

Return to sport after shoulder arthroplasty: a systematic review and meta-analysis.

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Liu, Joseph N; Steinhaus, Michael E; Garcia, Grant H; Chang, Brenda; Fields, Kara; Dines, David M; Warren, Russell F; Gulotta, Lawrence V

2018-01-01

With increasing incidence and indications for shoulder arthroplasty, there is an increasing emphasis on the ability to return to sports. The main goal of this study was to determine the rate of return to sport after shoulder arthroplasty. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review and meta-analysis. A search was performed on MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the Methodological Index for Nonrandomized Studies checklist. The main judgement outcome was the rate of return to sports activity after shoulder arthroplasty and the level of play upon return (identical or higher/lower level). Thirteen studies were reviewed, including 944 patients (506 athletes), treated with shoulder arthroplasty at an average follow-up of 5.1 years (range, 0.5-12.6 years). The most common sports were swimming (n = 169), golf (n = 144), fitness sports (n = 71), and tennis (n = 63). The overall rate of return to sport was 85.1% (95% CI, 76.5-92.3%), including 72.3% (95% CI, 60.6-82.8%) returning to an equivalent or improved level of play, after 1-36 months. Patients undergoing anatomic total shoulder arthroplasty returned at a significantly higher rate (92.6%) compared to hemiarthroplasty (71.1%, p = 0.02) or reverse total shoulder arthroplasty (74.9%, p = 0.003). Most patients are able to return to one or more sports following shoulder arthroplasty, with anatomic total shoulder arthroplasty having the highest rate of return. IV.

Predictors of return rate discrimination in slot machine play.

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Coates, Ewan; Blaszczynski, Alex

2014-09-01

The purpose of this study was to investigate the extent to which accurate estimates of payback percentages and volatility combined with prior learning, enabled players to successfully discriminate between multi-line/multi-credit slot machines that provided differing rates of reinforcement. The aim was to determine if the capacity to discriminate structural characteristics of gaming machines influenced player choices in selecting 'favourite' slot machines. Slot machine gambling history, gambling beliefs and knowledge, impulsivity, illusions of control, and problem solving style were assessed in a sample of 48 first year undergraduate psychology students. Participants were subsequently exposed to a choice paradigm where they could freely select to play either of two concurrently presented PC-simulated slot machines programmed to randomly differ in expected player return rates (payback percentage) and win frequency (volatility). Results suggest that prior learning and cognitions (particularly gambler's fallacy) but not payback, were major contributors to the ability of a player to discriminate volatility between slot machines. Participants displayed a general tendency to discriminate payback, but counter-intuitively placed more bets on the slot machine with lower payback percentage rates.

Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury

NARCIS (Netherlands)

van der Made, Anne D.; Almusa, Emad; Whiteley, Rod; Hamilton, Bruce; Eirale, Cristiano; van Hellemondt, Frank; Tol, Johannes L.

2018-01-01

Background Hamstring injury with intramuscular tendon involvement is regarded as a serious injury with a delay in return to play (RTP) of more than 50 days and reinjury rates up to 63%. However, this reputation is based on retrospective case series with high risk of bias. Objective Determine whether

Return to Play After Hamstring Injuries: A Qualitative Systematic Review of Definitions and Criteria.

Science.gov (United States)

van der Horst, Nick; van de Hoef, Sander; Reurink, Gustaaf; Huisstede, Bionka; Backx, Frank

2016-06-01

More than half of the recurrent hamstring injuries occur within the first month after return-to-play (RTP). Although there are numerous studies on RTP, comparisons are hampered by the numerous definitions of RTP used. Moreover, there is no consensus on the criteria used to determine when a person can start playing again. These criteria need to be critically evaluated, in an attempt to reduce recurrence rates and optimize RTP. To carry out a systematic review of the literature on (1) definitions of RTP used in hamstring research and (2) criteria for RTP after hamstring injuries. Systematic review. Seven databases (PubMed, EMBASE/MEDLINE, CINAHL, PEDro, Cochrane, SPORTDiscus, Scopus) were searched for articles that provided a definition of, or criteria for, RTP after hamstring injury. There were no limitations on the methodological design or quality of articles. Content analysis was used to record and analyze definitions and criteria for RTP after hamstring injury. Twenty-five papers fulfilled inclusion criteria, of which 13 provided a definition of RTP and 23 described criteria to support the RTP decision. "Reaching the athlete's pre-injury level" and "being able to perform full sport activities" were the primary content categories used to define RTP. "Absence of pain", "similar strength", "similar flexibility", "medical staff clearance", and "functional performance" were core themes to describe criteria to support the RTP decision after hamstring injury. Only half of the included studies provided some definition of RTP after hamstring injury, of which reaching the athlete's pre-injury level and being able to perform full sport activities were the most important. A wide variety of criteria are used to support the RTP decision, none of which have been validated. More research is needed to reach a consensus on the definition of RTP and to provide validated RTP criteria to facilitate hamstring injury management and reduce hamstring injury recurrence. PROSPERO

Implementation of concussion guidelines in community Australian Football and Rugby League-The experiences and challenges faced by coaches and sports trainers.

Science.gov (United States)

Kemp, Joanne L; Newton, Joshua D; White, Peta E; Finch, Caroline F

2016-04-01

While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them. Longitudinal study. 111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines. 71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p=0.002), football code (p=0.015), and team role (p=0.045). An interaction between team role and guideline use (p=0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players. This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Current thinking: return to play and transient quadriplegia.

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Cantu, Robert V; Cantu, Robert C

2005-02-01

Athletes that participate in contact and collision sports assume risk of serious injury each time they take the field. For those athletes that have sustained an episode of transient quadriplegia, the decision of whether to return to competition can be a difficult one. Some athletes, realizing how close they may have come to permanent injury, may decide that further participation is not in their best interest. Others may be somewhat undecided, and some may want to return at all costs. As the treating physician, the goal is to identify those athletes who after a single episode of transient quadriplegia are at increased risk for further injury and consequently should discontinue participation in contact sports. Factors that may contribute to that determination include mechanism of injury, prior history of neurologic symptoms or injury, and anatomic features that may predispose to further injury such as disc herniation, fracture, or cervical stenosis.

Coping strategies for adolescent birth-mothers who return to school ...

African Journals Online (AJOL)

... the birth-mothers using phenomenological interviews. The study aimed at providing an in-depth understanding of the factors that impacted negatively on the birth-mothers' school performance in order to ultimately develop guidelines for helping birth-mothers cope better when returning to school. South African Journal of ...

Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury.

Science.gov (United States)

Blanch, Peter; Gabbett, Tim J

2016-04-01

The return to sport from injury is a difficult multifactorial decision, and risk of reinjury is an important component. Most protocols for ascertaining the return to play status involve assessment of the healing status of the original injury and functional tests which have little proven predictive ability. Little attention has been paid to ascertaining whether an athlete has completed sufficient training to be prepared for competition. Recently, we have completed a series of studies in cricket, rugby league and Australian rules football that have shown that when an athlete's training and playing load for a given week (acute load) spikes above what they have been doing on average over the past 4 weeks (chronic load), they are more likely to be injured. This spike in the acute:chronic workload ratio may be from an unusual week or an ebbing of the athlete's training load over a period of time as in recuperation from injury. Our findings demonstrate a strong predictive (R(2)=0.53) polynomial relationship between acute:chronic workload ratio and injury likelihood. In the elite team setting, it is possible to quantify the loads we are expecting athletes to endure when returning to sport, so assessment of the acute:chronic workload ratio should be included in the return to play decision-making process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Predicting the intentions of women in domestic violence shelters to return to partners: does forgiveness play a role?

Science.gov (United States)

Gordon, Kristina Coop; Burton, Shacunda; Porter, Laura

2004-06-01

Recent findings indicate that college women's forgiveness of hypothetical dating violence was predictive of their hypothetical decisions to stay in the relationship. This study was designed to evaluate the role of forgiveness in women's intentions to return to their partners from a domestic violence shelter. A sample of 121 women residing in both urban and rural domestic violence shelters filled out a series of questionnaires evaluating demographic information, severity of violence, attributions for violence, psychological constraints (or investment), and forgiveness of the partner. Forgiveness was found to predict intention to return to partner over and above the other variables studied. These findings suggest that the degree to which women are willing to "move on" from the abuse and to let go of their anger toward their partners may play a significant role in their intention to remain in a relationship with their partners.

Return-to-work intervention during cancer treatment - The providers' experiences

DEFF Research Database (Denmark)

Petersen, K S; Momsen, A H; Stapelfeldt, C M

2018-01-01

To explore in-depth understanding of providers' experiences when involved in a return-to-work (RTW) intervention offered during cancer treatment. Semi-structured individual interviews and participant observations at a hospital department and two municipal job centers were carried out, including ten...... providers (physicians, nurses and social workers). A phenomenological-hermeneutic approach was applied, involving coding, identification of themes and interpretation of findings. Three major themes were identified: Treatment first, Work as an integrated component in cancer rehabilitation, and Challenges...... in bringing up work issues. Differences in providers' experiences of the RTW intervention offered to cancer patients were found: in the hospital setting RTW was a second priority, whereas in the municipality job centers it was an integrated component. Further studies are needed to investigate how and when...

Sex Differences in Time to Return-to-Play Progression After Sport-Related Concussion.

Science.gov (United States)

Stone, Sarah; Lee, Bobby; Garrison, J Craig; Blueitt, Damond; Creed, Kalyssa

2016-10-03

Recently, female sports participation has increased, and there is a tendency for women to experience more symptoms and variable presentation after sport-related concussion (SRC). The purpose of this study was to determine whether sex differences exist in time to begin a return-to-play (RTP) progression after an initial SRC. After initial SRC, female athletes (11-20 years old) would take longer to begin an RTP progression compared with age-matched male athletes. Retrospective cohort study. Level 3. A total of 579 participants (365 males [mean age, 15.0 ± 1.7 years], 214 females [mean age, 15.2 ± 1.5 years]), including middle school, high school, and collegiate athletes who participated in various sports and experienced an initial SRC were included and underwent retrospective chart review. The following information was collected: sex, age at injury, sport, history of prior concussion, date of injury, and date of initiation of RTP progression. Participants with a history of more than 1 concussion or injury sustained from non-sport-related activity were excluded. Despite American football having the greatest percentage (49.2%) of sport participation, female athletes took significantly longer to start an RTP progression after an initial SRC (29.1 ± 26.3 days) compared with age-matched male athletes (22.7 ± 18.3 days; P = 0.002). On average, female athletes took approximately 6 days longer to begin an RTP progression compared with age-matched male athletes. This suggests that sex differences exist between athletes, ages 11 to 20 years, with regard to initiation of an RTP progression after SRC. Female athletes may take longer to recover after an SRC, and therefore, may take longer to return to sport. Sex should be considered as part of the clinical decision-making process when determining plan of care for this population. © 2016 The Author(s).

Groin Injuries (Athletic Pubalgia) and Return to Play.

Science.gov (United States)

Elattar, Osama; Choi, Ho-Rim; Dills, Vickie D; Busconi, Brian

2016-07-01

Groin pain is a common entity in athletes involved in sports that require acute cutting, pivoting, or kicking such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. It is considered an overuse injury predisposing to disruption of the rectus tendon insertion to the pubis and weakness of the posterior inguinal wall without a clinically detectable hernia. These patients often require surgical therapy after failure of nonoperative measures. A variety of surgical options have been used, and most patients improve and return to high-level competition. PubMed databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms groin pain, sports hernia, athletic pubalgia, adductor strain, osteitis pubis, stress fractures, femoroacetabular impingement, and labral tears. Clinical review. Level 4. Athletic pubalgia is an overuse injury involving a weakness in the rectus abdominis insertion or posterior inguinal wall of the lower abdomen caused by acute or repetitive injury of the structure. A variety of surgical options have been reported with successful outcomes, with high rates of return to the sport in the majority of cases. © 2016 The Author(s).

Return-to-Play and Performance Outcomes of Professional Athletes in North America After Hip Arthroscopy From 1999 to 2016.

Science.gov (United States)

Schallmo, Michael S; Fitzpatrick, Thomas H; Yancey, Hunter B; Marquez-Lara, Alejandro; Luo, T David; Stubbs, Allston J

2018-05-01

The effect of hip arthroscopy on athletic performance compared with preinjury levels for professional athletes in different sports remains unknown. In addition, while return rates have been reported for professional baseball, football, and hockey players, return rates have not been reported for professional basketball players. Professional athletes in 4 major North American sports would be able to return to their sport and preoperative level of performance at a high rate after arthroscopic hip surgery. Descriptive epidemiology study. Major League Baseball (MLB), National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL) athletes who underwent hip arthroscopy were identified through a previously reported protocol based on public sources. Successful return to play (RTP) was defined as returning for at least 1 professional regular season game after surgery. Performance scores were calculated by use of previously established scoring systems. Each player served as his own control, with the season prior to surgery defined as baseline. To make comparisons across sports, the authors adjusted for expected season and career length differences between sports and calculated percentage changes in performance. The authors identified 227 procedures performed on 180 professional athletes between 1999 and 2016. Successful RTP was achieved in 84.6% (192/227) of the procedures. Compared with all other athletes, NBA athletes returned at a similar rate (85.7%, P ≥ .999). NFL offensive linemen returned at a significantly lower rate than all other athletes (61.1%, P = .010). NHL athletes returned at a significantly higher rate than all other athletes (91.8%, P = .048) and demonstrated significantly decreased performance during postoperative season 1 compared with baseline (-35.1%, P = .002). Lead leg surgery for MLB athletes (batting stance for hitters, pitching stance for pitchers) resulted in a 12.7% reduction in hitter performance score

Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Ivarsson A

2017-03-01

Full Text Available Andreas Ivarsson,1 Ulrika Tranaeus,2,3 Urban Johnson,1 Andreas Stenling 4 1Center of Research on Welfare, Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, 2Performance and Training Unit, The Swedish School of Sport and Health Sciences (GIH, 3Musculoskeletal & Sports Injury Epidemiology Center, IMM, Karolinska Institutet, Stockholm, 4Department of Psychology, Umeå University, Umeå, Sweden Abstract: Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP. The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence. Keywords: affective responses, rehabilitation behaviors, return to play, sport injuries

Return to rugby after brain concussion: a prospective study in 35 high level rugby players.

Science.gov (United States)

Chermann, Jean Francois; Klouche, Shahnaz; Savigny, Alexis; Lefevre, Nicolas; Herman, Serge; Bohu, Yoann

2014-12-01

Although guidelines based on expert opinions have been developed for the immediate management and return to play of athletes after a concussion, data are lacking on this issue. Evaluate a standardized management of brain concussion among rugby players to prevent the recurrence. A prospective study was performed from September 2009 to June 2012. All rugby players who had a concussion when playing rugby were included. Patients were managed by a specialized hospital team with a specific protocol developed in collaboration with the medical staff of the rugby clubs included in the study. The series included 35 rugby players, with 23 professionals and 12 high-level players, 30 men and 5 women, mean age 23.1 ± 5.5 years old. The median number of previous concussions was 2 (0-30) episodes. According to the Cantu concussion severity classification, 3 athletes were grade 1, 12 were grade 2 and 20 were grade 3. None of the injured athletes was lost to follow-up. The primary endpoint was the occurrence of a new concussion within 3 months after the first in patients who returned to rugby. Thirty-three patients returned to rugby after a mean 22.1 ± 10 days. The recurrence rate within 3 months was 2/33 (6.1%). The median delay before returning to rugby was 21 (7-45) days. Factors associated with a delayed return to play were young age, initial loss of consciousness, severity Cantu grade 3 and post-concussive syndrome of more than 5 days. Analysis of two failures showed that the initial injury was grade 3 and that both were professional athletes and had a history of concussion. This prospective study validated the study protocol for the management of concussion in rugby players.

Patient satisfaction as a predictor of return-to-provider behavior: analysis and assessment of financial implications.

Science.gov (United States)

Garman, Andrew N; Garcia, Joanne; Hargreaves, Marcia

2004-01-01

Although customer loyalty is frequently cited as a benefit of patient satisfaction, an empirical link between the two has not, to our knowledge, ever been statistically established in a hospital setting. The goal of the present study was to evaluate the relationship between self-reported patient satisfaction measures and subsequent return to the provider for care at a large academic medical center. Data from all adult medical patients responding to a patient satisfaction survey distributed by a large midwestern academic medical center during fiscal year 1997 (n = 1485) were analyzed. Response patterns were examined as they related to whether patients returned to the provider during the subsequent 2-year period. Analyses suggested that return-to-provider was associated with only a minority of the satisfaction items (approx. 11%). All items showing a significant relationship measured perceptions of how well physicians and nurses attended to, and provided information to, patients and their families. Although the size of these relationships was generally small, the estimated financial implications are substantial. Other implications of these findings for planning effective service improvement initiatives as well as improving patient survey design are discussed.

Institutional Venture Capital for the Space Industry: Providing Risk Capital for Space Companies that Provide Investor Returns

Science.gov (United States)

Moore, Roscoe M., III

2002-01-01

provided by an institution. Those institutions tend to be Banks, Pension Funds, Insurance Funds, Corporations, and other incorporated entities that are obligated to earn a return on their invested capital. These institutions invest in a venture capital firm for the sole purpose of getting their money back with a healthy profit - within a set period of time. The venture capital firm is responsible for investing in and managing companies whose risk and return are higher than other less risky classes of investment. The venture capital firm's primary skill is its ability to manage the high risk of its venture investments while maintaining the high return potential of its venture investments. to businesses for the purpose of providing the above-mentioned Institutions a substantial return on their invested capital. Institutional Venture Capital for the Space Industry cannot be provided to projects or companies whose philosophy or intention is not to increase shareholder equity value within a set time period. efficiently when tied up in companies that intend to spend billions of dollars before the first dollar of revenue is generated. If 2 billion dollars of venture capital is invested in the equity of a Space Company for a minority equity position, then that Space Company must build that minority shareholder's equity value to a minimum investment return of 4 to 8 billion dollars. There are not many start-up companies that are able to reach public market equity valuations in the tens of billions of dollars within reasonable time horizons. Foundations, Manufacturers, and Strategic Investors can invest in projects that cannot realistically provide a substantial return on their equity to their investors within a reasonable period (5-7 years) of time. Venture Capitalists have to make money. Venture capitalists have made money on Satellite Television, Satellite Radio, Fixed Satellite Services, and other businesses. Venture capitalists have not made money on stand

Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers

NARCIS (Netherlands)

Spiegel, B. M. R.; Farid, M.; van Oijen, M. G. H.; Laine, L.; Howden, C. W.; Esrailian, E.

2009-01-01

Although 'best practice' guidelines for dyspepsia management have been disseminated, it remains unclear whether providers adhere to these guidelines. To compare adherence to 'best practice' guidelines among dyspepsia experts, community gastroenterologists and primary-care providers (PCPs). We

Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers.

NARCIS (Netherlands)

Spiegel, B.M.; Farid, M.; Oijen, M.G.H. van; Laine, L.; Howden, C.W.; Esrailian, E.

2009-01-01

BACKGROUND: Although 'best practice' guidelines for dyspepsia management have been disseminated, it remains unclear whether providers adhere to these guidelines. AIM: To compare adherence to 'best practice' guidelines among dyspepsia experts, community gastroenterologists and primary-care providers

Collaborating with Parents to Establish Behavioral Goals in Child-Centered Play Therapy

Science.gov (United States)

Post, Phyllis B.; Ceballos, Peggy L.; Penn, Saundra L.

2012-01-01

The purpose of this article is to provide specific guidelines for child-centered play therapists to set behavioral outcome goals to effectively work with families and to meet the demands for accountability in the managed care environment. The child-centered play therapy orientation is the most widely practiced approach among play therapists who…

Epidemiology of Sports-Related Concussions in National Collegiate Athletic Association Athletes From 2009-2010 to 2013-2014: Symptom Prevalence, Symptom Resolution Time, and Return-to-Play Time.

Science.gov (United States)

Wasserman, Erin B; Kerr, Zachary Y; Zuckerman, Scott L; Covassin, Tracey

2016-01-01

Limited data exist among collegiate student-athletes on the epidemiology of sports-related concussion (SRC) outcomes, such as symptoms, symptom resolution time, and return-to-play time. This study used the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) to describe the epidemiology of SRC outcomes in 25 collegiate sports. Descriptive epidemiology study. SRC data from the NCAA ISP during the 2009-2010 to 2013-2014 academic years were analyzed regarding symptoms, time to resolution of symptoms, and time to return to play. Findings were also stratified by sex in sex-comparable sports (ie, ice hockey, soccer, basketball, lacrosse, baseball/softball) and whether SRCs were reported as recurrent. Of the 1670 concussions reported during the 2009-2010 to 2013-2014 academic years, an average (±SD) of 5.29 ± 2.94 concussion symptoms were reported, with the most common being headache (92.2%) and dizziness (68.9%). Most concussions had symptoms resolve within 1 week (60.1%); however, 6.2% had a symptom resolution time of over 4 weeks. Additionally, 8.9% of concussions required over 4 weeks before return to play. The proportion of SRCs that required at least 1 week before return to play increased from 42.7% in 2009-2010 to 70.2% in 2013-2014 (linear trend, P sports analyses, the average number of symptoms and symptom resolution time did not differ by sex. However, a larger proportion of concussions in male athletes included amnesia and disorientation; a larger proportion of concussions in female athletes included headache, excess drowsiness, and nausea/vomiting. A total of 151 SRCs (9.0%) were reported as recurrent. The average number of symptoms reported with recurrent SRCs (5.99 ± 3.43) was greater than that of nonrecurrent SRCs (5.22 ± 2.88; P = .01). A greater proportion of recurrent SRCs also resulted in a long symptom resolution time (14.6% vs 5.4%, respectively; P time (21.2% vs 7.7%, respectively; P time may indicate changing

Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre.

Science.gov (United States)

Barnes, Emily R; Theeke, Laurie A; Mallow, Jennifer

2015-04-01

Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. © 2015 John Wiley & Sons, Ltd.

What's in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use.

Science.gov (United States)

Hung, Dorothy Y; Leidig, Robynn; Shelley, Donna R

2014-01-01

Organizational culture is an important but underinvestigated feature of the work environment that can impact provider behavior, including adherence to clinical practice guidelines. There is substantial evidence that physician assistance to smokers can produce significant reductions in tobacco use. However, this evidence has not been well translated into practice, as only a small proportion of smokers receive recommended treatment during medical visits. This study examines organizational culture as a contextual feature of primary care clinics and its impact on adherence to evidence-based guidelines for treating tobacco use. Cross-sectional survey data were collected from 500 primary care providers in 60 community clinics located in New York City. Relationships between provider adherence to "5A" clinical guidelines, as recommended by the U.S. Public Health Service, and both provider and organizational covariates were described. We used hierarchical linear modeling to examine the associations between clinic culture and provider treatment patterns. Providers in clinics with stronger "group/clan," "hierarchical," and "rational" culture types, as compared with a "developmental" culture, reported greater adherence to 5A guidelines (p organizational culture can influence provider adherence to cessation treatment guidelines, even when controlling for other factors known to affect practice patterns. Specifically, cultures that emphasize human resources and performance standards are conducive to integrating 5A guidelines into routine practice. Understanding the role of organizational culture enables healthcare managers and practitioners to be strategic when implementing, and also sustaining, use of evidence-based guidelines.

Does well maintained graft provide consistent return to play after medial ulnar collateral ligament reconstruction of the elbow joint in elite baseball players?

Science.gov (United States)

Park, Jin-Young; Oh, Kyung-Soo; Bahng, Seung-Chul; Chung, Seok-Won; Choi, Jin-Ho

2014-06-01

Several studies have reported the clinical outcomes of medial ulnar collateral ligament (MUCL) reconstruction of the elbow joint in throwing athletes, including the rate of return to sports. However, little has been known about the imaging outcomes after MUCL reconstruction. The aim of this study is to report the clinical and imaging outcomes after MUCL reconstruction using figure of eight fashion in the elite and professional baseball players. This study included 17 baseball players, who underwent MUCL reconstruction between July 2007 and May 2010. The average follow-up period was 48.6 months. Imaging assessment consisted of preoperative plain and stress radiographs, magnetic resonance imaging, and postoperative serial ultrasonography. The clinical assessments were composed of visual analogue scale (VAS) for pain, range of motion, and the Conway scale. The mean VAS score was 6.4 (range, 3 to 8) preoperatively and 2.2 (range, 0 to 4) postoperatively (p returned to sports at the same or higher level compared to preinjury. Serial ultrasonography revealed well-maintained grafts at 3 and 12 months in all of the players. Five out of 17 players showed decreased echogenecity in the common flexor tendon at 3 months, which was considered as remaining tissue swelling and resolved completely at 12 months. All grafts are well-maintained until 12-months based on the ultrasonographic findings, although only 53% of the players returned to preinjury level.

Analyzing traffic source impact on returning visitors ratio in information provider website

Science.gov (United States)

Prasetio, A.; Sari, P. K.; Sharif, O. O.; Sofyan, E.

2016-04-01

Web site performance, especially returning visitor is an important metric for an information provider web site. Since high returning visitor is a good indication of a web site’s visitor loyalty, it is important to find a way to improve this metric. This research investigated if there is any difference on returning visitor metric among three web traffic sources namely direct, referral and search. Monthly returning visitor and total visitor from each source is retrieved from Google Analytics tools and then calculated to measure returning visitor ratio. The period of data observation is from July 2012 to June 2015 resulting in a total of 108 samples. These data then analysed using One-Way Analysis of Variance (ANOVA) to address our research question. The results showed that different traffic source has significantly different returning visitor ratio especially between referral traffic source and the other two traffic sources. On the other hand, this research did not find any significant difference between returning visitor ratio from direct and search traffic sources. The owner of the web site can focus to multiply referral links from other relevant sites.

Time-bound product returns and optimal order quantities for mass merchandisers

Science.gov (United States)

Yu, Min-Chun; Goh, Mark

2012-01-01

The return guidelines for a mass merchandiser usually entail a grace period, a markdown on the original price and the condition of the returned items. This research utilises eight scenarios formed from the variation of possible return guidelines to model the cost functions of single-product categories for a typical mass merchandiser. Models for the eight scenarios are developed and solved with the objective of maximising the expected profit so as to obtain closed form solutions for the associated optimal order quantity. An illustrative example and sensitivity analysis are provided to demonstrate the applicability of the model. Our results show that merchandisers who allow for returns within a time window, albeit with a penalty cost imposed and the returned products being recoverable, should plan for larger order amounts as such products do not affect the business. Similarly, the merchandisers who allow for returns beyond a grace period and without any penalty charges, but where the returned products are irrecoverable, should manage their stocks in this category more judiciously by ordering as little as possible so as to limit the number of returns and carefully consider the effects of their customer satisfaction-guaranteed policies, if any.

A Qualitative Investigation of Return to Sport After Arthroscopic Bankart Repair: Beyond Stability.

Science.gov (United States)

Tjong, Vehniah K; Devitt, Brian M; Murnaghan, M Lucas; Ogilvie-Harris, Darrell J; Theodoropoulos, John S

2015-08-01

Arthroscopic shoulder stabilization is known to have excellent functional results, but many patients do not return to their preinjury level of sport, with return to play rates reported between 48% and 100% despite good outcome scores. To understand specific subjective psychosocial factors influencing a patient's decision to return to sport after arthroscopic shoulder stabilization. Case series; Level of evidence, 4. Semistructured qualitative interviews were conducted with patients aged 18 to 40 years who had undergone primary arthroscopic shoulder stabilization and had a minimum 2-year follow-up. All patients participated in sport before surgery without any further revision operations or shoulder injuries. Qualitative data analysis was performed in accordance with the Strauss and Corbin theory to derive codes, categories, and themes. Preinjury and current sport participation was defined by type, level of competition, and the Brophy/Marx shoulder activity score. Patient-reported pain and shoulder function were also obtained. A total of 25 patients were interviewed, revealing that fear of reinjury, shifts in priority, mood, social support, and self-motivation were found to greatly influence the decision to return to sport both in patients who had and had not returned to their preinjury level of play. Patients also described fear of sporting incompetence, self-awareness issues, recommendations from physical therapists, and degree of confidence as less common considerations affecting their return to sport. In spite of excellent functional outcomes, extrinsic and intrinsic factors such as competing interests, kinesiophobia, age, and internal stressors and motivators can have a major effect on a patient's decision to return to sport after arthroscopic shoulder stabilization. The qualitative methods used in this study provide a unique patient-derived perspective into postoperative recovery and highlight the necessity to recognize and address subjective and psychosocial

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress? A one-year follow-up study.

Science.gov (United States)

Ladegaard, Yun; Skakon, Janne; Elrond, Andreas Friis; Netterstrøm, Bo

2017-08-28

To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors. Semi-structured interviews with 15 line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed. Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process. Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment. Implication for rehabilitation Organizations should aim to provide support for line managers handling the return to work process. Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process. Research-based knowledge and guidelines on work-related stress and return to work are essential. A common and formal definition of stress should be emphasized in the workplace.

Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers.

Science.gov (United States)

Spiegel, B M R; Farid, M; van Oijen, M G H; Laine, L; Howden, C W; Esrailian, E

2009-04-15

Although 'best practice' guidelines for dyspepsia management have been disseminated, it remains unclear whether providers adhere to these guidelines. To compare adherence to 'best practice' guidelines among dyspepsia experts, community gastroenterologists and primary-care providers (PCPs). We administered a vignette survey to elicit knowledge and beliefs about dyspepsia including a set of 16 best practices, to three groups: (i) dyspepsia experts; (ii) community gastroenterologists and (iii) PCPs. The expert, community gastroenterologist and PCP groups endorsed 75%, 73% and 57% of best practices respectively. Gastroenterologists were more likely to adhere with guidelines than PCPs (P guideline adherence (P = 0.04). Gastroenterologists are more likely than PCPs to comply with best practices in dyspepsia, although compliance remains incomplete in both groups. PCPs harbour more concerns regarding long-term PPI use and these concerns may affect therapeutic decision making. This suggests that best practices have not been uniformly adopted and persistent guideline-practice disconnects should be addressed.

Clinical providers' experiences with returning results from genomic sequencing: an interview study.

Science.gov (United States)

Wynn, Julia; Lewis, Katie; Amendola, Laura M; Bernhardt, Barbara A; Biswas, Sawona; Joshi, Manasi; McMullen, Carmit; Scollon, Sarah

2018-05-08

Current medical practice includes the application of genomic sequencing (GS) in clinical and research settings. Despite expanded use of this technology, the process of disclosure of genomic results to patients and research participants has not been thoroughly examined and there are no established best practices. We conducted semi-structured interviews with 21 genetic and non-genetic clinicians returning results of GS as part of the NIH funded Clinical Sequencing Exploratory Research (CSER) Consortium projects. Interviews focused on the logistics of sessions, participant/patient reactions and factors influencing them, how the sessions changed with experience, and resources and training recommended to return genomic results. The length of preparation and disclosure sessions varied depending on the type and number of results and their implications. Internal and external databases, online resources and result review meetings were used to prepare. Respondents reported that participants' reactions were variable and ranged from enthusiasm and relief to confusion and disappointment. Factors influencing reactions were types of results, expectations and health status. A recurrent challenge was managing inflated expectations about GS. Other challenges included returning multiple, unanticipated and/or uncertain results and navigating a rare diagnosis. Methods to address these challenges included traditional genetic counseling techniques and modifying practice over time in order to provide anticipatory guidance and modulate expectations. Respondents made recommendations to improve access to genomic resources and genetic referrals to prepare future providers as the uptake of GS increases in both genetic and non-genetic settings. These findings indicate that returning genomic results is similar to return of results in traditional genetic testing but is magnified by the additional complexity and potential uncertainty of the results. Managing patient expectations, initially

MRI assessment of calf injuries in Australian Football League players: findings that influence return to play

International Nuclear Information System (INIS)

Waterworth, George; Wein, Sara; Rotstein, Andrew H.; Gorelik, Alexandra

2017-01-01

Calf muscle strains have become increasingly prevalent in recent seasons of the Australian Football League (AFL) and represent a significant cause of time lost from competition. The purpose of this study was to examine the association between MRI features of calf muscle strains and games missed and to thereby identify parameters that are of prognostic value. A retrospective analysis of MRI scans of AFL players with calf strains referred to a musculoskeletal radiology clinic over a 5-year period (2008-2012) was performed. The muscle(s) and muscle component affected, the site and size of strain, and the presence of an intramuscular tendon tear or intermuscular fluid were recorded. These data were cross-referenced with whether a player missed at least one game. Imaging features of prognostic value were thus identified. Sixty-three athletes had MRI scans for calf muscle strains. Soleus strains were more common than strains of other muscles. Players with soleus strains were more likely to miss at least one game if they had multiple muscle involvement (p = 0.017), musculotendinous junction strains (p = 0.046), and deep strains (p = 0.036). In a combined analysis of gastrocnemius and soleus strains, intramuscular tendon tears were observed in a significantly greater proportion of players who missed games (p = 0.010). Amongst AFL players with calf injuries, there is an association between missing at least one game and multiple muscle involvement, musculotendinous junction strains, deep strain location, and intramuscular tendon tears. In this setting, MRI may therefore provide prognostic information to help guide return-to-play decisions. (orig.)

MRI assessment of calf injuries in Australian Football League players: findings that influence return to play

Energy Technology Data Exchange (ETDEWEB)

Waterworth, George; Wein, Sara; Rotstein, Andrew H. [Victoria House Medical Imaging, Prahran, Victoria (Australia); Gorelik, Alexandra [Royal Melbourne Hospital, University of Melbourne, Melbourne Epicentre, Parkville (Australia)

2017-03-15

Calf muscle strains have become increasingly prevalent in recent seasons of the Australian Football League (AFL) and represent a significant cause of time lost from competition. The purpose of this study was to examine the association between MRI features of calf muscle strains and games missed and to thereby identify parameters that are of prognostic value. A retrospective analysis of MRI scans of AFL players with calf strains referred to a musculoskeletal radiology clinic over a 5-year period (2008-2012) was performed. The muscle(s) and muscle component affected, the site and size of strain, and the presence of an intramuscular tendon tear or intermuscular fluid were recorded. These data were cross-referenced with whether a player missed at least one game. Imaging features of prognostic value were thus identified. Sixty-three athletes had MRI scans for calf muscle strains. Soleus strains were more common than strains of other muscles. Players with soleus strains were more likely to miss at least one game if they had multiple muscle involvement (p = 0.017), musculotendinous junction strains (p = 0.046), and deep strains (p = 0.036). In a combined analysis of gastrocnemius and soleus strains, intramuscular tendon tears were observed in a significantly greater proportion of players who missed games (p = 0.010). Amongst AFL players with calf injuries, there is an association between missing at least one game and multiple muscle involvement, musculotendinous junction strains, deep strain location, and intramuscular tendon tears. In this setting, MRI may therefore provide prognostic information to help guide return-to-play decisions. (orig.)

MRI assessment of calf injuries in Australian Football League players: findings that influence return to play.

Science.gov (United States)

Waterworth, George; Wein, Sara; Gorelik, Alexandra; Rotstein, Andrew H

2017-03-01

Calf muscle strains have become increasingly prevalent in recent seasons of the Australian Football League (AFL) and represent a significant cause of time lost from competition. The purpose of this study was to examine the association between MRI features of calf muscle strains and games missed and to thereby identify parameters that are of prognostic value. A retrospective analysis of MRI scans of AFL players with calf strains referred to a musculoskeletal radiology clinic over a 5-year period (2008-2012) was performed. The muscle(s) and muscle component affected, the site and size of strain, and the presence of an intramuscular tendon tear or intermuscular fluid were recorded. These data were cross-referenced with whether a player missed at least one game. Imaging features of prognostic value were thus identified. Sixty-three athletes had MRI scans for calf muscle strains. Soleus strains were more common than strains of other muscles. Players with soleus strains were more likely to miss at least one game if they had multiple muscle involvement (p = 0.017), musculotendinous junction strains (p = 0.046), and deep strains (p = 0.036). In a combined analysis of gastrocnemius and soleus strains, intramuscular tendon tears were observed in a significantly greater proportion of players who missed games (p = 0.010). Amongst AFL players with calf injuries, there is an association between missing at least one game and multiple muscle involvement, musculotendinous junction strains, deep strain location, and intramuscular tendon tears. In this setting, MRI may therefore provide prognostic information to help guide return-to-play decisions.

Provider Adherence to National Guidelines for Managing Hypertension in African Americans

Directory of Open Access Journals (Sweden)

Jeanette Sessoms

2015-01-01

Full Text Available Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.

26 CFR 301.6103(h)(2)-1 - Disclosure of returns and return information (including taxpayer return information) to and by...

Science.gov (United States)

2010-04-01

... administration. 301.6103(h)(2)-1 Section 301.6103(h)(2)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Returns Returns and Records § 301.6103(h)(2)-1 Disclosure of returns and return information (including..., shall, to the extent provided by section 6103(h)(2) (A), (B), and (C) and subject to the requirements of...

An observational analysis of provider adherence to AUA guidelines on the management of benign prostatic hyperplasia.

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Auffenberg, Gregory B; Gonzalez, Chris M; Wolf, J Stuart; Clemens, J Quentin; Meeks, William; McVary, Kevin T

2014-11-01

We retrospectively evaluated urologist adherence to the AUA guidelines on the management of new patients with benign prostatic hyperplasia related lower urinary tract symptoms in a large university urology group. All first time benign prostatic hyperplasia/lower urinary tract symptom visits to the urology clinic at the Northwestern Medical Faculty Foundation between January 1, 2008 and December 31, 2012 were evaluated using an institutionally managed electronic medical record data repository. Clinical documentation and orders from each encounter were assessed to determine the rate of performance of guideline measures. Approximately 1% of all results were manually reviewed in a validation process designed to determine the reliability of the electronic medical record based system. A total of 3,494 eligible encounters were evaluated in the final analysis. Provider adherence rates with the 9 measures recommended in the guidelines varied by measure from 53.0% to 92.8%. The rate of performance of 5 not routinely recommended measures was 10.2% or less. Post-void residual and urinary flow measurement were optional measures, and were performed on 68.1% and 4.6% of new encounters respectively. Manual validation revealed the electronic medical record data extraction was concordant with manual review in 96.7% of cases (95% CI 94.8-98.5). Using electronic medical record based data extraction techniques, we reliably document a baseline adherence rate with AUA guidelines on the management of benign prostatic hyperplasia. Establishing this benchmark will be important for future investigation into patient outcomes related to guideline adherence and into methods for improving provider adherence. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Communication and collaboration among return-to-work stakeholders.

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Russell, Elizabeth; Kosny, Agnieszka

2018-05-17

Workers who are injured or become ill on the job are best able to return-to-work when stakeholders involved in their case collaborate and communicate. This study examined health care providers' and case managers' engagement in rehabilitation and return-to-work following workplace injury or illness. In-depth interviews were conducted with 97 health care providers and 34 case managers in four Canadian provinces about their experiences facilitating rehabilitation and return-to-work, and interacting with system stakeholders. A qualitative thematic content analysis demonstrated two key findings. Firstly, stakeholders were challenged to collaborate as a result of: barriers to interdisciplinary and cross-professional communication; philosophical differences about the timing and appropriateness of return-to-work; and confusion among health care providers about the workers' compensation system. Secondly, these challenges adversely affected the co-ordination of patient care, and consequentially, injured workers often became information conduits, and effective and timely treatment and return-to-work was sometimes negatively impacted. Communication challenges between health care providers and case managers may negatively impact patient care and alienate treating health care providers. Discussion about role clarification, the appropriateness of early return-to-work, how paperwork shapes health care providers' role expectations, and strengthened inter-professional communication are considered. Implications for Rehabilitation Administrative and conceptual barriers in workers' compensation systems challenge collaboration and communication between health care providers and case managers. Injured workers may become conduits of incorrect information, resulting in adversarial relationships, overturned health care providers' recommendations, and their disengagement from rehabilitation and return-to-work. Stakeholders should clarify the role of health care providers during

Occupational health care return-to-work practices for workers with job burnout.

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Kärkkäinen, Riitta; Saaranen, Terhi; Räsänen, Kimmo

2018-02-23

Occupational health care supports return to work in cases of burnout; however, there is little research on return-to-work practices. To describe occupational health care return-to-work practices for workers with burnout and to identify potential for the development of the practices. Open-ended interviews and essays were used to collect data from 25 occupational health care professionals. A qualitative content analysis method was used. Occupational health care was involved in the return-to-work support in the off-work, work re-entry and maintenance phases during the return-to-work process. However, occupational health care had no influence in the advancement phase. The key return-to-work actions were: (i) defining burnout, (ii) supporting disengagement from work, (iii) supporting recovery, (iv) determining the return-to-work goal, (v) supporting re-engagement with work, (vi) monitoring the job-person match, (vii) re-evaluating the return-to-work goal, (viii) supporting the maintenance of the achieved return-to-work goal, and, where appropriate, (ix) supporting an alternative return-to-work goal. There were varied return-to-work practices among the occupational health care centers evaluated. The occupational health care return-to-work practices for workers with burnout are described with recommendations to further develop common practice guidelines.

Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines.

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Rath, Ehud; Sharfman, Zachary T; Paret, Matan; Amar, Eyal; Drexler, Michael; Bonin, Nicolas

2017-01-01

The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3-8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions.

Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana.

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Amoakoh-Coleman, Mary; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K

2016-09-21

Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment. Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8-54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities. Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.

Return to sports participation after articular cartilage repair in the knee: scientific evidence.

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Mithoefer, Kai; Hambly, Karen; Della Villa, Stefano; Silvers, Holly; Mandelbaum, Bert R

2009-11-01

Articular cartilage injury in the athlete's knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after articular cartilage repair in the knee. Systematic analysis of athletic participation after articular cartilage repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with articular cartilage injury of the knee. Systematic review. A comprehensive literature review of original studies was performed to provide information about athletic participation after articular cartilage repair. The athlete's ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time. Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the cartilage repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete's age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology. Articular cartilage repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the

Are Returns to Education on the Decline in Venezuela and Does Mission Sucre Have a Role to Play?

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Gonzalez, Naihobe; Oyelere, Ruth Uwaifo

2011-01-01

Anecdotal evidence points to a falling standard of living for the educated in Venezuela. During this same period, President Hugo Chavez implemented several education reforms. We focus on a major university education reform known as Mission Sucre and its potential impact on returns to university education. First, we show that returns to education…

Medical Malpractice Implications of Clinical Practice Guidelines.

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Ruhl, Douglas S; Siegal, Gil

2017-08-01

Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

76 FR 22611 - Specified Tax Return Preparers Required To File Individual Income Tax Returns Using Magnetic...

Science.gov (United States)

2011-04-22

... Specified Tax Return Preparers Required To File Individual Income Tax Returns Using Magnetic Media... Register on Wednesday, March 30, 2011 (76 FR 17521) providing guidance to specified tax return preparers who prepare and file individual income tax returns using magnetic media pursuant to section 6011(e)(3...

Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

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Roberts, James R.; McCurdy, Leyla Erk

2005-01-01

These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

Unhappy families: using tabletop games as a technology to understand play in education

Directory of Open Access Journals (Sweden)

John Lean

2018-05-01

Full Text Available In this article, we argue that tabletop games provide a helpful means of rethinking the affordances of digital games in pedagogy. We argue that tabletop games offer a distinctive technology from digital games in exploring the idea of play as experience, providing a sociable, accessible and tactile platform that can easily be adapted by players to suit their needs. At a workshop session at an international conference on play in education, we used tabletop games to enable discussion and observation of play. This workshop suggested that, rather than a singular definition, tabletop play means different things to different people, and what is ‘counted as’ play depends upon both individual and group interactions. Building upon this discussion, in this article, we return to both tabletop and digital games to discuss the idea of play as experience, especially with regard to the use of technology in educational settings, and how games might be seen as less ‘predictable’ than other technologies. We hope that this discussion provides future inspiration to other scholars who are considering the use of tabletop games in both pedagogical and technological research.

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial.

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Amemori, Masamitsu; Korhonen, Tellervo; Kinnunen, Taru; Michie, Susan; Murtomaa, Heikki

2011-02-14

Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial

Directory of Open Access Journals (Sweden)

Michie Susan

2011-02-01

Full Text Available Abstract Background Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster

Significance of T2 Hyperintensity on Magnetic Resonance Imaging After Cervical Cord Injury and Return to Play in Professional Athletes.

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Tempel, Zachary J; Bost, Jeffrey W; Norwig, John A; Maroon, Joseph C

2015-07-01

Cervical cord magnetic resonance imaging (MRI) T2 hyperintensity is used as evidence of cord trauma in the evaluation and management of athletes in contact sports. The long-term pathophysiologic and prognostic value of this finding is poorly understood, especially in return to play (RTP). To examine the significance of T2 hyperintensity in the cervical spinal cord of professional athletes. Retrospective review of MRI T2 hyperintensity findings between 2007 and 2014 in 5 professional athletes. Pertinent examination and demographics, including mechanism of injury, surgical intervention, radiographs, MRI studies, long-term outcomes, and RTP recommendations were collected. Four National Football League players and 1 professional wrestler had prior traumatic neurapraxia that at the time of initial consultation had resolved. MRIs showed congenitally small cervical canal (1) and multilevel spondylosis/stenosis/disc herniation (4) along with focal cord T2 hyperintensity (5). The signal abnormalities were at C3/C4 (3), C4 mid-vertebral body (1), and C5/C6 (1). Four athletes had single-level anterior cervical discectomy and fusion, and 1 was nonoperative. Serial MRI imaging at 3 months after surgery showed hyperintensity partially resolved (4) and unchanged (1), and at 9-months 3 of the 5 completely resolved. Based on the author's RTP criteria, 4 of 5 were released to return to their sport. Clearance for RTP preceded complete resolution of MRI T2 hyperintensity in 3 of 4 athletes. The 2 athletes that have returned to profession sport have not had any additional episodes of neurapraxia or any cervical spine-related complications. MRI T2 hyperintensity in contact sport athletes who are symptom-free with normal examination and no evidence of spinal instability may not be a contraindication to RTP. Additional observations are needed to confirm this observation.

Screening for non-alcoholic fatty liver disease in children: do guidelines provide enough guidance?

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Koot, B G P; Nobili, V

2017-09-01

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the industrialized world in children. Its high prevalence and important health risks make NAFLD highly suitable for screening. In practice, screening is widely, albeit not consistently, performed. To review the recommendations on screening for NAFLD in children. Recommendations on screening were reviewed from major paediatric obesity guidelines and NAFLD guidelines. A literature overview is provided on open questions and controversies. Screening for NAFLD is advocated in all obesity and most NAFLD guidelines. Guidelines are not uniform in whom to screen, and most guidelines do not specify how screening should be performed in practice. Screening for NAFLD remains controversial, due to lack of a highly accurate screening tool, limited knowledge to predict the natural course of NAFLD and limited data on its cost effectiveness. Guidelines provide little guidance on how screening should be performed. Screening for NAFLD remains controversial because not all conditions for screening are fully met. Consensus is needed on the optimal use of currently available screening tools. Research should focus on new accurate screening tool, the natural history of NAFLD and the cost effectiveness of different screening strategies in children. © 2017 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

[Returning to work after an acute coronary syndrome: When waiting is wasting].

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Latil, F; Iliou, M C; Boileau, C; Pietri, J X; Lechien, C; Ha-Vinh, P; Guimond, C

2017-04-01

Return to work (RTW) after acute coronary syndrome (ACS) is an important issue for the patient's future. The study aim was to determine whether RTW practice complies with guidelines or is delayed by failure in patient management. We analysed the factors influencing RTW beyond the 90-day period recommended by guidelines. We conducted a survey of 216 self-employed workers admitted to the hospital for ACS using self-report questionnaires and medical examination. Factors influencing RTW, occupational and cardiac features, and recall and source of medical information were investigated. Ninety-three of 216 patients did not return to work by 90 days, despite good cardiac performance in 30 cases (32 %). The mean sick leave duration was 93.3±103.7 days. Advice concerning return to work was completely missing for 44 % of patients. Cardiac performance was independent of sick leave duration, but was correlated with the likelihood of RTW (Pwork-related information. Recall of work-related information was better among patients admitted to a rehabilitation facility (65 %) compared to those who did not receive rehabilitation (Pperformance within 2 months after ACS. Patient management should also include cardiac rehabilitation or therapeutic education toward improving information recall. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Inactive nurses in Taiwan: human capital, intention to return to hospital nursing, and incentives for returning.

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Yu, Hsing-Yi; Tang, Fu-In; Chen, I-Ju; Yin, Teresa J C; Chen, Chu-Chieh; Yu, Shu

2016-04-01

To investigate inactive nurses' human capital, intention to return to hospital nursing and incentives for returning. Few studies have discussed the loss of human capital with regard to inactive nurses and how to attract them to return to clinical work. Systematic random sampling was used, with 328 subjects completing the mailed questionnaires, resulting in a response rate of 25.4%. Inactive nurses not only had moderate to high human capital (average years of nursing experience was 10.29, with moderate to high levels of nursing professional commitment and nursing competence) and were young. Forty-three percent of subjects reported intending to return to hospital nursing. Sufficient nurse staffing, greater safety in the working environment, and re-entry preparation programmes were incentives for returning. Recruiting inactive nurses back to hospital work is vital and feasible as inactive nurses had a moderate to high degree of human capital. The most feasible way is offering reasonable working conditions, in particular, providing sufficient staffing, a safe working environment and re-entry preparation programmes. The findings confirm the human capital of inactive nurses and provide concrete directions for nursing managers to follow when recruiting inactive nurses to hospital nursing. © 2015 John Wiley & Sons Ltd.

Guidelines prescribed by general practitioners to patients with acute ...

African Journals Online (AJOL)

The aim of this study was to investigate the guidelines prescribed by general practitioners (GPs) to patients with acute low back pain (ALBP) regarding 'return to work'. Methods: A systematic sample of 212 GPs, selected from a list supplied by the Health Professions Council of South Africa (HPCSA), was selected to complete ...

[Organising a successful return home].

Science.gov (United States)

Mézière, Anthony

Discharge from hospital is a major component of the quality and efficiency of the healthcare system. The failures of the return home of elderly people testify to the difficulties of applying guidelines in the area of hospital discharge. The action plan decided in the hospital for a successful return home can be jeopardised for personal, relational, functional and structural reasons originating from the different players involved in the hospital discharge. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Guidelines for Guidelines: Are They Up to the Task? A Comparative Assessment of Clinical Practice Guideline Development Handbooks

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Ansari, Shabnam; Rashidian, Arash

2012-01-01

Objectives We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. Methods We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as ‘necessary’ tasks. Result Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks’ weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. Discussion Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings

A qualitative study investigating the barriers to returning to work for breastfeeding mothers in Ireland.

Science.gov (United States)

Desmond, Deirdre; Meaney, Sarah

2016-01-01

The World Health Organization (WHO) recommends that mothers exclusively breastfeed for the first 6 months of an infant's life. In Ireland, currently paid maternity leave is 26 weeks and the expectant mother is required by law to finish work 2 weeks before her expected delivery date. Mothers wishing to exclusively breastfeed for 6 months or longer find themselves having to take holiday leave or unpaid leave from work in order to meet the WHO's guidelines. The aim of this study is to explore women's experiences of breastfeeding after their return to work in Ireland. This study was carried out utilizing a qualitative design. Initially 25 women who returned to the workforce while continuing to breastfeed were contacted, 16 women returned consent forms and were subsequently contacted to take part in an interview. Interviews were recorded and transcribed verbatim and thematic analysis was employed to establish recurring patterns and themes throughout the interviews. Women noted that cultural attitudes in Ireland coupled with inadequate or inconsistent advice from health professionals posed the biggest challenge they had to overcome in order to achieve to 6 months exclusive breastfeeding. The findings of this study illustrate that mothers with the desire to continue to breastfeed after their return to work did so with some difficulty. Many did not disclose to their employers that they were breastfeeding and did not make enquiries about being facilitated to continue to breastfeed after their return to the workplace. The perceived lack of support from their employers as well as embarrassment about their breastfeeding status meant many women concealed that they were breastfeeding after their return to the workplace. While it has been suggested that WHO guidelines for exclusive breastfeeding for 6 months may be unattainable for many women due to work commitments, a different problem exists in Ireland. Mothers struggle to overcome cultural and societal obstacles coupled

Guidelines for the Detection and Management of Lead Poisoning for Physicians and Health Care Providers.

Science.gov (United States)

Illinois State Dept. of Public Health, Springfield.

These Illinois guidelines provide information on the medical management and treatment of children with lead poisoning, based on Federal guidelines (revised in 1991) for determining lead poisoning at lower levels. The guidelines outline the effects of lead poisoning, sources of lead, estimated incidence of lead poisoning in Illinois, screening…

Rehabilitation after labral repair and femoroacetabular decompression: criteria-based progression through the return to sport phase.

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Wahoff, Michael; Dischiavi, Steve; Hodge, Jenna; Pharez, Joseph D

2014-11-01

Rehabilitation following hip arthroscopy for femoroacetabular impingement (FAI) and labral-chondral dysfunction has evolved rapidly over the past 15 years. There have been multiple commentaries published on rehabilitation following hip arthroscopy without any published standardized objective criteria to address the advancement of the athlete through the phases of rehabilitation. The purpose of this clinical commentary is to describe a criteria driven algorithm for safe integration and return to sport rehabilitation following hip arthroscopy. The criteria based program allows for individuality of the athlete while providing guidance from early post-operative phases through late return to sport phases of rehabilitation. Emphasis is placed on the minimum criteria to advance including healing restraints, patient reported outcomes, range of motion, core and hip stability, postural control, symmetry with functional tasks and gait, strength, power, endurance, agility, and sport-specific tasks. Evidence to support the criteria will be offered as available. Despite limitations, this clinical commentary will offer a guideline for safe return to sport for the athlete while identifying areas for further investigation. 5.

Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres.

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Nikolopoulos, Hara; Farmer, Anna; Berry, Tanya R; McCargar, Linda J; Mager, Diana R

2015-04-01

In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination. © 2012 Blackwell Publishing Ltd.

Hamstring Injuries in Professional Soccer Players: Extent of MRI-Detected Edema and the Time to Return to Play.

Science.gov (United States)

Crema, Michel D; Godoy, Ivan R B; Abdalla, Rene J; de Aquino, Jose Sanchez; Ingham, Sheila J McNeill; Skaf, Abdalla Y

Discrepancies exist in the literature regarding the association of the extent of injuries assessed on magnetic resonance imaging (MRI) with recovery times. MRI-detected edema in grade 1 hamstring injuries does not affect the return to play (RTP). Retrospective cohort study. Level 4. Grade 1 hamstring injuries from 22 professional soccer players were retrospectively reviewed. The extent of edema-like changes on fluid-sensitive sequences from 1.5-T MRI were evaluated using craniocaudal length, percentage of cross-sectional area, and volume. The time needed to RTP was the outcome. Negative binomial regression analysis tested the measurements of MRI-detected edema-like changes as prognostic factors. The mean craniocaudal length was 7.6 cm (SD, 4.9 cm; range, 0.9-19.1 cm), the mean percentage of cross-sectional area was 23.6% (SD, 20%; range, 4.4%-89.6%), and the mean volume was 33.1 cm 3 (SD, 42.6 cm 3 ; range, 1.1-161.3 cm 3 ). The mean time needed to RTP was 13.6 days (SD, 8.9 days; range, 3-32 days). None of the parameters of extent was associated with RTP. The extent of MRI edema in hamstring injuries does not have prognostic value. Measuring the extent of edema in hamstring injuries using MRI does not add prognostic value in clinical practice.

Nurses Returning to School: Motivators, Inhibitors and Job Satisfaction.

Science.gov (United States)

Harris, Patrick W; Burman, Mary E

2016-01-01

Health care employers and national nursing organizations are placing increased emphasis on nurses earning a baccalaureate degree or higher. This study examines the impact of motivators (professional and personal motivation), inhibitors (time constraints and employer discouragement), and job satisfaction on intent to return to school. Approximately half of the employed nurses in Wyoming were surveyed using a mailed questionnaire in the summer of 2013. Perceived employer discouragement and time constraints continued to play a direct role on intent to return to school regardless of nurse motivation or job satisfaction. However, motivation and job satisfaction also contributed to a nurse's intent to return to school. These results suggest that motivation and job satisfaction are significant regarding intent to return to school but can be limited by both perceived discouragement of one's employer and perceived time constraints. In order to meet the increasing demands of a better-educated nursing workforce, a shift in workplace dynamics may be warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Do not rush to return to sports after trigger finger injection.

Science.gov (United States)

Oh, Jeehae; Jo, Leechan; Lee, Jong In

2015-04-01

Trigger finger, or digital stenosing tenosynovitis, is a common hand problem. A widely accepted treatment is steroid injection into the flexor tendon sheath. This can cause rupture of the flexor tendon. However, to the best of our knowledge, there is no report on tendon rupture after a single corticosteroid injection. Moreover, there are no guidelines for patients with tendinopathy who want to return to sports after corticosteroid injection. Clinicians who perform local steroid injections for tendinopathy treatment should be aware of the possible dangers of tendon rupture and should confirm that steroids are not administrated into the tendon. Patients should also be warned about returning to sports prematurely and should be encouraged to gradually resume sports after the injection to prevent further damage. Herein, we report an unusual case of flexor digitorum profundus rupture after a single corticosteroid injection in a 57-yr-old male golfer and we also present a review of the literature.

Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making.

Science.gov (United States)

van der Horst, Nick; Backx, Fjg; Goedhart, Edwin A; Huisstede, Bionka Ma

2017-11-01

There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify RTP consultation and responsibilities after hamstring injury. The study used the Delphi procedure. The results of a systematic review were used as a starting point for the Delphi procedure. Fifty-eight experts in the field of hamstring injury management selected by 28 FIFA Medical Centres of Excellence worldwide participated. Each Delphi round consisted of a questionnaire, an analysis and an anonymised feedback report. After four Delphi rounds, with more than 83% response for each round, consensus was achieved that RTP should be defined as 'the moment a player has received criteria-based medical clearance and is mentally ready for full availability for match selection and/or full training'. The experts reached consensus on the following criteria to support the RTP decision: medical staff clearance, absence of pain on palpation, absence of pain during strength and flexibility testing, absence of pain during/after functional testing, similar hamstring flexibility, performance on field testing, and psychological readiness. It was also agreed that RTP decisions should be based on shared decision-making, primarily via consultation with the athlete, sports physician, physiotherapist, fitness trainer and team coach. The consensus regarding aspects of RTP should provide clarity and facilitate the assessment of when RTP is appropriate after hamstring injury, so as to avoid or reduce the risk of injury recurrence because of a premature RTP. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluating the Nintendo Wii for assessing return to activity readiness in youth with mild traumatic brain injury.

Science.gov (United States)

DeMatteo, Carol; Greenspoon, Dayna; Levac, Danielle; Harper, Jessica A; Rubinoff, Mandy

2014-08-01

Adolescents with mild traumatic brain injuries (MTBI) are at substantial risk for repeat injury if they return to activity too soon. Post-concussion symptoms and impaired balance are two factors that limit return to activity. Post-injury assessments that challenge activity tolerance and balance skills are needed to ensure readiness to return to activity. This cross-sectional study evaluated the Nintendo Wii as a measure of exertion (heart rate [HR], respiration rate [RR], and caloric expenditure) and balance testing for youth with MTBI in a clinical setting. Twenty-four youth with MTBI, ages 9-18, played six Wii games. The Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2) and the Community Balance and Mobility Scale (CBM) were used as balance indicators. The Wii Fit Running game demonstrated the highest caloric expenditure and HR (p = .010). Frequency counts of balance loss during Wii game play did not correlate with performance on the BOT-2 or the CBM. Type, number, and time since injury were predictive of balance performance on the CBM (p = .008). Findings provide preliminary evidence for the use of the Wii as an exertion challenge to evaluate tolerance for exercise post-concussion. Frequency count of balance loss during Wii game play, however, was not a valid measure of balance impairment post-MTBI.

Return to work and occupational physicians' management of common mental health problems--process evaluation of a randomized controlled trial

NARCIS (Netherlands)

Rebergen, David S.; Bruinvels, David J.; Bos, Chris M.; van der Beek, Allard J.; van Mechelen, Willem

2010-01-01

The aim of this study was to examine the adherence of occupational physicians (OP) to the Dutch guideline on the management of common mental health problems and its effect on return to work as part of the process evaluation of a trial comparing adherence to the guideline to care as usual. The first

Return-to-work coordination programmes for improving return to work in workers on sick leave.

Science.gov (United States)

Vogel, Nicole; Schandelmaier, Stefan; Zumbrunn, Thomas; Ebrahim, Shanil; de Boer, Wout El; Busse, Jason W; Kunz, Regina

2017-03-30

To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability. To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016. We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice. Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence. We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work

Amount of Minutes Played Does Not Contribute to Anterior Cruciate Ligament Injury in National Basketball Association Athletes.

Science.gov (United States)

Okoroha, Kelechi R; Marfo, Kojo; Meta, Fabien; Matar, Robert; Shehab, Ramsy; Thompson, Terry; Moutzouros, Vasilios; Makhni, Eric C

2017-07-01

There is limited information on the potential risk factors for sustaining an anterior cruciate ligament (ACL) tear in National Basketball Association (NBA) athletes. This study evaluated 83 NBA players who sustained an ACL injury between 1984 and 2015 to determine the influence of minutes played on injury risk. Minutes played in the injury game, during the season, and over their career were assessed, along with the ability to return to play, player efficiency rating, and playing time after return. Athletes in the NBA played significantly fewer minutes before sustaining an ACL injury (17.1 minutes) than their average minutes per game that season (23.5 minutes; PNBA competition the season following ACL injury. Players who were drafted as lottery picks (draft pick 1 to 15) or those who were starters played significantly more minutes the season following injury than those who were not (both PNBA game did not contribute to the risk of sustaining an ACL injury. Although there was a high rate of return to NBA competition the season following injury, those who were elite athletes played more minutes per game than those who were not. Athletes who returned to play sustained a decrease in player efficiency ratings compared with similar athletes without ACL injury. [Orthopedics. 2017; 40(4):e658-e662.]. Copyright 2017, SLACK Incorporated.

Return to football and long-term clinical outcomes after thumb ulnar collateral ligament suture anchor repair in collegiate athletes.

Science.gov (United States)

Werner, Brian C; Hadeed, Michael M; Lyons, Matthew L; Gluck, Joshua S; Diduch, David R; Chhabra, A Bobby

2014-10-01

To evaluate return to play after complete thumb ulnar collateral ligament (UCL) injury treated with suture anchor repair for both skill position and non-skill position collegiate football athletes and report minimum 2-year clinical outcomes in this population. For this retrospective study, inclusion criteria were complete rupture of the thumb UCL and suture anchor repair in a collegiate football athlete performed by a single surgeon who used an identical technique for all patients. Data collection included chart review, determination of return to play, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcomes. A total of 18 collegiate football athletes were identified, all of whom were evaluated for follow-up by telephone, e-mail, or regular mail at an average 6-year follow-up. Nine were skill position players; the remaining 9 played in nonskill positions. All players returned to at least the same level of play. The average QuickDASH score for the entire cohort was 1 out of 100; QuickDASH work score, 0 out of 100; and sport score, 1 out of 100. Average time to surgery for skill position players was 12 days compared with 43 for non-skill position players. Average return to play for skill position players was 7 weeks postoperatively compared with 4 weeks for non-skill position players. There was no difference in average QuickDASH overall scores or subgroup scores between cohorts. Collegiate football athletes treated for thumb UCL injuries with suture anchor repair had quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes. Skill position players had surgery sooner after injury and returned to play later than non-skill position players, with no differences in final level of play or clinical outcomes. Management of thumb UCL injuries in collegiate football athletes can be safely and effectively tailored according to the demands of the player's football position. Therapeutic IV. Copyright © 2014

Games To Play with Babies. Third Edition.

Science.gov (United States)

Silberg, Jackie

Intended for parents with infants, this book is a collection of 230 simple, fun-filled games that can be played with infants from birth to age 1 year. The book begins with guidelines for growth in motor, auditory, visual, language, cognitive, and self-concept skills from birth to 6 months and from 6 to 12 months. The remainder of the book presents…

Return to play criteria after hamstring muscle injury in professional football: a Delphi consensus study.

Science.gov (United States)

Zambaldi, Mattia; Beasley, Ian; Rushton, Alison

2017-08-01

Hamstring muscle injury (HMI) is the most common injury in professional football and has a high re-injury rate. Despite this, there are no validated criteria to support return to play (RTP) decisions. To use the Delphi method to reach expert consensus on RTP criteria after HMI in professional football. All professional football clubs in England (n=92) were invited to participate in a 3-round Delphi study. Round 1 requested a list of criteria used for RTP decisions after HMI. Responses were independently collated by 2 researchers under univocal definitions of RTP criteria. In round 2 participants rated their agreement for each RTP criterion on a 1-5 Likert Scale. In round 3 participants re-rated the criteria that had reached consensus in round 2. Descriptive statistics and Kendall's coefficient of concordance enabled interpretation of consensus. Participation rate was limited at 21.7% (n=20), while retention rate was high throughout the 3 rounds (90.0%, 85.0%, 90.0%). Round 1 identified 108 entries with varying definitions that were collated into a list of 14 RTP criteria. Rounds 2 and 3 identified 13 and 12 criteria reaching consensus, respectively. Five domains of RTP assessment were identified: functional performance, strength, flexibility, pain and player's confidence. The highest-rated criteria were in the functional performance domain, with particular importance given to sprint ability. This study defined a list of consensually agreed RTP criteria for HMI in professional football. Further work is now required to determine the validity of the identified criteria. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Online advertising and marketing claims by providers of proton beam therapy: are they guideline-based?

Science.gov (United States)

Corkum, Mark T; Liu, Wei; Palma, David A; Bauman, Glenn S; Dinniwell, Robert E; Warner, Andrew; Mishra, Mark V; Louie, Alexander V

2018-03-15

Cancer patients frequently search the Internet for treatment options, and hospital websites are seen as reliable sources of knowledge. Guidelines support the use of proton radiotherapy in specific disease sites or on clinical trials. This study aims to evaluate direct-to-consumer advertising content and claims made by proton therapy centre (PTC) websites worldwide. Operational PTC websites in English were identified through the Particle Therapy Co-Operative Group website. Data abstraction of website content was performed independently by two investigators. Eight international guidelines were consulted to determine guideline-based indications for proton radiotherapy. Univariate and multivariate logistic regression models were used to determine the characteristics of PTC websites that indicated proton radiotherapy offered greater disease control or cure rates. Forty-eight PTCs with 46 English websites were identified. 60·9% of PTC websites claimed proton therapy provided improved disease control or cure. U.S. websites listed more indications than international websites (15·5 ± 5·4 vs. 10·4 ± 5·8, p = 0·004). The most common disease sites advertised were prostate (87·0%), head and neck (87·0%) and pediatrics (82·6%), all of which were indicated in least one international guideline. Several disease sites advertised were not present in any consensus guidelines, including pancreatobiliary (52·2%), breast (50·0%), and esophageal (43·5%) cancers. Multivariate analysis found increasing number of disease sites and claiming their centre was a local or regional leader in proton radiotherapy was associated with indicating proton radiotherapy offers greater disease control or cure. Information from PTC websites often differs from recommendations found in international consensus guidelines. As online marketing information may have significant influence on patient decision-making, alignment of such information with accepted guidelines and consensus

Return-to-Work Program for Injured Workers: Factors of Successful Return to Employment.

Science.gov (United States)

Awang, Halimah; Shahabudin, Sharifah Muhairah; Mansor, Norma

2016-11-01

This study examined the factors of successful return to employment among participants in the return to work program (RTW) following work-related injury. Data were obtained from the Social Security Organization database containing 9850 injured workers who underwent RTW in 2010 to 2013. About 65% had successfully returned to employment. Significant factors of successful return include gender, employer interest, motivation, age, intervention duration, and type of injury. Male and motivated employees were more likely to return to employment compared with female and unmotivated employees, respectively. Participants from interested employers were 23.22 times more likely to return to work than those from uninterested employers, whereas participants whose intervention period exceeded 5 months were 41% less likely to return to work compared with those whose intervention period was within 3 months. Appropriate strategy and enhanced collaboration between the stakeholders would improve the proportion of successful return to employment. © 2016 APJPH.

Remote maintenance systems requirements are being developed to provide design guidelines for machine components, to define maintenance interfaces, and to quantify maintenance equipment and procedures needed

International Nuclear Information System (INIS)

Spampinato, P.T.; Tabor, M.A.

1988-01-01

Remote maintenance systems requirements are being developed to provide design guidelines for machine components, to define maintenance interfaces, and to quantify maintenance equipment and procedures needed

Guidelines for Biomarker of Food Intake Reviews (BFIRev)

DEFF Research Database (Denmark)

Praticò, Giulia; Gao, Qian; Scalbert, Augustin

2018-01-01

and that the quality of all suggested biomarkers should be systematically evaluated. In order to cover the literature on BFIs in the most appropriate and consistent manner, there is a need for appropriate guidelines on this topic. These guidelines should build upon guidelines in related areas of science while......Identification of new biomarkers of food and nutrient intake has developed fast over the past two decades and could potentially provide important new tools for compliance monitoring and dietary intake assessment in nutrition and health science. In recent years, metabolomics has played an important...... and on validating these as well as other biomarker candidates, thereby providing better tools for future studies in nutrition and health....

Return to National Basketball Association Competition Following Anterior Cruciate Ligament and Fibular Collateral Ligament Injuries: A Case Report.

Science.gov (United States)

LaPrade, Robert F; O'Brien, Luke; Kennedy, Nicholas I; Cinque, Mark E; Chahla, Jorge

2017-01-01

Numerous outcome studies regarding anterior cruciate ligament (ACL) reconstruction demonstrate the ability of athletes to return to a high level of play. However, to our knowledge, there is limited literature regarding return to play following injury to both the ACL and the fibular collateral ligament (FCL). We describe the case of a National Basketball Association (NBA) player who sustained a combined ACL and FCL knee injury and subsequently underwent surgical reconstruction of both affected ligaments. He was able to return to a preinjury level of competition at 9 months postoperatively. It is possible for athletes to return to competitive basketball and maintain a high production level following a single-staged reconstruction of both the ACL and the FCL.

Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes.

Science.gov (United States)

Toussi, Massoud; Lamy, Jean-Baptiste; Le Toumelin, Philippe; Venot, Alain

2009-06-10

Clinical guidelines carry medical evidence to the point of practice. As evidence is not always available, many guidelines do not provide recommendations for all clinical situations encountered in practice. We propose an approach for identifying knowledge gaps in guidelines and for exploring physicians' therapeutic decisions with data mining techniques to fill these knowledge gaps. We demonstrate our method by an example in the domain of type 2 diabetes. We analyzed the French national guidelines for the management of type 2 diabetes to identify clinical conditions that are not covered or those for which the guidelines do not provide recommendations. We extracted patient records corresponding to each clinical condition from a database of type 2 diabetic patients treated at Avicenne University Hospital of Bobigny, France. We explored physicians' prescriptions for each of these profiles using C5.0 decision-tree learning algorithm. We developed decision-trees for different levels of detail of the therapeutic decision, namely the type of treatment, the pharmaco-therapeutic class, the international non proprietary name, and the dose of each medication. We compared the rules generated with those added to the guidelines in a newer version, to examine their similarity. We extracted 27 rules from the analysis of a database of 463 patient records. Eleven rules were about the choice of the type of treatment and thirteen rules about the choice of the pharmaco-therapeutic class of each drug. For the choice of the international non proprietary name and the dose, we could extract only a few rules because the number of patient records was too low for these factors. The extracted rules showed similarities with those added to the newer version of the guidelines. Our method showed its usefulness for completing guidelines recommendations with rules learnt automatically from physicians' prescriptions. It could be used during the development of guidelines as a complementary source from

Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes

Directory of Open Access Journals (Sweden)

Toussi Massoud

2009-06-01

Full Text Available Abstract Background Clinical guidelines carry medical evidence to the point of practice. As evidence is not always available, many guidelines do not provide recommendations for all clinical situations encountered in practice. We propose an approach for identifying knowledge gaps in guidelines and for exploring physicians' therapeutic decisions with data mining techniques to fill these knowledge gaps. We demonstrate our method by an example in the domain of type 2 diabetes. Methods We analyzed the French national guidelines for the management of type 2 diabetes to identify clinical conditions that are not covered or those for which the guidelines do not provide recommendations. We extracted patient records corresponding to each clinical condition from a database of type 2 diabetic patients treated at Avicenne University Hospital of Bobigny, France. We explored physicians' prescriptions for each of these profiles using C5.0 decision-tree learning algorithm. We developed decision-trees for different levels of detail of the therapeutic decision, namely the type of treatment, the pharmaco-therapeutic class, the international non proprietary name, and the dose of each medication. We compared the rules generated with those added to the guidelines in a newer version, to examine their similarity. Results We extracted 27 rules from the analysis of a database of 463 patient records. Eleven rules were about the choice of the type of treatment and thirteen rules about the choice of the pharmaco-therapeutic class of each drug. For the choice of the international non proprietary name and the dose, we could extract only a few rules because the number of patient records was too low for these factors. The extracted rules showed similarities with those added to the newer version of the guidelines. Conclusion Our method showed its usefulness for completing guidelines recommendations with rules learnt automatically from physicians' prescriptions. It could be used

Librarian contributions to clinical practice guidelines.

Science.gov (United States)

Cruse, Peggy; Protzko, Shandra

2014-01-01

Librarians have become more involved in developing high quality systematic reviews. Evidence-based practice guidelines are an extension of systematic reviews and offer another significant area for librarian involvement. This column highlights opportunities and challenges for the librarian working on guideline panels and provides practical considerations for meaningful contributions to the guideline creation process.

Returns to schooling in the Portuguese economy: a reassessment

Directory of Open Access Journals (Sweden)

Maria Manuel Campos

2018-06-01

Full Text Available This paper provides an overview of the evolution of private returns to schooling in the Portuguese economy along the 1986-2013 period. We estimate the returns separately for men and women, at the mean and along the conditional wage distribution. Returns to schooling are found to be high, particularly for women, and to increase along the distribution. The magnitude of the returns increased throughout the 1986-2013 period, but particularly in the 1990s. We also provide estimates of the relative wage premium associated with specific levels of educational attainment and find that they are highest for tertiary education. In the first decades under analysis, relative wage premia associated with the 9th grade stand above those estimated for secondary education, whereas in the most recent period these differences are negligible.

The differences in physical activity levels in preschool children during free play recess and structured play recess

Directory of Open Access Journals (Sweden)

Megan L. Frank

2018-04-01

Full Text Available Background/Objective: Physical activity (PA is important in reducing childhood obesity, yet a majority of children are not meeting PA guidelines. Schools have been identified as a place to promote childhood PA. The purpose of this study was to determine the best type of physically active recess period to increase preschool-aged children's PA. Methods: PA was measured via accelerometers in preschool-aged children (n = 29 during three, 30-min recess conditions (control; structured play; free play on separate school days. Tertile splits were performed based on PA during the free play condition and children were divided into three groups: highly, moderately and least active. Results: For the aggregated sample, children were more (p ≤ 0.001 active during the free play (1282 ± 662 counts. min−1 and structured play (1416 ± 448 counts. min−1 recess versus the control condition (570 ± 460 counts. min−1 and activity was not different between the free play and structured conditions. However, children who were the most active during free play (1970 ± 647 counts·min−1 decreased (p ≤ 0.05 activity during structured play (1462 ± 535 counts·min−1, whereas children who were moderately active (1031 ± 112 counts·min−1 or the least (530 ± 239 counts·min−1 active during free play increased activity during structured play (1383 ± 345 counts·min−1 moderately active, 1313 ± 413 counts·min−1 least active. Conclusion: Providing a physically-active recess period will contribute to preschool-aged children meeting the recommended PA guidelines; however, different children may respond in a different way based upon the structure of the recess period.

Moderation in the Certificates of General Education for Adults. Guidelines for Providers.

Science.gov (United States)

Council of Adult Education, Melbourne (Australia).

This document provides guidelines for the process of moderation and verification of assessments for educators involved in adult education. As used in the education establishment in Australia, "moderation" is the process of ensuring the standardization of assessment. Through the moderation process, assessment procedures conducted in a…

Return of the pulmonary nodule: the radiologist's key role in implementing the 2015 BTS guidelines on the investigation and management of pulmonary nodules.

Science.gov (United States)

Graham, Richard N J; Baldwin, David R; Callister, Matthew E J; Gleeson, Fergus V

2016-01-01

The British Thoracic Society has published new comprehensive guidelines for the management of pulmonary nodules. These guidelines are significantly different from those previously published, as they use two malignancy prediction calculators to better characterize the risk of malignancy. There are recommendations for a higher nodule size threshold for follow-up (≥5 mm or ≥80 mm(3)) and a reduction of the follow-up period to 1 year for solid pulmonary nodules; both of these will reduce the number of follow-up CT scans. PET-CT plays a crucial role in characterization also, with an ordinal scale being recommended for reporting. Radiologists will be the key in implementing these guidelines, and routine use of volumetric image-analysis software will be required to manage patients with pulmonary nodules correctly.

Surgical reconstruction of spinal cord circuit provides functional return in humans

Directory of Open Access Journals (Sweden)

Thomas Carlstedt

2017-01-01

Full Text Available This mini review describes the current surgical strategy for restoring function after traumatic spinal nerve root avulsion in brachial or lumbosacral plexus injury in man. As this lesion is a spinal cord or central nervous injury functional return depends on spinal cord nerve cell growth within the central nervous system. Basic science, clinical research and human application has demonstrated good and useful motor function after ventral root avulsion followed by spinal cord reimplantation. Recently, sensory return could be demonstrated following spinal cord surgery bypassing the injured primary sensory neuron. Experimental data showed that most of the recovery depended on new growth reinnervating peripheral receptors. Restored sensory function and the return of spinal reflex was demonstrated by electrophysiology and functional magnetic resonance imaging of human cortex. This spinal cord surgery is a unique treatment of central nervous system injury resulting in useful functional return. Further improvements will not depend on surgical improvements. Adjuvant therapy aiming at ameliorating the activity in retinoic acid elements in dorsal root ganglion neurons could be a new therapeutic avenue in restoring spinal cord circuits after nerve root avulsion injury.

Stock Returns and Risk: Evidence from Quantile

Directory of Open Access Journals (Sweden)

Thomas C. Chiang

2012-12-01

Full Text Available This paper employs weighted least squares to examine the risk-return relation by applying high-frequency data from four major stock indexes in the US market and finds some evidence in favor of a positive relation between the mean of the excess returns and expected risk. However, by using quantile regressions, we find that the risk-return relation moves from negative to positive as the returns’ quantile increases. A positive risk-return relation is valid only in the upper quantiles. The evidence also suggests that intraday skewness plays a dominant role in explaining the variations of excess returns.

Guidelines for Posting Soil Contamination Areas

Energy Technology Data Exchange (ETDEWEB)

Mcnaughton, Michael [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Eisele, William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-02-01

All soil guidelines were determined using RESRAD, version 6.1. All offsite guidelines are based on 15 mrem/year. This dose rate is sufficiently low to protect human health and is in accordance with DOE guidance and the proposed EPA 40-CFR-196 regulations for members of the public (never promulgated). For those onsite areas where general employees (non-radiological workers) could have routine access, soil concentrations should be based on a dose rate of 30 mrem/year (approximately one-third of the onsite LANL non-radiological worker dose of 100 mrem/year). In this case, soil concentration guidelines may be obtained by doubling the 15 mrem/year guidelines. Several scenarios were developed to provide maximum flexibility for application of the guidelines. The offsite guidelines were developed using: residential scenarios for both adults and children; a construction worker scenario; a resource user (e.g., a hunter) scenario; a child playing within canyon reaches scenario, a trail using jogger within canyon reaches scenario, and a trail using hiker within canyon reaches scenario. The residential guidelines represent the lowest values from both the adult residential scenario and the child residential scenario.

A study on the effect of size and ratio of book value to market value on excessive return

Directory of Open Access Journals (Sweden)

Seyed Mohsen Tabatabaei Mozdabadi

2012-09-01

Full Text Available Stock market plays an important role on demonstrating economy direction and it provides good opportunities for people who wish to purchase a small portion of different firms' shares. In this paper, we propose an empirical study to measure the impact of the market size and the ratio of book value on market value on excessive return. The study gathers the necessary information from some of active stock shares traded on Tehran Stock Exchange over the period of 2010-2011. The proposed model of this paper uses linear regression analysis to investigate the relationship between the excessive return and other factors. The study divides the information into seven equal groups and fits the regression model using ordinary least square technique. The results indicate that there is a negative relationship between size and excessive return and a positive relationship between the ratio of BV/MV and excessive return. Although the results of both tests are positive, we have to be more cautious about what have reported on the second hypothesis.

Return to golf after spine surgery.

Science.gov (United States)

Abla, Adib A; Maroon, Joseph C; Lochhead, Richard; Sonntag, Volker K H; Maroon, Adara; Field, Melvin

2011-01-01

no published evidence indicates when patients can resume golfing after spine surgery. The objective of this study is to provide data from surveys sent to spine surgeons. a survey of North American Spine Society members was undertaken querying the suggested timing of return to golf. Of 1000 spine surgeons surveyed, 523 responded (52.3%). The timing of recommended return to golf and the reasons were questioned for college/professional athletes and avid and recreational golfers of both sexes. Responses were tallied for lumbar laminectomy, lumbar microdiscectomy, lumbar fusion, and anterior cervical discectomy with fusion. the most common recommended time for return to golf was 4-8 weeks after lumbar laminectomy and lumbar microdiscectomy, 2-3 months after anterior cervical fusion, and 6 months after lumbar fusion. The results showed a statistically significant increase in the recommended time to resume golf after lumbar fusion than after cervical fusion in all patients (p golf after spine surgery depends on many variables, including the general well-being of patients in terms of pain control and comfort when golfing. This survey serves as a guide that can assist medical practitioners in telling patients the average times recommended by surgeons across North America regarding return to golf after spine surgery.

The return to work discussion: a qualitative study of the line manager conversation about return to work and the development of an educational programme.

Science.gov (United States)

Cohen, Debbie; Allen, Joanna; Rhydderch, Melody; Aylward, Mansel

2012-07-01

To investigate the conversation between line manager and employee about return to work to inform the development of an online interactive educational programme for line managers to improve the effectiveness of their discussions. An inductive qualitative approach, using the principles of action research and motivational interviewing were adopted. The results informed the development of the educational programme for line managers. Middle grade line managers in a large public services employer in the UK. Four discussion groups were conducted over a period of 8 months. Line managers explored the challenges of the return to work interview, analysed their interactions with employees and constructed the content of an educational programme. Multiple methods were used to build engagement with participants, including video and role-play. Nine line managers were recruited across 3 business areas. Managers recognised that their conversations focused on the organisations' policies and procedures and the outcome, rather than the interaction. They recognised the strength of shifting style to shared decision-making and guidance rather than process and instruction. These communication strategies were depicted in the educational programme. The content and flow of the return to work discussion is of high importance and influences employee behaviour and return to work outcomes.

Concussion Incidence and Recurrence in Professional Australian Football Match-Play: A 14-Year Analysis

Directory of Open Access Journals (Sweden)

Nathan Gibbs

2017-01-01

Full Text Available Background. Concussion incidence rates in professional Australian football may be underreported due to the injury classification definition. A myriad of factors contribute to concussion risk; however, there is limited long-term surveillance in Australian football. This study analysed concussion in one Australian football team over an extended period. Method. Match-play concussion injuries in one team (n=116 participants were diagnosed and treated by the team physician over 14 years. Analysis of factors related to concussion including matches played, time of day and season, and return to play provided an insight into occurrence and recurrence rates. Results. 140 concussions were recorded (17.6 per 1000 player match hours. A strong relationship was evident between matches played and concussion incidence (r=0.70 and match conditions did not negatively affect the concussion rate. Whether an athlete returned to play in the same match or suffered a loss-of-consciousness concussion (p=0.84, their ensuing rate of concussion was not affected. Conclusion. Concussion in professional Australian football was related to the number of matches played. Further, neither previous incidence nor loss of consciousness affected future concussion risk. This study provides ecologically valid evidence of the concussion incidence rate in professional Australian football and has implications for the management of athletes sustaining concussion injuries.

Preoperative predictors of returning to work following primary total knee arthroplasty.

Science.gov (United States)

Styron, Joseph F; Barsoum, Wael K; Smyth, Kathleen A; Singer, Mendel E

2011-01-05

to return to work following a primary total knee arthroplasty, the patient's characteristics, particularly motivation, play a more important role.

Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update

Directory of Open Access Journals (Sweden)

Nyl

2016-02-01

Full Text Available John Nyland,1,2 Alma Mattocks,1 Shane Kibbe,2 Alaa Kalloub,2,3 Joe W Greene,4 David N M Caborn2,3 1Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA; 2Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; 3Shea Orthopedic Group, Louisville, KY, USA; 4Norton Orthopedic and Sports, Louisville, KY, USA Abstract: Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends. Keywords: arthroscopy, knee, function, outcomes, decision-making 

A Qualitative Study of Provider Perceptions of Influences on Uptake of Pediatric Hospital Guidelines in Lao PDR.

Science.gov (United States)

Gray, Amy Z; Soukaloun, Douangdao; Soumphonphakdy, Bandith

2017-08-01

Strategies to improve the quality of hospital care are needed if ongoing gains in child health and survival are to be made. We previously reported on improvements in the quality of case management in hospitals following a guideline-based intervention in Lao PDR, with variation in the degree of change achieved between clinical conditions. This study aims to understand the factors that influenced the uptake of the guideline-based intervention, and its impact on care. This qualitative study was embedded in a mixed-methods evaluation of guideline implementation in nine hospitals in Lao PDR. Focus groups and individual interviews were conducted with 70 health staff from central, provincial, and district hospitals. The interview guide was based on the Theoretical Domains Framework. Inductive content analysis was performed on interview transcripts to identify themes, supported by field notes from the intervention. Findings were triangulated against previously reported quantitative outcomes using driver diagrams. Key influences on guidelines uptake related to the guideline and intervention (filling a void, physical accessibility, comprehensibility, training in guideline use), health staff (behavior regulation, trust in guidelines, and beliefs about consequences), and the environment (social influences particularly consensus and incorporation into clinical norms). The major barrier was family preference for treatments in conflict with guideline recommendations. This study identifies contextual factors that explain, as well as validate previously identified improvements in care following guideline implementation in Lao PDR. It provides novel understanding of why the same intervention may have a differential impact on different clinical conditions.

Recommendations for the Return of Research Results to Study Participants and Guardians: A Report From the Children's Oncology Group

Science.gov (United States)

Fernandez, Conrad V.; Ruccione, Kathleen; Wells, Robert J.; Long, Jay B.; Pelletier, Wendy; Hooke, Mary C.; Pentz, Rebecca D.; Noll, Robert B.; Baker, Justin N.; O'Leary, Maura; Reaman, Gregory; Adamson, Peter C.; Joffe, Steven

2012-01-01

Purpose The Children's Oncology Group (COG) strongly supports the widely recognized principle that research participants should be offered a summary of study results. The mechanism by which to do so in a cooperative research group setting has not been previously described. Methods On the basis of a review of the available empirical and theoretic literature and on iterative, multidisciplinary discussion, a COG Return of Results Task Force (RRTF) offered detailed recommendations for the return of results to research study participants. Results The RRTF established guidelines for the notification of research participants and/or their parents/guardians about the availability of research results, a mechanism for and timing of sharing results via registration on the COG public Web site, the scope of the research to be shared, the target audience, and a process for creating and vetting lay summaries of study results. The RRTF recognized the challenges in adequately conveying complex scientific results to audiences with varying levels of health literacy and recommended that particularly sensitive or complex results be returned using direct personal contact. The RRTF also recommended evaluation of the cost, effectiveness, and impact of sharing results. Conclusion These recommendations provide a framework for the offering and returning of results to participants. They can be used by individual investigators, multi-investigator research collaboratives, and large cooperative groups. PMID:23109703

[Psychiatric Inpatient Treatment and Return to Work].

Science.gov (United States)

Mernyi, Lena; Hölzle, Patricia; Hamann, Johannes

2017-05-12

Objective People with mental diseases have a high risk of unemployment and they have only limited access to the labor market. The return to work is often associated with fears.The present study aims to provide an overview of the number of hospitalized psychiatric patients with permanent employment. Moreover it should give an insight into the process of return to work, the experiences patients gain and the support they receive. Methods In the participating clinics we measured the number of patients with permanent employment. The main inclusion criteria for further survey were the status of permanent employment and age between 18 and 65. The participating patients were interviewed on two occasions, at the time of inclusion and 3 months after the patient was discharged. The questions addressed working conditions, job satisfaction and the process of return-to-work. For statistical analysis, descriptive statistics (frequencies, means, standard deviations) were used. Results Only 21 % of n = 815 inpatients of the participating hospitals were permanently employed. Many patients did not return to work after being discharged. In many cases the interviewed patients saw a connection between their job and their current episode of illness. In this context patients reported unsatisfying workplace conditions such as long working hours, bad work organization and social conflicts. Conclusions For mentally ill patients, the employment rate in the primary labor market is devastating low. After psychiatric inpatient treatment patients are at high risk to lose their jobs. In order to prevent this development, work-related stress factors should be discussed with inpatients at an early stage and support should be provided during the return-to-work-process. © Georg Thieme Verlag KG Stuttgart · New York.

Endoscopic training in gastroenterology fellowship: adherence to core curriculum guidelines.

Science.gov (United States)

Jirapinyo, Pichamol; Imaeda, Avlin B; Thompson, Christopher C

2015-12-01

The Gastroenterology Core Curriculum and American Society of Gastrointestinal Endoscopy provide guidelines for endoscopic training. Program adherence to these recommendations is unclear. This study aims to assess endoscopic training experience during fellowship. Questionnaire study. The questionnaire was circulated to US fellowship programs, with the assistance of the American Gastroenterological Association. Graduating third-year fellows. Seventy-three fellows returned the questionnaire. Nearly all fellows met the required numbers for esophagoduodenoscopy (98%) and colonoscopy (100%), with fewer meeting requirements for PEG (73%) and non-variceal hemorrhage (75%). The majority of fellows did not meet minimum numbers for variceal banding (40%), esophageal dilation (43%), capsule endoscopy (42%). Fellows rated training in cognitive aspects of endoscopy as 3.86 [1 (inadequate), 5 (excellent)] and reported greatest emphasis on interpreting endoscopic findings and least on virtual colonography. Quality indicators of endoscopy received little emphasis (rating of 3.04; p = 0.00001), with adenoma detection rate being least emphasized. Fifty-six percent of fellows reported having routine endoscopy conferences. Half of the programs have endoscopic simulators, with 15% of fellows being required to use simulation. Following direct hands-on experience, fellows rated external endoscopy courses (64%) as the next most useful experience. Many fellows do not meet required numbers for several endoscopic procedures, and quality indicators receive little emphasis during training. Most programs do not provide simulation training or hold regular endoscopy conferences. Fellowship programs should perform internal audits and make feasible adjustments. Furthermore, it may be time for professional societies to revisit training guidelines.

At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits

NARCIS (Netherlands)

Tol, Johannes L.; Hamilton, Bruce; Eirale, Cristiano; Muxart, Patrice; Jacobsen, Philipp; Whiteley, Rod

2014-01-01

There is an ongoing debate regarding the optimal criteria for return to sport after an acute hamstring injury. Less than 10% isokinetic strength deficit is generally recommended but this has never been documented in professional football players after rehabilitation. Our aim was to evaluate

Providing Demonstrable Return-on-Investment for Organisational Learning and Training

Science.gov (United States)

Elliott, Michael; Dawson, Ray; Edwards, Janet

2009-01-01

Purpose: The aim of this paper is to present a holistic approach to training, that clearly demonstrates cost savings with improved effectiveness and efficiencies that are aligned to business objectives. Design/methodology/approach: Extending Kirkpatrick's evaluation framework with Phillips's return-on-investment (ROI) concepts, the paper conveys a…

Concussion Assessment in California Community College Football: Athletic Trainers' Strides toward a Safer Return to Play

Science.gov (United States)

Chinn, Nancy Resendes

2010-01-01

The purpose of this mixed method study was to compare current practices of athletic trainers in the management of concussion in football at California Community Colleges (CCC) with the concussion management guidelines set forth by the National Athletic Trainers Association (NATA). The study also set out to gain understanding of why some athletic…

Stock returns and foreign investment in Brazil

OpenAIRE

Reis, Luciana; Meurer, Roberto; Da Silva, Sergio

2008-01-01

We examine the relationship between stock returns and foreign investment in Brazil, and find that the inflows of foreign investment boosted the returns from 1995 to 2005. There was a strong contemporaneous correlation, although not Granger-causality. Foreign investment along with the exchange rate, the influence of the world stock markets, and country risk can explain 73 percent of the changes that occurred in the stock returns over the period. We also find that positive feedback trading play...

[Needs assessment to improve the applicability and methodological quality of a German S3 guideline].

Science.gov (United States)

Burckhardt, Marion; Hoffmann, Cristina; Nink-Grebe, Brigitte; Sänger, Sylvia

2018-04-01

Clinical practice guidelines can change the practice in healthcare only if their recommendations are implemented in a comprehensive way. The German S3 guideline "Local Therapy of Chronic Wounds in Patients with Peripheral Vascular Disease, Chronic Venous Insufficiency, and Diabetes" will be updated in 2017. The emphasis here is on the guideline's validity, user-friendliness and implementation into practice. Therefore, the aim was to identify the improvements required in regard to the guideline's methods and content presentation. The methodological approach used was the critical appraisal of the guideline according to established quality criteria and an additional stakeholder survey. Both were conducted between August and November 2016. The guideline and its related documents were reviewed independently by two researchers according to the criteria of the "Appraisal of Guidelines for Research and Evaluation" (AGREE-II). Published reviews and peer reviews by external experts and organisations were also taken into account. For the stakeholder survey, a questionnaire with open questions was distributed by e-mail and via the Internet to health professionals and organisations involved in the care of patients with leg ulcers in Germany. The questions were aimed at amendments and new topics based on the stakeholders' experience in inpatient and outpatient care. In addition, the survey focused on gathering suggestions to improve the applicability of the guideline. Suggested new topics and amendments were summarised thematically. The stakeholders' suggestions to improve the applicability, the results of the critical appraisal and the relevant aspects of the external reviews were then summarised according to the AGREE-II domains and presented in a cause and effect diagram. 17 questionnaires (out of 864 sent out by e-mail) were returned. Due to high practice relevance, the stakeholders suggested an expansion of the inclusion criteria to patients with infected wounds and

Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines

Science.gov (United States)

Lugtenberg, Marjolein; Burgers, Jako S.; Clancy, Carolyn; Westert, Gert P.; Schneider, Eric C.

2011-01-01

Background Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more

26 CFR 1.6013-2 - Joint return after filing separate return.

Science.gov (United States)

2010-04-01

... the case of a joint return made under section 6013(b), the period of limitations provided in sections... (c)(1) of this section, relating to the application of sections 6501 and 6651 with respect to a joint... 26 Internal Revenue 13 2010-04-01 2010-04-01 false Joint return after filing separate return. 1...

Critical factors influencing physicians' intention to use computerized clinical practice guidelines: an integrative model of activity theory and the technology acceptance model.

Science.gov (United States)

Hsiao, Ju-Ling; Chen, Rai-Fu

2016-01-16

With the widespread use of information communication technologies, computerized clinical practice guidelines are developed and considered as effective decision supporting tools in assisting the processes of clinical activities. However, the development of computerized clinical practice guidelines in Taiwan is still at the early stage and acceptance level among major users (physicians) of computerized clinical practice guidelines is not satisfactory. This study aims to investigate critical factors influencing physicians' intention to computerized clinical practice guideline use through an integrative model of activity theory and the technology acceptance model. The survey methodology was employed to collect data from physicians of the investigated hospitals that have implemented computerized clinical practice guidelines. A total of 505 questionnaires were sent out, with 238 completed copies returned, indicating a valid response rate of 47.1 %. The collected data was then analyzed by structural equation modeling technique. The results showed that attitudes toward using computerized clinical practice guidelines (γ = 0.451, p technology) factors mentioned in the activity theory should be carefully considered when introducing computerized clinical practice guidelines. Managers should pay much attention on those identified factors and provide adequate resources and incentives to help the promotion and use of computerized clinical practice guidelines. Through the appropriate use of computerized clinical practice guidelines, the clinical benefits, particularly in improving quality of care and facilitating the clinical processes, will be realized.

Return Migration and Working Choices

OpenAIRE

TANI, Massimiliano; MAHUTEAU, Stéphane

2008-01-01

Collective Action to Support the Reintegration of Return Migrants in their Country of Origin (MIREM) This paper uses the recent survey carried out in the framework of the MIREM project on returnees to Algeria, Morocco and Tunisia and studies the duration of emigration and the labour force status upon returning. The results suggest that age and the year of emigration play a central role in the migration decision, but they do not support the hypothesis that the duration of migration is deter...

The Return to Foreign Aid

DEFF Research Database (Denmark)

Dalgaard, Carl-Johan Lars; Hansen, Henrik

2017-01-01

We estimate the average rate of return on investments financed by aid and by domestic resource mobilisation, using aggregate data. Both returns are expected to vary across countries and time. Consequently we develop a correlated random coefficients model to estimate the average returns. Across...... different estimators and two different data sources for GDP and investment our findings are remarkably robust; the average gross return on ‘aid investments’ is about 20 per cent. This is in accord with micro estimates of the economic rate of return on aid projects and with aggregate estimates of the rate...

Housing market volatility in the OECD area: Evidence from VAR based return decompositions

DEFF Research Database (Denmark)

Engsted, Tom; Pedersen, Thomas Quistgaard

. For the majority of countries news about future returns is the main driver, and both real interest rates and risk premia play an important role in accounting for housing market volatility. Bivariate cross-country correlations and principal components analyses indicate that part of the return movements have......Vector-autoregressive models are used to decompose housing returns in 18 OECD countries into cash ‡ow (rent) news and discount rate (return) news. Only for two countries - Germany and Ireland - do changing expectations of future rents play a dominating role in explaining housing return volatility...... a common factor among the majority of countries. However, in a minority of countries (Germany, Japan, and the Netherlands) return movements have been basically unrelated to return movements in other countries....

Time to detoxify medical literature from guideline overdose

Institute of Scientific and Technical Information of China (English)

Dinesh Vyas; Arpita K Vyas

2012-01-01

The current financial turmoil in the United States has been attributed to multiple reasons including healthcare expenditure.Health care spending has increased from 5.7 percent of the gross domestic product (GDP)in 1965 to 16 percent of the GDP in 2004.Healthcare is driven with a goal to provide best possible care available at that period of time.Guidelines are generally assumed to have the high level of certainty and security as conclusions generated by the conventional scientific method leading many clinicians to use guidelines as the final arbiters of care.To provide the standard of care,physicians follow guidelines,proposed by either groups of physicians or various medical societies or government organizations like National Comprehensive Cancer Network.This has lead to multiple tests for the patient and has not survived the test of time.This independence leads to lacunae in the standardization of guidelines,hence flooding of literature with multiple guidelines and confusion to patients and physicians and eventually overtreatment,inefficiency,and patient inconvenience.There is an urgent need to restrict articles with Guidelines and develop some strategy like have an intermediate stage of pre-guidelines and after 5-10 years of trials,a systematic launch of the Guidelines.There can be better ways than this for putting together guidelines as has been suggested by multiple authors and researchers.

Multiple Smaller Missions as a Direct Pathway to Mars Sample Return

Science.gov (United States)

Niles, P. B.; Draper, D. S.; Evans, C. A.; Gibson, E. K.; Graham, L. D.; Jones, J. H.; Lederer, S. M.; Ming, D.; Seaman, C. H.; Archer, P. D.;

Stormwater Design Return Period Standards for U.S. Transportation Infrastructure: How Are States Approaching Resilience?

Science.gov (United States)

Samaras, C.; Lopez, T.

2016-12-01

Climate change is projected to increase the frequency and intensity of precipitation in many regions, which is relevant for stormwater engineering designs and resilience in the transportation sector. Existing and future stormwater infrastructure is generally designed for historical and stationary hydrologic conditions. For example, the design return period is based on statistical analysis of past precipitation events, often over a 50-year historical timeline. The design return period translates into how much peak precipitation volume a system is designed for in a state, and provides information about the performance of a drainage structure. The higher the design period used by an engineer for a given stormwater system, the more peak stormwater volume the system can convey. Therefore, design return periods can be associated with a design's near-term and long-term resilience. However, there is a tradeoff between the choice of design return period, the total infrastructure capital cost, and the resilience of a system to heavy precipitation events. This study analyzes current stormwater infrastructure design guidelines for state departments of transportation in the contiguous United States, in order to understand how stormwater design return periods vary across states and provide insight into the resilience of current stormwater systems design. The study found that the design return period varies considerably across the United States by roadway functional class and drainage classification, as well as within climate regions. Understanding this variation will help states identify possible vulnerabilities, highlight deficiencies across states and infrastructure types, and help in updating design return periods to increase the climate resilience of stormwater infrastructure.

Strength Asymmetry and Landing Mechanics at Return to Sport after ACL Reconstruction

Science.gov (United States)

Schmitt, Laura C.; Paterno, Mark V.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.

2014-01-01

Purpose Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the impact of QF strength asymmetry on knee landing biomechanics at the time of return to sport following ACL reconstruction. Methods Seventy-seven individuals (17.4 years) at the time of return to sport following primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 years) (CTRL group) participated. QF strength was assessed and Quadriceps Index calculated (QI = [involved strength/uninvolved strength]*100%). The ACLR group was sub-divided based on QI: High Quadriceps (HQ, QI≥90%) and Low-Quadriceps (LQ, QIkinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing, and discrete variables were compared among the groups with multivariate analysis of variance and linear regression analyses. Results The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (p.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain and symptoms. Conclusion At the time of return to sport, individuals post-ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision-making to optimize sports participation following ACL reconstruction. PMID:25373481

The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature.

Science.gov (United States)

Hilton, Gillean; Unsworth, Carolyn; Murphy, Gregory

2018-07-01

This review sought to answer the question "What are the barriers and facilitators influencing people's experience of return to work following spinal cord injury?" Studies that met the selection criteria were identified, presented and critically appraised using National Institute for Health and Care Excellence guidelines. Thematic synthesis was completed with studies possessing strong methodological rigor. Synthesis and interpretation involved three stages; coding of primary data; development of descriptive themes reflective of the primary data; and establishment of analytical themes to answer the review question. Data from nine papers were included in the thematic synthesis. Several descriptive themes and three analytical themes were drawn from the data to answer the research question. Analytical themes included: a matrix of personal and environmental factors exists requiring complex navigation in order to create possibilities and opportunities for postinjury employment; the process of seeking or gaining employment shares a reciprocal relationship with the temporal nature of adjustment to spinal cord injury; and there is an intrinsic need for occupational engagement through paid employment. Returning to or gaining employment after spinal cord injury is a fundamentally difficult experience for people. Multiple strategies are required to support the navigation of the process. There is, however, a need in people with spinal cord injury, to be a worker, and with that comes the inherent benefits of being employed. Implications for rehabilitation Returning to work should be a significant focus of spinal cord injury rehabilitation. Employment is both possible and health promoting following spinal cord injury. Multiple strategies are required to support people to navigate the return to work process. It is important to be cognizant of the individual motivations for being a worker and the complexity of the adjustment process. Spinal cord injury centers can provide a

Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge.

Science.gov (United States)

Blumenthal, Kimberly G; Shenoy, Erica S; Hurwitz, Shelley; Varughese, Christy A; Hooper, David C; Banerji, Aleena

2014-01-01

Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P allergy over time (54% vs 80%; P allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Childhood and the right to play: from the didatization of the playful to the free expression of children

Directory of Open Access Journals (Sweden)

Raquel Franco Ferronato

2017-12-01

Full Text Available This article is part of the theoretical studies carried out by the group of researchers participating in the project "Study of the profile of toy library in Brazilian Municipal Schools of Early Childhood Education". It is a bibliographical and documentary research, based on the legal guidelines on childhood (BRAZIL, 1990, BRAZIL, 2005, BRAZIL, 2005 and literature on children's education (SANTOS, 2000, POSTMAN, 2002; DAHLBERG; MOSS; PENCE, 2003; FRIEDMAN, 2005; KRAMER, 2007, among others.The study observed the childhood and the right to play. The analysis made it possible to understand that at the same time that the conception of childhood was modified in the legal documents recognizing it as a historical, social and citizen subject, the right to play also assumed new meanings such as that of essentiality in children's expressions. However, it is possible to consider that this expression. does not always find free space in the school, resulting in challenges and search for formative processes that allow the understanding of the place of play in the school, not only as a pedagogical activity, but as a free expression and language of the child Learns and develops.

Pre-return-to-work medical consultation for low back pain workers. Good practice recommendations based on systematic review and expert consensus.

Science.gov (United States)

Petit, A; Rozenberg, S; Fassier, J B; Rousseau, S; Mairiaux, P; Roquelaure, Y

2015-10-01

The pre-return-to-work medical consultation during sick leave for low back pain (LBP) aims at assessing the worker's ability to resume working without risk for his/her health, and anticipating any difficulties inherent to returning to work and job retention. This article summarizes the good practices guidelines proposed by the French Society of Occupational Medicine (SFMT) and the French National Health Authority (HAS), and published in October 2013. Good practices guidelines developed by a multidisciplinary and independent task force (24 experts) and peer review committee (50 experts) based on a literature review from 1990 to 2012, according to the HAS methodology. According to the labour regulations, workers can request a medical consultation with their occupational physician at any time. The pre-return-to-work consultation precedes the effective return-to-work and can be requested by the employee regardless of their sick leave duration. It must be scheduled early enough to: (i) deliver reassuring information regarding risks to the lower back and managing LBP; (ii) evaluate prognostic factors of chronicity and prolonged disability in relations to LBP and its physical, social and occupational consequences in order to implement the necessary conditions for returning to work; (iii) support and promote staying at work by taking into account all medical, social and occupational aspects of the situation and ensure proper coordination between the different actors. A better understanding of the pre-return-to-work consultation would improve collaboration and coordination of actions to facilitate resuming work and job retention for patients with LBP. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The return to foreign aid

DEFF Research Database (Denmark)

Dalgaard, Carl-Johan Lars; Hansen, Henrik

We investigate the marginal productivity of investment across countries. The aim is to estimate the return on investments financed by foreign aid and by domestic resource mobilization, using aggregate data. Both returns are expected to vary across countries and time. Consequently we develop...... a correlated random coefficients model, to estimate the average aggregate return on ‘aid investments’ and ‘domestic investments’. Across different estimators and two different sources for GDP and investment data our findings are remarkably robust; the average gross return on ‘aid investments’ is about 20 per...

Return to sport and knee functional scores after anterior cruciate ligament reconstruction: 2 to 10 years' follow-up

Directory of Open Access Journals (Sweden)

Sukrom Cheecharern

2018-04-01

Full Text Available Background: Anterior cruciate ligament (ACL reconstruction is one of the most common knee ligament reconstruction sustained by sports players. Previous studies have revealed different rates of returning to play sports depending on study sites, subjects, and time to follow-up; however, this subject has not been adequately investigated in Thailand. Objectives: This study aimed to assess the percentage of ACL reconstruction patients who successfully returned to sport activities. Factors associated with being able to return to sport were also determined. Materials and methods: A cross-sectional study was conducted to assess the rates of return to sport of patients who underwent ACL reconstruction between 2005 and 2015. All potential patients were initially contacted via letter or mobile phone and asked to report their long-term follow-up outcomes. Collected data from the interview, including return to sport status, performance following ACL, and reasons for not returning to play (if applicable were then combined with the initial surgical findings and enrollment/follow-up cohort data for analysis. This study was reviewed and approved by the ethics committee of Rajavithi Hospital. Results: A total of 110 participants were recruited, with a mean age of 35.05 ± 9.16 years. Most of the patients were male, single, with bachelor degree education, engaged in “other” occupations, had income up to 10,000 baht/month, were in the social security scheme (54.5%, and had no underlying diseases (85.5%. The mean ± SD of BMI was 25.58 ± 4.30 kg/m2. When classified by whether or not they returned to sports, it was found that sex, education, income and underlying disease of those who returned to sport were significantly different from those of subjects who did not (p < 0.05. At follow-up, 36.4% had returned to sport. The main reasons stated for not returning to sport following ACL were fear of injury, concern about possible long-term effects

Keeping the Body in Play: Pain, Injury, and Socialization in Male Rugby

Science.gov (United States)

Fenton, Lindsay T.; Pitter, Robert

2010-01-01

This paper discusses participant observation studies of two rugby seasons--one rural high school and one university club--in which one author served as a first aid provider and student athletic trainer, respectively. Through analysis using triangulation, we explored how the rules, athlete's status, and return-to-play boundary influenced decisions…

Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

International Nuclear Information System (INIS)

Wu, Jackson Sai-Yiu; Wong, Rebecca KS; Lloyd, Nancy S; Johnston, Mary; Bezjak, Andrea; Whelan, Timothy

2004-01-01

This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently

Opportunities for Pharmacists and Student Pharmacists to Provide Clinical Preventive Services

Directory of Open Access Journals (Sweden)

Natalie A. DiPietro Mager

2017-01-01

Full Text Available Pharmacists and student pharmacists can play an important role in providing clinical preventive services as specified by the United States Preventive Services Task Force (USPSTF. The USPSTF guidelines provide evidence-based recommendations about clinical preventive services for the general population. The purpose of this paper is to provide information to pharmacists and student pharmacists developing and implementing preventive health care services. Examples of successful pharmacy-based programs are also provided. Pharmacists and student pharmacists can provide preventive health care interventions by conducting screenings, providing education, and making referrals. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties   Type: Idea Paper

Clinical management of cranio-vertebral instability after whiplash, when guidelines should be adapted: a case report.

Science.gov (United States)

Rebbeck, Trudy; Liebert, Ann

2014-12-01

Cranio-vertebral instability (CVI) due to loss of bony or ligamentous integrity is one of the sequelae that may result after a whiplash mechanism injury. Due to the lack of specificity of diagnostic tests, this condition is often missed and the default classification of whiplash associated disorder (WAD) is assigned. This case report describes a 14-year-old boy who was initially classified with WAD II after a rugby injury. He was initially advised to return to usual activity, a treatment recommended in clinical guidelines for WAD. Due to an adverse response to this course of action, his primary carer, a musculoskeletal physiotherapist, continued with facilitating secondary referrals that ultimately led to a specialist physiotherapist. The patient was subsequently found to have CVI arising from a loss of bony integrity due to spina bifida atlanto, a congenital defect in the atlas. Treatment thus was immobilization and stabilization, a treatment usually recommended against in WAD guidelines. The patient recovered and within 8 weeks had returned to school and non-contact sports. This case study, therefore, presents a scenario where current clinical guidelines for whiplash could not be followed, and where pursuing clinical reasoning led to accurate diagnosis as well as safe and tailored management. The case also highlights the integrated roles that primary and specialist health professionals should play in the clinical pathway of care after WAD. As a result, an expanded diagnostic algorithm and pathway of care for WAD are proposed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Volatility smile and stochastic arbitrage returns

OpenAIRE

Sergei Fedotov; Stephanos Panayides

2004-01-01

The purpose of this work is to explore the role that random arbitrage opportunities play in pricing financial derivatives. We use a non-equilibrium model to set up a stochastic portfolio, and for the random arbitrage return, we choose a stationary ergodic random process rapidly varying in time. We exploit the fact that option price and random arbitrage returns change on different time scales which allows us to develop an asymptotic pricing theory involving the central limit theorem for random...

Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group.

Science.gov (United States)

Lehman, Ronald A; Kang, Daniel G; Lenke, Lawrence G; Sucato, Daniel J; Bevevino, Adam J

2015-05-01

There are no guidelines for when surgeons should allow patients to return to sports and athletic activities after spinal fusion for adolescent idiopathic scoliosis (AIS). Current recommendations are based on anecdotal reports and a survey performed more than a decade ago in the era of first/second-generation posterior implants. To identify current recommendations for return to sports and athletic activities after surgery for AIS. Questionnaire-based survey. Adolescent idiopathic scoliosis after corrective surgery. Type and time to return to sports. A survey was administered to members of the Spinal Deformity Study Group. The survey consisted of surgeon demographic information, six clinical case scenarios, three different construct types (hooks, pedicle screws, hybrid), and questions regarding the influence of lowest instrumented vertebra (LIV) and postoperative physical therapy. Twenty-three surgeons completed the survey, and respondents were all experienced expert deformity surgeons. Pedicle screw instrumentation allows earlier return to noncontact and contact sports, with most patients allowed to return to running by 3 months, both noncontact and contact sports by 6 months, and collision sports by 12 months postoperatively. For all construct types, approximately 20% never allow return to collision sports, whereas all surgeons allow eventual return to contact and noncontact sports regardless of construct type. In addition to construct type, we found progressively distal LIV resulted in more surgeons never allowing return to collision sports, with 12% for selective thoracic fusion to T12/L1 versus 33% for posterior spinal fusion to L4. Most respondents also did not recommend formal postoperative physical therapy (78%). Of all surgeons surveyed, there was only one reported instrumentation failure/pullout without neurologic deficit after a patient went snowboarding 2 weeks postoperatively. Modern posterior instrumentation allows surgeons to recommend earlier return

Colorectal Cancer Screening: A Guide to the Guidelines

Directory of Open Access Journals (Sweden)

Douglas K Rex

1999-01-01

Full Text Available The two most recent guidelines for colorectal cancer screening are those of the Agency for Healthcare Policy and Research, and the American Cancer Society. The guidelines are similar in many regards and reflect current literature, consensus opinion and compromise between members of multidisciplinary panels. The emphasis of both guidelines is to increase the options available for colorectal cancer screening. Increasing choice should expand the attractiveness of colorectal cancer screening to more patients and physicians, and the development of guidelines should help compel payers to provide reimbursement for colorectal cancer screening. These guidelines are summarized and evaluated as they pertain to colorectal cancer screening.

Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury.

Science.gov (United States)

van der Made, Anne D; Almusa, Emad; Whiteley, Rod; Hamilton, Bruce; Eirale, Cristiano; van Hellemondt, Frank; Tol, Johannes L

2018-01-01

Hamstring injury with intramuscular tendon involvement is regarded as a serious injury with a delay in return to play (RTP) of more than 50 days and reinjury rates up to 63%. However, this reputation is based on retrospective case series with high risk of bias. Determine whether intramuscular tendon involvement is associated with delayed RTP and elevated rates of reinjury. MRI of male athletes with an acute hamstring injury was obtained within 5 days of injury. Evaluation included standardised MRI scoring and scoring of intramuscular tendon involvement. Time to RTP and reinjury rate were prospectively recorded. Out of 70 included participants, intramuscular tendon disruption was present in 29 (41.4%) injuries. Injuries without intramuscular tendon disruption had a mean time to RTP of 22.2±7.4 days. Injuries with Injuries with full-thickness disruption took longer to RTP compared with injuries without disruption (p=0.025). Longitudinal intramuscular tendon disruption was not significantly associated with time to RTP. Waviness was present in 17 (24.3%) injuries. Mean time to RTP for injuries without and with waviness was 22.6±7.5 and 30.2±10.8 days (p=0.014). There were 11 (15.7%) reinjuries within 12 months, five (17.2%) in the group with intramuscular tendon disruption and six (14.6%) in the group without intramuscular tendon disruption. Time to RTP for injuries with full-thickness disruption of the intramuscular tendon and waviness is significantly longer (by slightly more than 1 week) compared with injuries without intramuscular tendon involvement. However, due to the considerable overlap in time to RTP between groups with and without intramuscular tendon involvement, its clinical significance for the individual athlete is limited. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

In-hospital Breastfeeding and Intention to Return to Work Influence Mothers' Breastfeeding Intentions.

Science.gov (United States)

Thomas-Jackson, Shera C; Bentley, Gail E; Keyton, Kristina; Reifman, Alan; Boylan, Mallory; Hart, Sybil L

2016-11-01

Research continues to demonstrate that formula feeding is associated with numerous long-term negative outcomes for a mother and her infant. However, many women cease breastfeeding sooner than intended and recommended. Breastfeeding has been found to be related to demographics, maternal mood, and returning to work outside the home. This study aimed to shed light on the woman's perception of the effect of working on intended breastfeeding duration. This study used intentions to return to work and in-hospital breastfeeding to predict breastfeeding intentions. Women (N = 160) were surveyed during the first 48 hours postdelivery of healthy, full-term infants. Survey instruments included demographics (socioeconomic status, maternal age, education, and marital status), depression, fetal attachment, current exclusive breastfeeding status, as well as breastfeeding and return-to-work intentions for the next year. A path analysis was used to explore relationships and predictors of breastfeeding intentions. The model had a good fit and breastfeeding intentions were predicted by exclusive breastfeeding in the hospital (β = 0.21, P work (β = -0.18, P work influence how long a mother intends to breastfeed. Attention to these areas can be provided immediately postpartum to support exclusive breastfeeding and provide informational support on continuing to breastfeed/express milk upon return to work if the mother intends to return to work.

Return to the... past

International Nuclear Information System (INIS)

Ammerich, M.

2009-01-01

This article goes back over the incidents occurring during the summer 2008, that is to say the uranium release from the Socatri facility in the South of France. From this point, the purpose studies the radiological situation of the Camargue seashore; the levels of radioactivity are from 3 to thirty times higher than these ones expected in this area, but the natural radioactivity with thorium and uranium coming from the granitic massifs erosion brings an important part. It is difficult to make the part between human and natural contribution to ambient radioactivity. However, it appears that to limit the water consumption until the time of dilution played its part was absolutely necessary. Then, because it is question of water, the drinking water is tackled. Some mineral waters go over the recommended limits of doses. A last return to the past with the radioactive watches, but this time with actual watches that activate detection. Two watches contained promethium 147, 147 Pm is a beta emitter but also gamma emitter. To end, in Ireland and Great Britain, some fire detectors contain americium 241. In fact, this article constitutes a summary of different abnormalities around radioactivity. (N.C.)

Interventions to enhance return-to-work for cancer patients

NARCIS (Netherlands)

de Boer, Angela G. E. M.; Taskila, Tyna K.; Tamminga, Sietske J.; Feuerstein, Michael; Frings-Dresen, Monique H. W.; Verbeek, Jos H.

2015-01-01

Cancer patients are 1.4 times more likely to be unemployed than healthy people. Therefore it is important to provide cancer patients with programmes to support the return-to-work (RTW) process. This is an update of a Cochrane review first published in 2011. To evaluate the effectiveness of

"Playing" with our users

DEFF Research Database (Denmark)

Brooks, Anthony Lewis

2014-01-01

was from the amazing Dr Anthony Lewis Brooks (aka Tony) who has conceived the concepts GameAbilitation, ArtAbilitation, and Ludic Engagement Designs for All. While presenting some of his work on GameAbilitation and ArtAbilitation he brought up the subject of conducting research with users with disabilities...... to be positive for the users. Well this might be how research works and we do try to be ethical, explain terms and conditions to our users and then say thank you, we sometimes return to present the results, give more “thank you”s and promise that “if it becomes available/when they acquire such an expensive...... device/when such smartphones become cheaper/when we’ll have funds” they can have such an experience again and that we make sure to upload everything online for free and so on and so forth. And sometimes we do actually try to leave devices, guidelines and software behind, though we never return to check...

Cross-cultural adaptation and validation of the Injury-Psychological Readiness to Return to Sport scale to Persian language.

Science.gov (United States)

Naghdi, Soofia; Nakhostin Ansari, Noureddin; Farhadi, Yasaman; Ebadi, Safoora; Entezary, Ebrahim; Glazer, Douglas

2016-10-01

The aim of the present study was to develop and provide validation statistics for the Persian Injury-Psychological Readiness to Return to Sport scale (I-PRRS) following a cross-sectional and prospective cohort study design. The I-PRRS was forward/back-translated and culturally adapted into Persian language. The Persian I-PRRS was administered to 100 injured athletes (93 male; age 26.0 ± 5.6 years; time since injury 4.84 ± 6.4 months) and 50 healthy athletes (36 male; mean age 25.7 ± 6.0 years). The Persian I-PRRS was re-administered to 50 injured athletes at 1 week to examine test-retest reliability. There were no floor or ceiling effects confirming the content validity of Persian I-PRRS. The internal consistency reliability was good. Excellent test-retest reliability and agreement were demonstrated. The statistically significant difference in Persian I-PRRS total scores between the injured athletes and healthy athletes provides an evidence of discriminative validity. The Persian I-PRRS total scores were positively correlated with the Farsi Mood Scale (FARMS) total scores, showing construct validity. The principal component analysis indicated a two-factor solution consisting of "Confidence to play" and "Confidence in the injured body part and skill level". The Persian I-PRRS showed excellent reliability and validity and can be used to assess injured athletes' psychological readiness to return to sport among Persian-speaking populations.

Concussion Management Practice Patterns Among Sports Medicine Physicians.

Science.gov (United States)

Stache, Stephen; Howell, David; Meehan, William P

2016-09-01

The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States. Cross-sectional study using a web-based survey. Members of the American Medical Society for Sports Medicine (AMSSM). We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies. Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol. Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines. Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

Healthcare providers' attitudes and behaviours related to paediatric mild traumatic brain injury: results from the 2014 DocStyles survey.

Science.gov (United States)

Sarmiento, Kelly; Donnell, Zoe; Hoffman, Rosanne; Tennant, Bethany

2018-04-23

Explore healthcare providers' experiences managing mTBI and better understand their use of mTBI assessment tools and guidelines. Cross-sectional Methods: A random sample of 1,760 healthcare providers responded to the web-based DocStyles survey between June 18 and 30, 2014. The sample included family/general practitioners, internists, pediatricians, and nurse practitioners who reported seeing pediatric patients. We examined their experiences with mTBI to identify opportunities to increase preparedness and improve management of mTBI. Fifty-nine percent of healthcare providers reported that they diagnosed or managed pediatric patients with mTBI within the last 12 months. Of those, 44.4% felt 'very prepared' to make decisions about when pediatric patients can safety return to activities, such as school and sports after a mTBI. When asked how often they use screening or assessment tools to assess pediatric patients with mTBI, almost half reported that they 'seldom' or 'never' use those resources (24.6% and 22.0%, respectively). Most healthcare providers reported seeing pediatric patients with mTBI, yet most feel only somewhat prepared to manage this injury in their practise. Broader use of screening tools and guidelines, that include clinical decision support tools, may be useful for healthcare providers who care for pediatric patients with mTBI.

Brain network activation as a novel biomarker for the return-to-play pathway following sport-related brain injury: A prospective case study

Directory of Open Access Journals (Sweden)

Adam W Kiefer

2015-11-01

Full Text Available Children and adolescent athletes are at a higher risk for concussion than adults, and also experience longer recovery times and increased associated symptoms. It has also recently been demonstrated that multiple, seemingly mild concussions may result in exacerbated and prolonged neurologic deficits. Objective assessments and return to play criteria are needed to reduce risk and morbidity associated with concussive events in these populations. Recent research has pushed to study the use of electroencephalography as an objective measure of brain injury. In the present case study, we present a novel approach that examines event related potentials via a brain network activation (BNA analysis as a biomarker of concussion and recovery. Specifically, changes in BNA scores as indexed through this approach, offer a potential indicator of neurological health as the BNA assessment qualitatively and quantitatively indexes the network dynamics associated with brain injury. Objective tools such as these support accurate and efficient assessment of brain injury and may offer a useful step in categorizing the temporal and spatial changes in brain activity following concussive blows, as well as the functional connectivity of brain networks, associated with concussion.

Realized volatility and absolute return volatility: a comparison indicating market risk.

Science.gov (United States)

Zheng, Zeyu; Qiao, Zhi; Takaishi, Tetsuya; Stanley, H Eugene; Li, Baowen

2014-01-01

Measuring volatility in financial markets is a primary challenge in the theory and practice of risk management and is essential when developing investment strategies. Although the vast literature on the topic describes many different models, two nonparametric measurements have emerged and received wide use over the past decade: realized volatility and absolute return volatility. The former is strongly favored in the financial sector and the latter by econophysicists. We examine the memory and clustering features of these two methods and find that both enable strong predictions. We compare the two in detail and find that although realized volatility has a better short-term effect that allows predictions of near-future market behavior, absolute return volatility is easier to calculate and, as a risk indicator, has approximately the same sensitivity as realized volatility. Our detailed empirical analysis yields valuable guidelines for both researchers and market participants because it provides a significantly clearer comparison of the strengths and weaknesses of the two methods.

Realized volatility and absolute return volatility: a comparison indicating market risk.

Directory of Open Access Journals (Sweden)

Zeyu Zheng

Full Text Available Measuring volatility in financial markets is a primary challenge in the theory and practice of risk management and is essential when developing investment strategies. Although the vast literature on the topic describes many different models, two nonparametric measurements have emerged and received wide use over the past decade: realized volatility and absolute return volatility. The former is strongly favored in the financial sector and the latter by econophysicists. We examine the memory and clustering features of these two methods and find that both enable strong predictions. We compare the two in detail and find that although realized volatility has a better short-term effect that allows predictions of near-future market behavior, absolute return volatility is easier to calculate and, as a risk indicator, has approximately the same sensitivity as realized volatility. Our detailed empirical analysis yields valuable guidelines for both researchers and market participants because it provides a significantly clearer comparison of the strengths and weaknesses of the two methods.

Return to sports after ankle fractures: a systematic review.

Science.gov (United States)

Del Buono, Angelo; Smith, Rebecca; Coco, Manuela; Woolley, Laurence; Denaro, Vincenzo; Maffulli, Nicola

2013-01-01

This review aims to provide information on the time athletes will take to resume sports activity following ankle fractures. We systematically searched Medline (PubMED), EMBASE, CINHAL, Cochrane, Sports Discus and Google scholar databases using the combined keywords 'ankle fractures', 'ankle injuries', 'athletes', 'sports', 'return to sport', 'recovery', 'operative fixation', 'pinning', 'return to activity' to identify articles published in English, Spanish, French, Portuguese and Italian. Seven retrospective studies fulfilled our inclusion criteria. Of the 793 patients, 469 (59%) were males and 324 (41%) were females, and of the 356 ankle fractures we obtained information on, 338 were acute and 18 stress fractures. The general principles were to undertake open reduction and internal fixation of acute fractures, and manage stress fractures conservatively unless a thin fracture line was visible on radiographs. The best timing to return to sports after an acute ankle fracture is still undefined, given the heterogeneity of the outcome measures and results. The time to return to sports after an acute stress injury ranged from 3 to 51 weeks. When facing athletes with ankle fractures, associated injuries have to be assessed and addressed to improve current treatment lines and satisfy future expectancies. The best timing to return to sports after an ankle fracture has not been established yet. The ideas of the return to activity parameter and surgeon databases including sports-related information could induce research to progress.

Computing return times or return periods with rare event algorithms

Science.gov (United States)

Lestang, Thibault; Ragone, Francesco; Bréhier, Charles-Edouard; Herbert, Corentin; Bouchet, Freddy

2018-04-01

The average time between two occurrences of the same event, referred to as its return time (or return period), is a useful statistical concept for practical applications. For instance insurances or public agencies may be interested by the return time of a 10 m flood of the Seine river in Paris. However, due to their scarcity, reliably estimating return times for rare events is very difficult using either observational data or direct numerical simulations. For rare events, an estimator for return times can be built from the extrema of the observable on trajectory blocks. Here, we show that this estimator can be improved to remain accurate for return times of the order of the block size. More importantly, we show that this approach can be generalised to estimate return times from numerical algorithms specifically designed to sample rare events. So far those algorithms often compute probabilities, rather than return times. The approach we propose provides a computationally extremely efficient way to estimate numerically the return times of rare events for a dynamical system, gaining several orders of magnitude of computational costs. We illustrate the method on two kinds of observables, instantaneous and time-averaged, using two different rare event algorithms, for a simple stochastic process, the Ornstein–Uhlenbeck process. As an example of realistic applications to complex systems, we finally discuss extreme values of the drag on an object in a turbulent flow.

Mars Sample Return Architecture Overview

Science.gov (United States)

Edwards, C. D.; Vijendran, S.

2018-04-01

NASA and ESA are exploring potential concepts for a Sample Retrieval Lander and Earth Return Orbiter that could return samples planned to be collected and cached by the Mars 2020 rover mission. We provide an overview of the Mars Sample Return architecture.

Understanding Computational Thinking before Programming: Developing Guidelines for the Design of Games to Learn Introductory Programming through Game-Play

Science.gov (United States)

Kazimoglu, Cagin; Kiernan, Mary; Bacon, Liz; MacKinnon, Lachlan

2011-01-01

This paper outlines an innovative game-based approach to learning introductory programming that is grounded in the development of computational thinking at an abstract conceptual level, but also provides a direct contextual relationship between game-play and learning traditional introductory programming. The paper proposes a possible model for,…

The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study

Directory of Open Access Journals (Sweden)

Oyun Chimeddamba

2016-04-01

Full Text Available (1 Background: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2 Methods: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3 Results: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4 Conclusions: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

Using Early Learning Standards to Provide High-Quality Education for All Children: The Early Learning Guidelines Toolkit

Science.gov (United States)

Flores, Roseanne L.; Curby, Timothy W.; Coleman, Hardin; Melo, Kristan

2016-01-01

Today with the rise in the number of 3- to 6-year-old children enrolled in center-based early childhood programs, and a focus on program quality, it becomes imperative for educators to have a better understanding of the role research plays in establishing high-quality programs as these programs provide much of the foundation that supports early…

Impact Of Retirement Benefit Act (RBA) On Investment Returns To Pension Funds In Kenya

OpenAIRE

Lucy Jepchoge Rono; Julius Kibet Bitok; Gordon N Asamoah

2010-01-01

This study focused on the analysis of the impact of RBA guidelines on the return on investments of both pension funds under management and those for pension schemes. A random sample of 175 fund trustees and a census of 13 fund managers from registered fund management companies participated in the survey. The questionnaire was administered through the drop-and-pick method. Data were analyzed using SPSS (Statistical Package for Social Sciences) and summarized in descriptive statistics, such as ...

Guidelines for Biomarker of Food Intake Reviews (BFIRev: how to conduct an extensive literature search for biomarker of food intake discovery

Directory of Open Access Journals (Sweden)

Giulia Praticò

2018-02-01

Full Text Available Abstract Identification of new biomarkers of food and nutrient intake has developed fast over the past two decades and could potentially provide important new tools for compliance monitoring and dietary intake assessment in nutrition and health science. In recent years, metabolomics has played an important role in identifying a large number of putative biomarkers of food intake (BFIs. However, the large body of scientific literature on potential BFIs outside the metabolomics area should also be taken into account. In particular, we believe that extensive literature reviews should be conducted and that the quality of all suggested biomarkers should be systematically evaluated. In order to cover the literature on BFIs in the most appropriate and consistent manner, there is a need for appropriate guidelines on this topic. These guidelines should build upon guidelines in related areas of science while targeting the special needs of biomarker methodology. This document provides a guideline for conducting an extensive literature search on BFIs, which will provide the basis to systematically validate BFIs. This procedure will help to prioritize future work on the identification of new potential biomarkers and on validating these as well as other biomarker candidates, thereby providing better tools for future studies in nutrition and health.

Guidelines for Biomarker of Food Intake Reviews (BFIRev): how to conduct an extensive literature search for biomarker of food intake discovery.

Science.gov (United States)

Praticò, Giulia; Gao, Qian; Scalbert, Augustin; Vergères, Guy; Kolehmainen, Marjukka; Manach, Claudine; Brennan, Lorraine; Pedapati, Sri Harsha; Afman, Lydia A; Wishart, David S; Vázquez-Fresno, Rosa; Lacueva, Cristina Andres; Garcia-Aloy, Mar; Verhagen, Hans; Feskens, Edith J M; Dragsted, Lars O

2018-01-01

Identification of new biomarkers of food and nutrient intake has developed fast over the past two decades and could potentially provide important new tools for compliance monitoring and dietary intake assessment in nutrition and health science. In recent years, metabolomics has played an important role in identifying a large number of putative biomarkers of food intake (BFIs). However, the large body of scientific literature on potential BFIs outside the metabolomics area should also be taken into account. In particular, we believe that extensive literature reviews should be conducted and that the quality of all suggested biomarkers should be systematically evaluated. In order to cover the literature on BFIs in the most appropriate and consistent manner, there is a need for appropriate guidelines on this topic. These guidelines should build upon guidelines in related areas of science while targeting the special needs of biomarker methodology. This document provides a guideline for conducting an extensive literature search on BFIs, which will provide the basis to systematically validate BFIs. This procedure will help to prioritize future work on the identification of new potential biomarkers and on validating these as well as other biomarker candidates, thereby providing better tools for future studies in nutrition and health.

The development of a multidisciplinary, evidence-based guideline for "HIV and employment".

Science.gov (United States)

Wagener, Marlies N; Roelofs, Pepijin; Miedema, Harold S; Brandjes, Dees P M; Dahmen, Rutger; van Gorp, Eric C M

2015-01-01

The objective of this study was to develop a multidisciplinary guideline that supports the care and vocational rehabilitation of HIV-infected people with employment-related problems. The guideline was developed according to the "evidence-based guideline development" method developed by the Dutch Institute for Health Care Improvement. This method consists of the following steps: forming a multidisciplinary core group and an expert panel, formulating key questions, searching and appraising the available literature, formulating considerations and recommendations, peer reviewing the draft guideline, and authorizing the final guideline. All relevant professional associations were represented in the core group that was assembled to develop the guideline, i.e., HIV doctors, HIV nurses, general practitioners, occupational health physicians, psychologists, social workers, occupational health nurses, vocational experts, and insurance physicians. Five key questions for the guideline were formulated with the following themes: determinants of employment, disclosure and stigma, self-management, interventions, and the organization of care. In the literature review on these topics, 45 studies met the inclusion criteria. The methodological quality of the included articles was poor. Factors such as patient preferences and medical/ethical issues were considered. The recommendations in the guideline are a weighting of the scientific evidence and the considerations of the core group. The guideline, as well as its summary for daily practice, clarifies the most important barriers and facilitators to people with HIV either staying at work or returning to work, and it constitutes a clinical, easy-to-use guideline for health-care providers and how they can support people with HIV who want to work.

Characteristics of donors who do or do not return to give blood and barriers to their return

Science.gov (United States)

Wevers, Anne; Wigboldus, Daniël H.J.; de Kort, Wim L.A.M.; van Baaren, Rick; Veldhuizen, Ingrid J.T.

2014-01-01

Background In the Netherlands about 50% of whole blood donors return to give blood after an invitation to donate. This study aimed to investigate the characteristics of donor return behaviour and to gain insight into the barriers to blood donation reported by the donors themselves. Materials and methods A total of 4,901 whole blood donors were invited to donate in week 39 of 2009. Barriers mentioned by donors who informed the blood bank for not donating were registered for 1 month. Logistic regression analyses assessed relevant characteristics of return behaviour, such as age and blood type, in men and women separately. Results Of the invited donors, 55% returned to give a donation, whereas 45% did not return. Male donors were more likely to return when they were older, had a higher previous return rate and had no past deferrals. The same pattern was found among women, but was less strong. The main barriers were: time constraints (35%), preference to postpone donation due to general physical problems although being eligible to donate (29%), and being ineligible to donate due to medical deferral criteria (9%). Discussion Specific donor characteristics are associated with return behaviour. Not donating due to time constraints could mean that donors do not feel the urgency of donating blood. Interventions targeted to increase commitment among specific donor groups should be tested further. PMID:23522891

Agricultural Returns to Labor and the Origins of Work Ethics

OpenAIRE

Fouka, Vasiliki; Schlaepfer, Alain

2017-01-01

We examine the historical determinants of differences in preferences for work across societies today. Our hypothesis is that a society’s work ethic depends on the role that labor has played in it historically, as an input in agricultural production: societies that have for centuries depended on the cultivation of crops with high returns to labor effort will work longer hours and develop a preference for working hard. We formalize this prediction in the context of a model of endogenous prefere...

Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

Directory of Open Access Journals (Sweden)

Bezjak Andrea

2004-10-01

Full Text Available Abstract Background This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. Methods A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Results Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%. Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. Conclusion For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and

Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Patient Perspective

Directory of Open Access Journals (Sweden)

A Hillary Steinhart

2015-01-01

Full Text Available A series of clinical practice guidelines were recently developed by the Canadian Association of Gastroenterology (CAG to provide clinicians with recommendations for the medical management of nonhospitalized ulcerative colitis (UC patients. These guidelines were developed, reviewed and agreed on by expert clinicians and methodologists. Following the finalization of the guidelines, a group of patients with UC as well as several inflammatory bowel disease clinicians, were brought together for a half-day workshop to provide feedback from the patient perspective. At the workshop, the guideline development process was described and the guidelines were reviewed to ensure comprehension. Patients then had the opportunity to provide their insight to the relevance of the guideline development process and the content of the guidelines as it related to their personal experiences with UC. The patient group believed that, although the new guidelines will be a tremendous resource for the health care provider community, a more ‘lay-friendly’ version would better facilitate dialogue between patients and their health care practitioners. The importance of the patient/physician relationship is paramount when making decisions regarding treatment plans, in which patient preferences play a key role in determining the most appropriate therapy and dosing regimen, which, in turn, impact the likelihood of adherence to the treatment plan. It was also believed that quality of life issues were not fully addressed in the guidelines. Much could be learned from shared experiences and coping strategies that would empower patients to take charge of their health and become equal partners with their care providers.

Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.

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Fältström, A; Hägglund, M; Kvist, J

2016-11-01

This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: short time between injury and ACLR (0-3 months, OR 5.6; 3-12 months OR 4.7 vs reference group > 12 months) and high motivation. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P football after ACLR. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: applying common sense in the absence of evidence

Science.gov (United States)

Weiler, Richard; Monte-Colombo, Mathew; Mitchell, Adam; Haddad, Fares

2015-01-01

This case report illustrates and discusses the non-operative management of a complete anterior cruciate ligament (ACL) injury in an English Premier League football player, his return to play within 8 weeks and problem-free follow-up at 18 months post injury. When non-operative verses surgical ACL reconstruction is considered there are many fundamental gaps in our knowledge and currently, at elite level, there are no cases in cutting sports within the literature to guide these decisions. When the norm is for all professional footballers to be recommended surgery, it will be very challenging when circumstances and patient autonomy dictate a conservative approach, where prognosis, end points and risk are unclear and assumed to be high. This case challenges current dogma and provides a starting point for much needed debate about best practice, treatment options, research direction and not just at the elite level of sport. PMID:25917066

An Internationally Coordinated Science Management Plan for Samples Returned from Mars

Science.gov (United States)

Haltigin, T.; Smith, C. L.

2015-12-01

Mars Sample Return (MSR) remains a high priority of the planetary exploration community. Such an effort will undoubtedly be too large for any individual agency to conduct itself, and thus will require extensive global cooperation. To help prepare for an eventual MSR campaign, the International Mars Exploration Working Group (IMEWG) chartered the international Mars Architecture for the Return of Samples (iMARS) Phase II working group in 2014, consisting of representatives from 17 countries and agencies. The overarching task of the team was to provide recommendations for progressing towards campaign implementation, including a proposed science management plan. Building upon the iMARS Phase I (2008) outcomes, the Phase II team proposed the development of an International MSR Science Institute as part of the campaign governance, centering its deliberations around four themes: Organization: including an organizational structure for the Institute that outlines roles and responsibilities of key members and describes sample return facility requirements; Management: presenting issues surrounding scientific leadership, defining guidelines and assumptions for Institute membership, and proposing a possible funding model; Operations & Data: outlining a science implementation plan that details the preliminary sample examination flow, sample allocation process, and data policies; and Curation: introducing a sample curation plan that comprises sample tracking and routing procedures, sample sterilization considerations, and long-term archiving recommendations. This work presents a summary of the group's activities, findings, and recommendations, highlighting the role of international coordination in managing the returned samples.

Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines

Science.gov (United States)

2014-01-01

Background It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness. Methods A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37–41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members’ satisfaction with the research method, participants were invited to provide their feedback after the final survey. Results From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists. Conclusion Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who

Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines.

Science.gov (United States)

Chalmers, Kathryn J; Bond, Kathy S; Jorm, Anthony F; Kelly, Claire M; Kitchener, Betty A; Williams-Tchen, Aj

2014-01-28

It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness. A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37-41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members' satisfaction with the research method, participants were invited to provide their feedback after the final survey. From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists. Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a

Medical care of hepatitis B among Asian American populations: perspectives from three provider groups.

Science.gov (United States)

Hwang, Jessica P; Roundtree, Aimee K; Engebretson, Joan C; Suarez-Almazor, Maria E

2010-03-01

Physicians can play a significant role in helping to decrease the hepatitis B virus (HBV) burden among Asian Americans. Few studies have described knowledge and practice patterns in the medical community among different provider types regarding HBV and liver cancer. Our study explores the HBV beliefs, attitudes and practice patterns of medical providers serving Asian American communities. We conducted three focus groups with primary care providers, liver specialists, and other providers predominantly serving Asian American community. We asked about practices and barriers to appropriate medical care and outreach. We moderated three focus groups with 23 participants, 18 of whom completed and returned demographic surveys. Twelve were of Asian ethnicity and 13 spoke English as a second language. Only eight screened at least half of their patients, most (72%) using the hepatitis B surface antigen test. We used grounded theory methods to analyze focus group transcripts. Participants frequently discussed cultural and financial barriers to hepatitis care. They admitted reluctance to screen for HBV because patients might be unwilling or unable to afford treatment. Cultural differences were discussed most by primary care providers; best methods of outreach were discussed most by liver specialists; and alternative medicine was discussed most by acupuncturists and other providers. More resources are needed to lower financial barriers complicating HBV care and encourage providing guideline-recommended screenings. Other providers can help promote HBV screening and increase community and cultural awareness.

Return to Sport-Specific Performance After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Science.gov (United States)

Mohtadi, Nicholas G; Chan, Denise S

2017-10-01

Physicians counseling athletes on the prognosis of sport-specific performance outcomes after anterior cruciate ligament reconstruction (ACLR) depend on the published literature. However, critical appraisal of the validity and biases in these studies is required to understand how ACLR affects an athlete's ability to return to sport, the athlete's sport-specific performance, and his or her ability to achieve preinjury levels of performance. This review identifies the published prognostic studies evaluating sport-specific performance outcomes after ACLR. A risk of bias assessment and summaries of return to sport and career longevity results are provided for each included study. Systematic review. Electronic databases (Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PUBMED) were searched via a defined search strategy with no limits, to identify relevant studies for inclusion in the review. A priori defined eligibility criteria included studies measuring sport-specific performance within an athlete's sport, before and after primary ACLR. Reference lists of eligible studies were hand-searched for additional relevant studies. Data extraction was performed by use of a standardized spreadsheet. Each included study was assessed by use of 6 bias domains of the Quality in Prognosis Studies tool to critically appraise study participation, study attrition, prognostic factors, outcome measurement, confounders, and statistical analysis and reporting. Two authors independently performed each stage of the review and reached consensus through discussion. Fifteen pertinent prognostic studies evaluated sport-specific performance outcomes and/or return to play after ACLR for athletes participating in competitive soccer, football, ice hockey, basketball, Alpine ski, X-Games ski and snowboarding, and baseball. Twelve of these studies were considered to have a high level of bias. This review demonstrated that most high

Promoting Positive Peer Interactions in the Preschool Classroom: The Role and the Responsibility of the Teacher in Supporting Children's Sociodramatic Play

Science.gov (United States)

Stanton-Chapman, Tina L.

2015-01-01

Teachers play an important role in expanding and supporting children's play and interactions with peers. This manuscript provides specific guidelines for interventions teachers can use to promote successful peer interactions in preschool settings. The strategies discussed include: (a) preparing the physical environment for play (e.g., toy…

Exposure to Free-Play Modes in Simulated Online Gaming Increases Risk-Taking in Monetary Gambling.

Science.gov (United States)

Frahn, Tahnee; Delfabbro, Paul; King, Daniel L

2015-12-01

This study examined the behavioral effects of practice modes in simulated slot machine gambling. A sample of 128 participants predominantly aged 18-24 years were randomly allocated to 1 of 4 pre-exposure conditions: control (no practice), standard 90% return to player, inflated return to player and inflated return with pop-up messages. Participants in all conditions engaged in monetary gambling using a realistic online simulation of a slot machine. As predicted, the results showed that those players exposed to inflated or 'profit' demonstration modes placed significantly higher bets in the real-play mode as compared to the other groups. However, the groups did not differ in relation to how long they persisted in the real-play mode. Pop-up messages had no significant effect on monetary gambling behavior. The results of this study confirm that exposure to inflated practice or "demo" modes lead to short-term increases in risk-taking. These findings highlight the need for careful regulation and monitoring of internet gambling sites, as well as further research on the potential risks of simulated gambling activities for vulnerable segments of the gambling population.

Return to sports after shoulder arthroplasty

Science.gov (United States)

Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

2016-01-01

Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

Returns to Tenure or Seniority?

DEFF Research Database (Denmark)

Buhai, Ioan Sebastian; Portela, Miguel; Teulings, Coen

  This study documents two empirical regularities, using data for Denmark and Portugal. First, workers who are hired last, are the first to leave the firm (Last In, First Out; LIFO). Second, workers' wages rise with seniority (= a Worker's tenure relative to the tenure of her colleagues). We seek...... at the moment of separation). The LIFO rule provides a stronger bargaining position for senior workers, leading to a return to seniority in wages. Efficiency in hiring requires the workers' .bargaining power to be in line with their share in the cost of specific investment. Then, the LIFO rule is a way...

Childhood obesity: knowledge, attitudes, and practices of European pediatric care providers.

Science.gov (United States)

Mazur, Artur; Matusik, Pawel; Revert, Krista; Nyankovskyy, Sergey; Socha, Piotr; Binkowska-Bury, Monika; Grzegorczyk, Joanna; Caroli, Margherita; Hassink, Sandra; Telega, Grzegorz; Malecka-Tendera, Ewa

2013-07-01

To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.

Landscape diversity and the resilience of agricultural returns: a portfolio analysis of land-use patterns and economic returns from lowland agriculture

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Abson David J

2013-01-01

Full Text Available Abstract Background Conventional agriculture is increasingly based on highly specialized, highly productive farms. It has been suggested that 1 this specialization leads to farms that lack resilience to changing market and environmental conditions; and 2 that by decreasing agricultural diversity, the resilience of the farming system also decreases. Methods We used agricultural gross margin (GM forecasts from 1966 to 2010 and remote sensing data from agricultural landscapes in the lowland UK, in conjunction with modern portfolio theory, to test the hypothesis that decreasing land-use diversity results in landscapes that provide higher, but more volatile, economic returns. We considered the role of spatial scale on the expected levels of volatility and resilience of agricultural returns. Results We found that: 1 there was a strong linear trade-off between expected GMs and the expected volatility of those GMs in real lowland agricultural landscapes in the UK; 2 land-use diversification was negatively correlated with expected GMs from agriculture, and positively correlated with decreasing expected volatility in GMs; 3 the resilience of agricultural returns was positively correlated with the diversity of agricultural land use, and the resilience of agricultural returns rose quickly with increased land-holding size at small spatial extents, but this effect diminished after landholdings reached 12,000 hectares. Conclusions Land-use diversity may have an important role in ensuring resilient agricultural returns in the face of uncertain market and environmental conditions, and land-holding size plays a pivotal role in determining the relationships between resilience and returns at a landscape scale. Creating finer-grained land-use patterns based on pre-existing local land uses may increase the resilience of individual farms, while maintaining aggregate yield across landscapes.

Concise set of files for smooth return to work in employees with mental disorders.

Science.gov (United States)

Yoshitsugu, Kiyoshi; Kuroda, Yuko; Hiroyama, Yuji; Nagano, Nobuhisa

2013-01-01

Sick leave due to mental disorders is a societal problem. It carries a high cost in terms of loss of labor productivity and absenteeism. Partial remission increases the risk of relapse after a return to work. There is sometimes a difference between the ability to return to work as judged by a general practitioner (GP) and the needs of the workplace. GPs are the main controllers of treatment and tend to protect their patients. Communication and agreement by GPs and occupational physicians play an effective role in the return to work. However, it requires considerable effort for both of them to make time to do this. We have developed a concise set of files for a smooth return to work. The files consist of three parts: "Suggestions for corresponding with employees taking sick leave"; "Checklist for smooth return to work"; and "Pattern of living". We put them into practice among 20 companies in Japan from January 2012 to October 2013. The companies had 8244 workers in total and 116 workers were on sick-leave due to mental disorders. Our set of files contributed to sharing the written basic policy of return to work among employees on sick leave with mental disorders, GPs, occupational physicians and personnel officers. That sharing led to facilitating a smooth return to work. Although there are differences in the legal and medical systems between Japan and other countries, our concept of sharing the written basic policy may give some help to occupational physicians in other parts of the world as well.

Employer Satisfaction With an Injured Employee's Health Care: How Does It Affect the Selection of an Occupational Health Care Provider?

Science.gov (United States)

Keleher, Myra P; Stanton, Marietta P

2016-01-01

The purpose of this article is to explore the most important factors that an employer utilizes in selecting an occupational health care provider for their employees injured on the job. The primary practice setting is the attending physician's office who is an occupational health care provider. The responding employers deemed "work restrictions given after each office visit" as their most important factor in selecting an occupational health care provider, with a score of 43. This was followed in order in the "very important" category by communication, appointment availability, employee return to work within nationally recognized guidelines, tied were medical provider professionalism and courtesy with diagnostics ordered timely, next was staff professionalism and courtesy, and tied with 20 responses in the "very important" category were wait time and accurate billing by the provider.The selection of an occupational health care provider in the realm of workers' compensation plays a monumental role in the life of a claim for the employer. Safe and timely return to work is in the best interest of the employer and their injured employee. For the employer, it can represent hard dollars saved in indemnity payments and insurance premiums when the employee can return to some form of work. For the injured employee, it can have a positive impact on their attitude of going back to work as they will feel they are a valued asset to their employer. The case managers, who are the "eyes and ears" for the employer in the field of workers' compensation, have a valuable role in a successful outcome of dollars saved and appropriate care rendered for the employees' on the job injury. The employers in the study were looking for case managers who could ensure their employees received quality care but that this care is cost-effective. The case manager can be instrumental in assisting the employer in developing and monitoring a "stay-at-work" program, thereby reducing the financial exposure

Demarcating Mobile Phone Interface Design Guidelines to Expedite Selection

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Karen Vera Renaud

2017-12-01

Full Text Available Guidelines are recommended as a tool for informing user interface design. Despite a proliferation of guidelines in the research literature, there is little evidence of their use in industry, nor their influence in academic literature. In this paper, we explore the research literature related to mobile phone design guidelines to find out why this should be so. We commenced by carrying out a scoping literature review of the mobile phone design guideline literature to gain insight into the maturity of the field. The question we wanted to explore was: “Are researchers building on each others’ guidelines, or is the research field still in the foundational stage?” We discovered a poorly structured field, with many researchers proposing new guidelines, but little incremental refinement of extant guidelines. It also became clear that the current reporting of guidelines did not explicitly communicate their multi-dimensionality or deployment context. This leaves designers without a clear way of discriminating between guidelines, and could contribute to the lack of deployment we observed. We conducted a thematic analysis of papers identified by means of a systematic literature review to identify a set of dimensions of mobile phone interface design guidelines. The final dimensions provide a mechanism for differentiating guidelines and expediting choice.

Choosing to Work? Mothers Return-to-Work Decisions, Social Class, and the Local Labor Market

Directory of Open Access Journals (Sweden)

Tiina Sihto

2015-10-01

Full Text Available The aim of this study is to examine the ways in which social class shapes the return-to-work decisions of Finnish working-class and middle-class mothers, and how these decisions are structured by the constraints and opportunities mothers face in the local labor market. The focus of the study is in the local labor market of the city of Jyväskylä. The data consist of two semi-structured focus group interviews of 14 employed mothers of below school-age children. Using the framework of “gendered moral rationalities,” the study shows that there are similarities in mothers’ experiences, while the structural constraints mothers faced when deciding about the timing of returning back to work differ. The analysis highlights that the differences were not only dependent on social class but also on the situation in the local labor market. For working-class mothers, the most crucial issue was the financial strain that their staying at home caused to their families. For middle-class mothers, finding employment opportunities that would match their educational qualifications in the local labor market had been challenging, which affected their timing of returning back to work. The paper concludes that local labor market plays an important role in mother’s return-to-work decisions and should be explored further in differing geographical contexts.

Barriers to return to work after burn injuries.

Science.gov (United States)

Esselman, Peter C; Askay, Shelley Wiechman; Carrougher, Gretchen J; Lezotte, Dennis C; Holavanahalli, Radha K; Magyar-Russell, Gina; Fauerbach, James A; Engrav, Loren H

2007-12-01

To identify barriers to return to work after burn injury as identified by the patient. A cohort study with telephone interview up to 1 year. Hospital-based burn centers at 3 national sites. Hospitalized patients (N=154) meeting the American Burn Association criteria for major burn injury, employed at least 20 hours a week at the time of injury, and with access to a telephone after discharge. Patients were contacted via telephone every 2 weeks up to 4 months, then monthly up to 1 year after discharge. A return to work survey was used to identify barriers that prevented patients from returning to work. A graphic rating scale determined the impact of each barrier. By 1 year, 79.7% of patients returned to work. Physical and wound issues were barriers early after discharge. Although physical abilities continued to be a significant barrier up to 1 year, working conditions (temperature, humidity, safety) and psychosocial factors (nightmares, flashbacks, appearance concerns) became important issues in those with long-term disability. The majority of patients return to work after a burn injury. Although physical and work conditions are important barriers, psychosocial issues need to be evaluated and treated to optimize return to work.

FAILURES-TO-LAUNCH AND BOOMERANG KIDS: CONTEMPORARY DETERMINANTS OF LEAVING AND RETURNING TO THE PARENTAL HOME.

Science.gov (United States)

South, Scott J; Lei, Lei

2015-12-01

The percentage of young American adults residing in their parents' home has increased markedly over recent years, but we know little about how sociodemographic, life-course, and parental characteristics facilitate or impede leaving or returning home. We use longitudinal data from the Panel Study of Income Dynamics' Transition into Adulthood survey to examine the determinants of leaving and returning home among youth who turned age 18 between 2005 and 2011. Findings from event history models show that while leaving and returning home is to some extent a function of normative life-course transitions, characteristics of the parental home (e.g., presence of co-resident siblings, mother's educational attainment) and the degree of family connectivity (e.g., emotional closeness to mother, instrumental help from family) also play important roles. Experiencing physical, including sexual, victimization drives young adults both out of, and back into, the parental home. Having parents in poor physical health encourages young adults to move back home. Overall, the results suggest that a comprehensive explanation for both home-leaving and home-returning will need to look beyond life-course transitions and standard economic accounts to encompass a broader array of push and pull factors, particularly those that bond young adults with their parents.

When human immunodeficiency virus (HIV) treatment goals conflict with guideline-based opioid prescribing: A qualitative study of HIV treatment providers.

Science.gov (United States)

Starrels, Joanna L; Peyser, Deena; Haughton, Lorlette; Fox, Aaron; Merlin, Jessica S; Arnsten, Julia H; Cunningham, Chinazo O

2016-01-01

Human immunodeficiency virus (HIV)-infected patients have a high prevalence of chronic pain and opioid use, making HIV care a critical setting for improving the safety of opioid prescribing. Little is known about HIV treatment providers' perspectives about opioid prescribing to patients with chronic pain. The authors administered a questionnaire and conducted semistructured telephone interviews with 18 HIV treatment providers (infectious disease specialists, general internists, family medicine physicians, nurse practitioners, and physician assistants) in Bronx, NY. Open-ended interview questions focused on providers' experiences, beliefs, and attitudes about opioid prescribing and about the use of guideline-based opioid prescribing practices (conservative prescribing, and monitoring for and responding to misuse). Transcripts were thematically analyzed using a modified grounded theory approach. Eighteen HIV treatment providers included 13 physicians, four nurse practitioners, and one physician assistant. They were 62% female, 56% white, and practiced as HIV treatment providers for a mean of 14.6 years. Most reported always or almost always using opioid treatment agreements (56%) and urine drug testing (61%) with their patients on long-term opioid therapy. HIV treatment providers tended to view opioid prescribing for chronic pain within the "HIV paradigm," a set of priorities and principles defined by three key themes: (1) primacy of HIV goals, (2) familiarity with substance use, and (3) the clinician as ally. The HIV paradigm sometimes supported, and sometimes conflicted with, guideline-based opioid prescribing practices. For HIV treatment providers, perceived alignment with the HIV paradigm determined whether and how guideline-based opioid prescribing practices were adopted. For example, the primacy of HIV goals superseded conservative opioid prescribing when providers prescribed opioids with the goal of retaining patients in HIV care. These findings highlight

Return to nucleate boiling

International Nuclear Information System (INIS)

Shumway, R.W.

1985-01-01

This paper presents a collection of TMIN (temperature of return to nucleate boiling) correlations, evaluates them under several conditions, and compares them with a wide range of data. Purpose is to obtain the best one for use in a water reactor safety computer simulator known as TRAC-B. Return to nucleate boiling can occur in a reactor accident at either high or low pressure and flow rates. Most of the correlations yield unrealistic results under some conditions. A new correlation is proposed which overcomes many of the deficiencies

Does Pay-For-Performance Program Increase Providers Adherence to Guidelines for Managing Hepatitis B and Hepatitis C Virus Infection in Taiwan?

Science.gov (United States)

Chen, Huei-Ju; Huang, Nicole; Chen, Long-Sheng; Chou, Yiing-Jenq; Li, Chung-Pin; Wu, Chen-Yi; Chang, Yu-Chia

2016-01-01

Many people are concerned about that the quality of preventive care for patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is suboptimal. Taiwan, a hyperendemic area of chronic HBV and HCV infection, implemented a nationwide pay-for-performance (P4P) program in 2010, which aimed to improve the preventive care provided to HBV and HCV patients by increasing physicians' adherence to guidelines through financial incentives. The objective of this study was to evaluate the early effects of the P4P program on utilization of preventive services by HBV and HCV patients. Using a quasi-experimental design with propensity score matching method, we matched the HBV and HCV patients enrolled in the P4P program with non-enrollees in 2010, resulting in 21,643 patients in each group. Generalized estimating equations was applied to examine the difference-in-difference effects of P4P program enrollment on the utilization of three guideline-recommended preventive services (regular outpatient follow-up visits, abdominal ultrasonography (US) examinations, and aspartate aminotransferase and alanine aminotransferase (AST/ALT) tests by HBV and HCV patients. The P4P program enrollees were significantly more likely to attend twice-annual follow-up visits, to receive recommended US examinations and AST/ALT tests, than non-enrollees. The results of our preliminary assessment indicate that financial incentives offered by the P4P program was associated with a modest improvement in adherence to guidelines for better chronic HBV and HBC management.

Translating sickle cell guidelines into practice for primary care providers with Project ECHO

Directory of Open Access Journals (Sweden)

Lisa M. Shook

2016-11-01

Full Text Available Background: Approximately 100,000 persons with sickle cell disease (SCD live in the United States, including 15,000 in the Midwest. Unfortunately, many patients experience poor health outcomes due to limited access to primary care providers (PCPs who are prepared to deliver evidence-based SCD care. Sickle Treatment and Outcomes Research in the Midwest (STORM is a regional network established to improve care and outcomes for individuals with SCD living in Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin. Methods: STORM investigators hypothesized that Project ECHO® methodology could be replicated to create a low-cost, high-impact intervention to train PCPs in evidence-based care for pediatric and young adult patients with SCD in the Midwest, called STORM TeleECHO. This approach utilizes video technology for monthly telementoring clinics consisting of didactic and case-based presentations focused on the National Heart, Lung and Blood Institute (NHLBI evidence-based guidelines for SCD. Results: Network leads in each of the STORM states assisted with developing the curriculum and are recruiting providers for monthly clinics. To assess STORM TeleECHO feasibility and acceptability, monthly attendance and satisfaction data are collected. Changes in self-reported knowledge, comfort, and practice patterns will be compared with pre-participation, and 6 and 12 months after participation. Conclusions: STORM TeleECHO has the potential to increase implementation of the NHLBI evidence-based guidelines, especially increased use of hydroxyurea, resulting in improvements in the quality of care and outcomes for children and young adults with SCD. This model could be replicated in other pediatric chronic illness conditions to improve PCP knowledge and confidence in delivering evidence-based care.

Barriers to physician adherence to nonsteroidal anti-inflammatory drug guidelines: a qualitative study.

Science.gov (United States)

Cavazos, J M; Naik, A D; Woofter, A; Abraham, N S

2008-09-15

Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope.

The Returns to Entrepreneurship

DEFF Research Database (Denmark)

Van Praag, Mirjam; Raknerud, Arvid

Empirical studies show low pecuniary returns of switching from wage employment to entrepreneurship. We reconsider the pecuniary gains of this switching by employing a two-stage procedure, where the randomness in the timing of inheritance transfers is used as an exclusion restriction to identify...... causal effects. The model is estimated on data covering the whole Norwegian population of individuals matched to the entire population of firms established in the period 2002-2011. The results indicate that the average returns to entrepreneurship are significantly negative for individuals entering...... entrepreneurship through self-employment and modest, but significantly positive, for incorporated startups....

Gender Gap in Returns to Schooling in Palestine

Science.gov (United States)

Daoud, Yousef

2005-01-01

This study provides estimates of the private returns to schooling in Palestine utilizing eight quarterly labor force surveys for 1999 and 2001. This period was chosen to investigate the differential impact of the Israeli closure policy on Palestinian male and female workers. Although gross enrollment ratios for males and females reveal little to…

Considerations in the Diagnosis and Accelerated Return to Sport of a Professional Basketball Player With a Triceps Surae Injury: A Case Report.

Science.gov (United States)

Anloague, Philip A; Strack, Donald S

2018-05-01

Study Design Case report. Background Acute injuries of the triceps surae and Achilles tendon are common in sports. Rupture of the plantaris tendon can be challenging to diagnose. There is limited evidence detailing the diagnosis, rehabilitation, and accelerated return to sport of elite professional basketball players who have sustained calf injuries. Case Description A 25-year-old male professional basketball player sustained an injury to his calf during a professional basketball game. This case report details the presumptive diagnosis, graduated progression of intervention, and return to play of a professional athlete with a likely isolated plantaris tendon tear. Outcomes The patient returned to postseason competition 10 days post injury. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Before returning to play, the athlete showed improvements beyond the minimal clinically important difference for calf girth (2 cm) and numeric pain-rating scale score (4 points, 0-10 scale). Functional testing was conducted that included the Y Balance Test lower quarter and the Functional Movement Screen, with results that exceeded or returned the athlete to preseason levels. Discussion This report details the case of a professional basketball player who returned to competitive play in an accelerated time frame following injury to his calf. Diagnosing a plantaris tendon rupture can be challenging, and anatomical variations of this muscle should be considered. It was demonstrated in this case that physical therapy rehabilitation was helpful in making a treatment-based clinical diagnosis when imaging was unclear. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(5):388-397. Epub 6 Apr 2018. doi:10.2519/jospt.2018.7192.

Are there Diminishing Returns to R&D?

DEFF Research Database (Denmark)

Madsen, Jakob B.

Semi-endogenous models and, to some extent, also Schumpeterian models are based on the assumption of diminishing returns to R&D. This paper shows that the null hypothesis of constant returns to R&D cannot be rejected for the OECD countries......Semi-endogenous models and, to some extent, also Schumpeterian models are based on the assumption of diminishing returns to R&D. This paper shows that the null hypothesis of constant returns to R&D cannot be rejected for the OECD countries...

26 CFR 1.818-8 - Special rules relating to consolidated returns and certain capital losses.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Special rules relating to consolidated returns... Special rules relating to consolidated returns and certain capital losses. Section 818(g) provides that, in the case of a life insurance company filing or required to file a consolidated return under...

Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure

Science.gov (United States)

Raschle, Nora M.; Lee, Michelle; Buechler, Roman; Christodoulou, Joanna A.; Chang, Maria; Vakil, Monica; Stering, Patrice L.; Gaab, Nadine

2009-01-01

Within the last decade there has been an increase in the use of structural and functional magnetic resonance imaging (fMRI) to investigate the neural basis of human perception, cognition and behavior 1, 2. Moreover, this non-invasive imaging method has grown into a tool for clinicians and researchers to explore typical and atypical brain development. Although advances in neuroimaging tools and techniques are apparent, (f)MRI in young pediatric populations remains relatively infrequent 2. Practical as well as technical challenges when imaging children present clinicians and research teams with a unique set of problems 3, 2. To name just a few, the child participants are challenged by a need for motivation, alertness and cooperation. Anxiety may be an additional factor to be addressed. Researchers or clinicians need to consider time constraints, movement restriction, scanner background noise and unfamiliarity with the MR scanner environment2,4-10. A progressive use of functional and structural neuroimaging in younger age groups, however, could further add to our understanding of brain development. As an example, several research groups are currently working towards early detection of developmental disorders, potentially even before children present associated behavioral characteristics e.g.11. Various strategies and techniques have been reported as a means to ensure comfort and cooperation of young children during neuroimaging sessions. Play therapy 12, behavioral approaches 13, 14,15, 16-18 and simulation 19, the use of mock scanner areas 20,21, basic relaxation 22 and a combination of these techniques 23 have all been shown to improve the participant's compliance and thus MRI data quality. Even more importantly, these strategies have proven to increase the comfort of families and children involved 12. One of the main advances of such techniques for the clinical practice is the possibility of avoiding sedation or general anesthesia (GA) as a way to manage children

SECTORAL RISK AND RETURN FOR COMPANIES IN ROMANIA

Directory of Open Access Journals (Sweden)

Anis Cecilia

2012-12-01

Full Text Available probability that cash flows or return will vary from expectations. Standard corporate finance theory supposes that a company chooses a capital structure that maximizes company value. A fundamental idea in finance is the relationship between risk and return. The greater the amount of risk that an investor is willing to take on, the greater the potential return. The reason for this is that investors need to be compensated for taking on additional risk. Why put capital at significant risk for a return that is no higher than the return on government bonds? Or expect higher than averages returns from low-risk activities? It is impossible to separate measuring the performance of a company from the risks that the management takes to achieve it.In most aspects of company operations, risk assessment plays a different but equally important, role. It is an integral part of informed decision taking in achieving performance. Risk assessment is involved from the highest level in strategic choices about what activities to undertake, what assets to buy or what markets to serve all the way to detailed operational decisions about whether to accept payment in foreign currencies and the adequacy of safety measures in the workplace. It plays a part whether or not an organization is aware of managing risk and many managers feel that their instinct and judgment are enough – a behavior risk. The danger is that this leaves company risk unplanned and unmanaged. This paper proposes a framework where we realized a study cases: we test if return on assets and return on equity has influence on the risk, both on long and short term. For this purposes, we conduct an empirical research that covers 59 selected companies traded at the Bucharest Stock Exchange within the time period 1999-2010. For this study our results reveal that dynamic global risk can be associated to a low intensity with total assets performance of the company’s. Investments efficiency and the

IRB PERSPECTIVES ON THE RETURN OF INDIVIDUAL RESULTS FROM GENOMIC RESEARCH

Science.gov (United States)

Dressler, Lynn G.; Smolek, Sondra; Ponsaran, Roselle; Markey, Janell M.; Starks, Helene; Gerson, Nancy; Lewis, Susan; Press, Nancy; Juengst, Eric; Wiesner, Georgia L.

2012-01-01

Purpose Return of individual research results from genomic studies is a hotly debated ethical issue in genomic research. However, the perspective of key stakeholders—Institutional Review Board (IRB) reviewers—has been missing from this dialogue. This study explores the positions and experiences of IRB members and staff regarding this issue. Methods In depth interviews with 31 IRB professionals at six sites across the United States. Results IRB professionals agreed that research results should be returned to research participants when results are medically actionable but only if the participants wanted to know the result. Many respondents expected researchers to address the issue of return of results (ROR) in the IRB application and informed-consent document. Many respondents were not comfortable with their expertise in genomics research, and only a few described actual experiences in addressing ROR. Although participants agreed that guidelines would be helpful, most were reticent to develop them in isolation. Even where IRB guidance exists (e.g., CLIA lab certification required for return), in practice, the guidance has been overruled to allow return (e.g., no CLIA lab performs the assay). Conclusion An IRB-researcher partnership is needed to help inform responsible and feasible institutional approaches to returning research results. PMID:22241094

Hypertension guideline implementation: experiences of Finnish primary care nurses

DEFF Research Database (Denmark)

Alanen, Seija; Ijäs, Jarja; Kaila, Minna

2008-01-01

RATIONALE, AIMS AND OBJECTIVES: Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses. METHOD: We assessed the style of implementation and adoption of the national...... Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers...... were telephoned to enquire if the implementation of the HT Guideline had led to a new division of labour between nurses and doctors. RESULTS: Questionnaires were returned from 327 nurses (80.0%), while all senior nursing officers (n = 32) were contacted. The majority of nurses were of the opinion...

Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes.

Science.gov (United States)

Ardern, Clare L; Taylor, Nicholas F; Feller, Julian A; Whitehead, Timothy S; Webster, Kate E

2015-04-01

A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. Case series; Level of evidence, 4. A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2

26 CFR 20.6018-2 - Returns; person required to file return.

Science.gov (United States)

2010-04-01

... executor or administrator shall file the return. If there is more than one executor or administrator, the return must be made jointly by all. If there is no executor or administrator appointed, qualified and... decedent situated in the United States is constituted an executor for purposes of the tax (see § 20.2203-1...

Using research metrics to evaluate the International Atomic Energy Agency guidelines on quality assurance for R&D

Energy Technology Data Exchange (ETDEWEB)

Bodnarczuk, M.

1994-06-01

The objective of the International Atomic Energy Agency (IAEA) Guidelines on Quality Assurance for R&D is to provide guidance for developing quality assurance (QA) programs for R&D work on items, services, and processes important to safety, and to support the siting, design, construction, commissioning, operation, and decommissioning of nuclear facilities. The standard approach to writing papers describing new quality guidelines documents is to present a descriptive overview of the contents of the document. I will depart from this approach. Instead, I will first discuss a conceptual framework of metrics for evaluating and improving basic and applied experimental science as well as the associated role that quality management should play in understanding and implementing these metrics. I will conclude by evaluating how well the IAEA document addresses the metrics from this conceptual framework and the broader principles of quality management.

Manager Experiences with the Return to Work Process in a Large, Publically Funded, Hospital Setting

DEFF Research Database (Denmark)

Stochkendahl, Mette Jensen; Myburgh, Corrie; Young, Amanda Ellen

2015-01-01

Purpose Previous research on the role of managers in the return to work (RTW) process has primarily been conducted in contexts where the workplace has declared organizational responsibility for the process. While this is a common scenario, in some countries, including Denmark, there is no explicit......, organizational, and policy factors. Instances were observed where supervisors faced the dilemma of balancing ethical and managerial principles with requirements of keeping staffing budgets. Conclusion Although it is not their legislative responsibility, Danish managers play a key role in the RTW process. As has...... been observed in other contexts, Danish supervisors struggle to balance considerations for the returning worker with those of their teams....

Guidelines for providing privileges and credentials to physicians for transvaginal placement of surgical mesh for pelvic organ prolapse.

Science.gov (United States)

2012-01-01

The adoption of new technology or procedures into a clinician's surgical armamentarium is driven by multiple factors. Patient safety and anticipated long-term improvement in outcomes should be the primary objective that guides a surgeon's decision to deliver care involving new procedures. Surgically complex procedures require a balance of knowledge, surgical skill, and experience, with appropriate ongoing surgical volume and monitoring of outcomes and adverse events. Transvaginal placement of surgical mesh for pelvic organ prolapse has the potential to improve quality of life and anatomic outcomes (especially in the anterior compartment), but also has potential serious adverse events as outlined by the FDA's July 2011 Safety Communication. This document provides Guidelines for privileging and credentialing of physicians planning to implement or continue using this new technology in clinical practice.

26 CFR 301.6679-1 - Failure to file returns, etc. with respect to foreign corporations or foreign partnerships for...

Science.gov (United States)

2010-04-01

... foreign corporations or foreign partnerships for taxable years beginning after September 3, 1982. 301.6679... returns, etc. with respect to foreign corporations or foreign partnerships for taxable years beginning... thereunder, who fails to file such a return within the time provided, or who files a return which does not...

OSART guidelines

International Nuclear Information System (INIS)

1988-02-01

The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the operational safety of nuclear power plants. These OSART Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of the operational safety review. Specific guidelines are provided as guide for the systematic review in the following areas important to operational safety: management, organization and administration, training and qualification, operations, maintenance, technical support, radiation protection, chemistry, emergency planning and preparedness

Who among patients with acquired brain injury returned to work after occupational rehabilitation? The rapid-return-to-work-cohort-study.

Science.gov (United States)

Aas, Randi Wågø; Haveraaen, Lise Aasen; Brouwers, Evelien P M; Skarpaas, Lisebet Skeie

2017-07-20

Acquired brain injury (ABI) is known to be severely disabling. On average, 40% of employees return to work (RTW) within two years after injury. There is, however, limited research on what might contribute to successful RTW. To examine factors that might impact the time-to first RTW for patients with ABI, participating in a RTW-program. The study was designed as a cohort study of patients on sick leave due to mild or moderate ABI (n = 137). The mean age of the patients was 51 years, and 58% were men. The most common diagnoses were stroke (75%) and traumatic brain injury (12%). Data were collected through questionnaires, and combined with register data on sickness absence. Survival analyses were used to analyse the effect of different variables on time to first RTW (full or partial), at one- and two-year follow-up. Generally, women (HR = 0.447; CI: 0.239-0.283) had higher RTW-rates than men, and patients with non-comorbid impairments returned to work earlier than patients with multiple impairments. Although not statistically significant, receiving individual consultations and participating in group-sessions were generally associated with a delayed RTW at both follow-up-times. The only service-related factor significantly associated with delayed RTW was meetings with the social insurance office (HR = 0.522; CI: 0.282-0.965), and only at one-year follow-up. Women and patients with non-comorbid impairments returned to work earlier than men and patients with multiple impairments. There seems to be an association between intense and long-lasting participation in the RTW program and prolonged time-to first-RTW, even after controlling for level of cognitive impairments and comorbidity. Implications for Rehabilitation Acquired brain injury (ABI) is known to be severely disabling, and persons with ABI often experience difficulties in regard to returning to work. This study provides information on prognostic factors that might contribute to return to work (RTW

Do expectancies of return to work and Job satisfaction predict actual return to work in workers with long lasting LBP?

Science.gov (United States)

Opsahl, Jon; Eriksen, Hege R; Tveito, Torill H

2016-11-17

Musculoskeletal disorders including low back pain have major individual and socioeconomic consequences as it often leads to disability and long-term sick leave and exclusion from working life. Predictors of disability and return to work often differ, and the dominant knowledge is on predictors for prolonged sick leave and disability. Therefore it is also important to identify key predictors for return to work. The aim of the study was to assess if overall job satisfaction and expectancies of return to work predicts actual return to work after 12 months, among employees with long lasting low back pain, and to assess if there were gender differences in the predictors. Data from the Cognitive interventions and nutritional supplements trial (CINS Trial) was used. Predictors for return to work were examined in 574 employees that had been on sick leave 2-10 months for low back pain, before entering the trial. Data were analysed with multiple logistic regression models stratified by gender, and adjusted for potential confounders. Regardless of gender high expectancies were a strong and significant predictor of return to work at 12 months, while high levels of job satisfaction were not a significant predictor. There were no differences in the levels of expectancies or overall job satisfaction between men and women. However, men had in general higher odds of returning to work compared with women. Among individuals with long lasting low back pain high expectancies of returning to work were strongly associated with successful return to work. We do not know what factors influence individual expectancies of return to work. Screening expectancies and giving individuals with low expectancies interventions with a goal to change expectancies of return to work, such as CBT or self-management interventions, may contribute to increase actual return to work. http://www.clinicaltrials.gov/ , with registration number NCT00463970 . The trial was registered at the 18th of April 2007.

The role of remote voting in encouraging return

Directory of Open Access Journals (Sweden)

Djordje Stefanovic

2015-09-01

Full Text Available Once there is a genuine possibility of going home, what influences a forced migrant’s decision to return to a pre-conflict residence, often in the face of very difficult conditions? What role can remote voting play?

Firm Efficiency and Returns-to-Scale in the Honey Bee Pollination Services Industry.

Science.gov (United States)

Jones Ritten, Chian; Peck, Dannele; Ehmke, Mariah; Patalee, M A Buddhika

2018-04-03

While the demand for pollination services have been increasing, continued declines in honey bee, Apis mellifera L. (Hymenoptera: Apidae), colonies have put the cropping sector and the broader health of agro-ecosystems at risk. Economic factors may play a role in dwindling honey bee colony supply in the United States, but have not been extensively studied. Using data envelopment analysis (DEA), we measure technical efficiency, returns to scale, and factors influencing the efficiency of those apiaries in the northern Rocky Mountain region participating in the pollination services market. We find that, although over 25% of apiaries are technically efficient, many experience either increasing or decreasing returns to scale. Smaller apiaries (under 80 colonies) experience increasing returns to scale, but a lack of available financing may hinder them from achieving economically sustainable colony levels. Larger apiaries (over 1,000 colonies) experience decreasing returns to scale. Those beekeepers may have economic incentivizes to decrease colony numbers. Using a double bootstrap method, we find that apiary location and off-farm employment influence apiary technical efficiency. Apiaries in Wyoming are found to be more efficient than those in Utah or Montana. Further, engagement in off-farm employment increases an apiary's technical efficiency. The combined effects of efficiency gains through off-farm employment and diseconomies of scale may explain, in part, the historical decline in honey bee numbers.

[Standards and guidelines of radiation protection and safety in dental X-ray examinations].

Science.gov (United States)

Guo, X L; Li, G; Cheng, Y; Yu, Q; Wang, H; Zhang, Z Y

2017-12-09

With the rapid development of imaging technology, the application of dental imaging in diagnosis, treatment planning, intraoperative surgical navigation, monitoring of treatment or lesion development and assessment of treatment outcomes is playing an essential role in oral healthcare. The increased total number of dental X-ray examinations is accompanied by a relatively significant increase in collective dose to patients as well as to dental healthcare workers, which is harmful to human bodies to a certain degree. Some radiation protection standards and guidelines in dental radiology have been published in European countries, US, Canada and Australia, etc. Adherence to these standards and guidelines helps to achieve images with diagnostic quality and avoid unnecessary and repeated exposures. However, no radiation protection standard or guideline with regard to dental X-ray examinations has been put in force so far in mainland China. Therefore, a literature review on available radiation protection standards and guidelines was conducted to provide reference to the development of radiation protection standards or guidelines in mainland China.

Does graded return-to-work improve sick-listed workers' chance of returning to regular working hours?

Science.gov (United States)

Høgelund, Jan; Holm, Anders; McIntosh, James

2010-01-01

Using Danish register and survey data, we examine the effect of a national graded return-to-work program on the probability of sick-listed workers returning to regular working hours. During program participation, the sick-listed worker works fewer hours and receives the normal hourly wage for the hours worked and sickness benefit for the hours off work. When the worker's health improves, working hours are increased until the sick-listed worker is able to work regular hours. Taking account of unobserved differences between program participants and non-participants, we find that participation in the program significantly increases the probability of returning to regular working hours. Copyright 2009 Elsevier B.V. All rights reserved.

Spatially dynamic forest management to sustain biodiversity and economic returns.

Science.gov (United States)

Mönkkönen, Mikko; Juutinen, Artti; Mazziotta, Adriano; Miettinen, Kaisa; Podkopaev, Dmitry; Reunanen, Pasi; Salminen, Hannu; Tikkanen, Olli-Pekka

2014-02-15

Production of marketed commodities and protection of biodiversity in natural systems often conflict and thus the continuously expanding human needs for more goods and benefits from global ecosystems urgently calls for strategies to resolve this conflict. In this paper, we addressed what is the potential of a forest landscape to simultaneously produce habitats for species and economic returns, and how the conflict between habitat availability and timber production varies among taxa. Secondly, we aimed at revealing an optimal combination of management regimes that maximizes habitat availability for given levels of economic returns. We used multi-objective optimization tools to analyze data from a boreal forest landscape consisting of about 30,000 forest stands simulated 50 years into future. We included seven alternative management regimes, spanning from the recommended intensive forest management regime to complete set-aside of stands (protection), and ten different taxa representing a wide variety of habitat associations and social values. Our results demonstrate it is possible to achieve large improvements in habitat availability with little loss in economic returns. In general, providing dead-wood associated species with more habitats tended to be more expensive than providing requirements for other species. No management regime alone maximized habitat availability for the species, and systematic use of any single management regime resulted in considerable reductions in economic returns. Compared with an optimal combination of management regimes, a consistent application of the recommended management regime would result in 5% reduction in economic returns and up to 270% reduction in habitat availability. Thus, for all taxa a combination of management regimes was required to achieve the optimum. Refraining from silvicultural thinnings on a proportion of stands should be considered as a cost-effective management in commercial forests to reconcile the conflict

49 CFR Appendix F to Part 240 - Medical Standards Guidelines

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Medical Standards Guidelines F Appendix F to Part 240 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD.... F Appendix F to Part 240—Medical Standards Guidelines (1) The purpose of this appendix is to provide...

Influence of Planetary Protection Guidelines on Waste Management Operations

Science.gov (United States)

Hogan, John A.; Fisher, John W.; Levri, Julie A.; Wignarajah, Kanapathipi; Race, Margaret S.; Stabekis, Perry D.; Rummel, John D.

2005-01-01

Newly outlined missions in the Space Exploration Initiative include extended human habitation on Mars. During these missions, large amounts of waste materials will be generated in solid, liquid and gaseous form. Returning these wastes to Earth will be extremely costly, and will therefore likely remain on Mars. Untreated, these wastes are a reservoir of live/dead organisms and molecules considered to be "biomarkers" i.e., indicators of life). If released to the planetary surface, these materials can potentially confound exobiology experiments and disrupt Martian ecology indefinitely (if existent). Waste management systems must therefore be specifically designed to control release of problematic materials both during the active phase of the mission, and for any specified post-mission duration. To effectively develop waste management requirements for Mars missions, planetary protection guidelines must first be established. While previous policies for Apollo lunar missions exist, it is anticipated that the increased probability of finding evidence of life on Mars, as well as the lengthy mission durations will initially lead to more conservative planetary protection measures. To facilitate the development of overall requirements for both waste management and planetary protection for future missions, a workshop was conducted to identify how these two areas interface, and to establish a preliminary set of planetary protection guidelines that address waste management operations. This paper provides background regarding past and current planetary protection and waste management issues, and their interactions. A summary of the recommended planetary protection guidelines, anticipated ramifications and research needs for waste management system design for both forward (Mars) and backward (Earth) contamination is also provided.

EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma

Energy Technology Data Exchange (ETDEWEB)

Bluemel, Christina; Herrmann, Ken; Lassmann, Michael [Universitaetsklinikum Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Giammarile, Francesco; Dubreuil, Julien [Universite Claude Bernard Lyon 1, Medecine Nucleaire, Hospices Civils de Lyon and EA 3738, Lyon (France); Nieweg, Omgo E.; Chakera, Annette H. [The Poche Centre, Melanoma Institute Australia, North Sydney (Australia); Testori, Alessandro [European Institute of Oncology, Milan (Italy); Audisio, Riccardo A. [University of Liverpool, St Helens Teaching Hospital, St Helens (United Kingdom); Zoras, Odysseas [University Hospital of Heraklion, Department of Surgical Oncology, Heraklion (Greece); Uren, Roger [The University of Sydney, Sydney Medical School, Sydney, NSW (Australia); Alfred Nuclear Medicine and Ultrasound, RPAH Medical Centre, Newtown, NSW (Australia); Chondrogiannis, Sotirios; Rubello, Domenico [' Santa Maria della Misericordia' Hospital, Department of Nuclear Medicine, PET/CT Centre, Radiology, NeuroRadiology, Medical Physics, Rovigo (Italy); Colletti, Patrick M. [University of Southern California, Department of Radiology, Los Angeles, CA (United States)

2015-10-15

Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized melanoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with melanoma. These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, national nuclear medicine societies, the European Society of Surgical Oncology (ESSO) and the European Association for Research and Treatment of Cancer (EORTC) melanoma group. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of melanoma patients. (orig.)

Stochastic arbitrage return and its implications for option pricing

OpenAIRE

Fedotov, Sergei; Panayides, Stephanos

2004-01-01

The purpose of this work is to explore the role that arbitrage opportunities play in pricing financial derivatives. We use a non-equilibrium model to set up a stochastic portfolio, and for the random arbitrage return, we choose a stationary ergodic random process rapidly varying in time. We exploit the fact that option price and random arbitrage returns change on different time scales which allows us to develop an asymptotic pricing theory involving the central limit theorem for random proces...

Different forms, reasons and motivations for return migration of persons who voluntarily decide to return to their countries of origin.

Science.gov (United States)

Callea, S

1986-03-01

Although the 1973 oil crisis did not have the drastic effects on immigration which were originally feared, it did end a period of quasi-liberal immigration policy, establish intense and effective international cooperation on immigration, and arouse great interest in immigration studies and research. This paper analyzes the situations arising as a result of the petroleum shortage and focuses on the conditions relating to the return of emigrants to Southern European countries. This new research draws attention to the following fundamental aspects of the immigration problem: 1) the emigrant's return to his homeland cannot be considered a factor in development; it is a positive element in development only if the right socioeconomic conditions exist in the country of origin. 2) Concern for children's education is one of the most common reasons for return. 3) A large percentage of emigrants are satisfied with their work abroad. 4) An emigrant's return potential is wasted due to the slight use that is made of the resources he offers. 5) Returning workers most often want to set up an independent enterprise. 6) Savings are generally used to buy a house or farm. 7) Vocational level does not increase significantly between emigration and returning, though this increase becomes greater the longer the emigrant stays abroad. 8) The number of returning emigrants is too slight to bring about any change in the country of origin. 9) Incentives and subsidies to encourage return have not had a considerable impact on the decision to return. Callea recommends that officials of the country of origin posted abroad be assigned to counsel returning emigrants on finding employment, attending vocational development courses, obtaining housing, accruing interests and savings, and on the problems and perspectives of sociocultural reintegration.

Motivators and barriers to returning to school: RN to BSN.

Science.gov (United States)

Romp, Celeste R; Kiehl, Ermalynn M; Bickett, Anette; Bledsoe, Sarah F; Brown, Debbie S; Eitel, Stephanie B; Wall, Mary Patricia

2014-01-01

With national emphasis on increasing baccalaureate-prepared nurses, the role of the staff development educator of promoting lifelong learning is ideal for advising and mentoring non-bachelor's-prepared nurses to return to school. However, an understanding of the motivators and barriers for nurses to return to school is essential for success. A descriptive correlational research study was completed to determine the motivators and barriers of returning to school for registered nurses without a bachelor's degree.

Experiences of returning to elite beach volleyball after shoulder injury.

Science.gov (United States)

Bele, Sofie; Östenberg, Anna Hafsteinsson; Sjöström, Rita; Alricsson, Marie

2015-08-01

The purpose of this study was to examine beach volleyball players' experience regarding shoulder injury and how it affects their return to play. To achieve the research aims a qualitative design with semi-structured interviews had been conducted, five elite beach volleyball players, four men and one woman aged 27-42 participated in the study. All participants had suffered a severe shoulder injury, with absence from training and competing for at least 28 days. The findings of this study indicate that it is the individual's inner motivation, together with a clear goal and support from the community, family, teammate and coach that are the most important factors when going through rehabilitation and getting back to playing beach volleyball after a shoulder injury. All participants had been affected by their injury in some way; some of the participants had been affected in a positive way since they had become mentally stronger and had developed better volleyball technique after rehabilitation. The conclusions of this study indicate that there are three distinct factors that increase the chances of getting back to playing beach volleyball after shoulder injury; it is the players' self motivation, together with a clear goal and support from the community.

Going Back Part-time: Family Leave Legislation and Women's Return to Work.

Science.gov (United States)

Schott, Whitney

2012-02-01

Using a multinomial logit model with data from the Survey of Income and Program Participation, this paper tests whether the implementation of the Family and Medical Leave Act (FMLA) is associated with an increase in return to work at part-time status among first-time mothers working full-time during their pregnancy. I find a statistically significant trend of increasingly higher odds of returning to work at part-time status relative to return at full-time status, beginning in 1993 (the year in which the FMLA is implemented). Furthermore, an additional week of either state or federal leave is significantly associated with a higher odds of return at part-time status. This article provides evidence that job protection and leave legislation may help facilitate higher levels of labor force participation among women with small children, through more flexible work arrangements.

Index-TB Guidelines: Guidelines on extrapulmonary tuberculosis for India

Science.gov (United States)

Sharma, Surendra K.; Ryan, H.; Khaparde, Sunil; Sachdeva, K. S.; Singh, Achintya D.; Mohan, Alladi; Sarin, Rohit; Paramasivan, C N; Kumar, Prahlad; Nischal, Neeraj; Khatiwada, Saurav; Garner, Paul; Tharyan, Prathap

2017-01-01

Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research. PMID:28862176

Estimating returns to scale and scale efficiency for energy consuming appliances

Energy Technology Data Exchange (ETDEWEB)

Blum, Helcio [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Efficiency Standards Group; Okwelum, Edson O. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Efficiency Standards Group

2018-01-18

Energy consuming appliances accounted for over 40% of the energy use and $17 billion in sales in the U.S. in 2014. Whether such amounts of money and energy were optimally combined to produce household energy services is not straightforwardly determined. The efficient allocation of capital and energy to provide an energy service has been previously approached, and solved with Data Envelopment Analysis (DEA) under constant returns to scale. That approach, however, lacks the scale dimension of the problem and may restrict the economic efficient models of an appliance available in the market when constant returns to scale does not hold. We expand on that approach to estimate returns to scale for energy using appliances. We further calculate DEA scale efficiency scores for the technically efficient models that comprise the economic efficient frontier of the energy service delivered, under different assumptions of returns to scale. We then apply this approach to evaluate dishwashers available in the market in the U.S. Our results show that (a) for the case of dishwashers scale matters, and (b) the dishwashing energy service is delivered under non-decreasing returns to scale. The results further demonstrate that this method contributes to increase consumers’ choice of appliances.

Maternal depression, pregnancy intention, and return to paid work after childbirth.

Science.gov (United States)

Dagher, Rada K; Hofferth, Sandra L; Lee, Yoonjoo

2014-01-01

Maternal depression is an important public health issue for women, their families, and their employers. Previous studies have examined the impact of leave duration on maternal depression, but none have studied the association between maternal depression and the pace of return to paid work. We examine herein the relationship between maternal depression and return to work, and the moderating effects of pregnancy intention. We utilized data from the Listening to Mothers II Survey collected from January 20 through February 21, 2006. The woman had to be 18 to 45 years old, speak English, and have given birth in 2005 to a live singleton baby in a U.S. hospital. Our analyses were limited to women who worked for an employer during pregnancy (n = 882). The primary outcome was return to paid work at the time of the interview and the analyses utilized Cox proportional hazard models. In combination, intending the baby and being depressed suppressed return to paid work. Nondepressed mothers with unintended pregnancies returned to work the soonest. Compared with mothers who were not depressed and with unintended pregnancy, the risk ratio of returning to paid work (0.70) was significantly lower for mothers who were depressed and had an intended pregnancy. Mothers who were not depressed and with intended pregnancy also had a significantly lower risk ratio (0.60) of returning to paid work than those who were not depressed and with unintended pregnancy. Primary care providers and policy makers can use these findings to support employed women in their childbearing years. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Measuring the Effect of Exchange Rate Movements on Stock Market Returns Volatility: GARCH Model

Directory of Open Access Journals (Sweden)

Abdelkadir BESSEBA

2017-06-01

Full Text Available This paper aims to investigate the dynamic links between exchange rate fluctuations and stock market return volatility. For this purpose, we have employed a Generalized Autoregressive Conditional Heteroscedasticity model (GARCH model. Stock market returns sensitivities are found to be stronger for exchange rates, implying that exchange rate change plays an important role in determining the dynamics of the stock market returns.

Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

Science.gov (United States)

Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

2012-01-01

Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

The Importance of Meteorite Collections to Sample Return Missions: Past, Present, and Future Considerations

Science.gov (United States)

Welzenbach, L. C.; McCoy, T. J.; Glavin, D. P.; Dworkin, J. P.; Abell, P. A.

2012-01-01

While much of the scientific community s current attention is drawn to sample return missions, it is the existing meteorite and cosmic dust collections that both provide the paradigms to be tested by these missions and the context for interpreting the results. Recent sample returns from the Stardust and Hayabusa missions provided us with new materials and insights about our Solar System history and processes. As an example, Stardust sampled CAIs among the population of cometary grains, requiring extensive and unexpected radial mixing in the early solar nebula. This finding would not have been possible, however, without extensive studies of meteoritic CAIs that established their high-temperature, inner Solar System formation. Samples returned by Stardust also revealed the first evidence of a cometary amino acid, a discovery that would not have been possible with current in situ flight instrument technology. The Hayabusa mission provided the final evidence linking ordinary chondrites and S asteroids, a hypothesis that developed from centuries of collection and laboratory and ground-based telescopic studies. In addition to these scientific findings, studies of existing meteorite collections have defined and refined the analytical techniques essential to studying returned samples. As an example, the fortuitous fall of the Allende CV3 and Murchison CM2 chondrites within months before the return of Apollo samples allowed testing of new state-of-the-art analytical facilities. The results of those studies not only prepared us to better study lunar materials, but unanticipated discoveries changed many of our concepts about the earliest history and processes of the solar nebula. This synergy between existing collections and future space exploration is certainly not limited to sample return missions. Laboratory studies confirmed the existence of meteorites from Mars and raised the provocative possibility of preservation of ancient microbial life. The laboratory studies in

Doctors' health: obstacles and enablers to returning to work.

Science.gov (United States)

Cohen, D; Rhydderch, M; Reading, P; Williams, S

2015-08-01

For doctors returning to work after absence due to ill-health or performance concerns, the obstacles can seem insurmountable. Doctors' perspectives of these obstacles have been investigated. To support them more effectively, the perspectives of organizations that interact with such doctors should also be considered. To explore the obstacles and enablers to doctors' return to work after long-term absence from the perspective of key organizations involved in assessment and support. We identified organizations operating in the field of doctors' health, well-being and performance. We conducted semi-structured, 30-45 min telephone interviews with representatives of the organizations, exploring problems that they had encountered that were experienced by doctors with health or performance concerns returning to work after absence of a month or longer. We analysed our field notes using theoretical analysis. We conducted 11 telephone interviews. Data analysis identified four key themes of obstacles and enablers to returning to work: 'communication', 'return to work', 'finance and funding' and 'relationships and engagement'. Sub-themes relating to the organization and the individual also emerged. Organizations responsible for supporting doctors back to work reported poor communication as a significant obstacle to doctors returning to work after illness. They also reported differences between specialities, employing organizations, occupational health departments and human resources in terms of knowledge and expertise in supporting doctors with complex issues. Clear communication channels, care pathways and support processes, such as workplace advocates, were perceived as strong enablers to return to work for doctors after long-term absence. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

D 59 Design Guidelines

DEFF Research Database (Denmark)

Burcharth, Hans F.; Lamberti, Alberto

The present guidelines are specifically dedicated to Low Crested Structures on attempt to provide methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts. It is anticipated that the guidelines will provide valuable inputs to c...

75 FR 76940 - Specified Tax Return Preparers Required To File Individual Income Tax Returns Using Magnetic...

Science.gov (United States)

2010-12-10

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 1 and 301 [REG-100194-10] RIN 1545-BJ52 Specified Tax Return Preparers Required To File Individual Income Tax Returns Using Magnetic... for ``specified tax return prepares,''. FOR FURTHER INFORMATION CONTACT: Keith L. Brau at (202) 622...

20 CFR 216.24 - Relinquishment of rights to return to work.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Relinquishment of rights to return to work... of rights to return to work. (a) What return to work rights must be given up. Before an individual... work for any railroad employer. (b) When right to return to work is ended. An individual's right to...

640 Gbit/s return-to-zero to non-return-to-zero format conversion based on optical linear spectral phase filtering

DEFF Research Database (Denmark)

Maram, Reza; Kong, Deming; Galili, Michael

2016-01-01

We propose a novel approach for all-optical return-to-zero (RZ) to non-return-to-zero (NRZ) telecommunication data format conversion based on linear spectral phase manipulation of an RZ data signal. The operation principle is numerically analyzed and experimentally validated through successful fo...

Risk-return relationship in a complex adaptive system.

Directory of Open Access Journals (Sweden)

Kunyu Song

Full Text Available For survival and development, autonomous agents in complex adaptive systems involving the human society must compete against or collaborate with others for sharing limited resources or wealth, by using different methods. One method is to invest, in order to obtain payoffs with risk. It is a common belief that investments with a positive risk-return relationship (namely, high risk high return and vice versa are dominant over those with a negative risk-return relationship (i.e., high risk low return and vice versa in the human society; the belief has a notable impact on daily investing activities of investors. Here we investigate the risk-return relationship in a model complex adaptive system, in order to study the effect of both market efficiency and closeness that exist in the human society and play an important role in helping to establish traditional finance/economics theories. We conduct a series of computer-aided human experiments, and also perform agent-based simulations and theoretical analysis to confirm the experimental observations and reveal the underlying mechanism. We report that investments with a negative risk-return relationship have dominance over those with a positive risk-return relationship instead in such a complex adaptive systems. We formulate the dynamical process for the system's evolution, which helps to discover the different role of identical and heterogeneous preferences. This work might be valuable not only to complexity science, but also to finance and economics, to management and social science, and to physics.

Risk-return relationship in a complex adaptive system.

Science.gov (United States)

Song, Kunyu; An, Kenan; Yang, Guang; Huang, Jiping

2012-01-01

For survival and development, autonomous agents in complex adaptive systems involving the human society must compete against or collaborate with others for sharing limited resources or wealth, by using different methods. One method is to invest, in order to obtain payoffs with risk. It is a common belief that investments with a positive risk-return relationship (namely, high risk high return and vice versa) are dominant over those with a negative risk-return relationship (i.e., high risk low return and vice versa) in the human society; the belief has a notable impact on daily investing activities of investors. Here we investigate the risk-return relationship in a model complex adaptive system, in order to study the effect of both market efficiency and closeness that exist in the human society and play an important role in helping to establish traditional finance/economics theories. We conduct a series of computer-aided human experiments, and also perform agent-based simulations and theoretical analysis to confirm the experimental observations and reveal the underlying mechanism. We report that investments with a negative risk-return relationship have dominance over those with a positive risk-return relationship instead in such a complex adaptive systems. We formulate the dynamical process for the system's evolution, which helps to discover the different role of identical and heterogeneous preferences. This work might be valuable not only to complexity science, but also to finance and economics, to management and social science, and to physics.

Financial Burden Associated with Time to Return to Work After Living Kidney Donation.

Science.gov (United States)

Larson, Dawn B; Wiseman, Jennifer F; Vock, David; Bergund, Danielle M; Roman, Ashley; Ibrahim, Hassan Nimer; Matas, Arthur J

2018-05-25

Many living kidney donors undertake a significant financial burden in order to donate. We studied the association between time to return to work and reported financial burden. Kidney donors, who donated from 2/2005 - through 12/2015 (n=1012) were surveyed 6 months postdonation, and asked about occupation; time to return to work; and financial burden (on a 10-point Likert scale). Of 856 donors working for pay, 629 (73%) responded. After adjusting for donor characteristics, increased length of time to return to work was a significant predictor of financial burden (pfinancial burden for each week away from work (p=0.003). Older age at donation and nondirected (vs directed) donation were associated with significantly decreased financial burden. These observations provide additional information to better inform donor candidates, and further emphasize the need to develop policies so that living kidney donation can be financially neutral. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Attitudes towards disability management: A survey of employees returning to work and their supervisors.

Science.gov (United States)

Busse, Jason W; Dolinschi, Roman; Clarke, Andrew; Scott, Liz; Hogg-Johnson, Sheilah; Amick, Benjamin C; Rivilis, Irina; Cole, Donald

2011-01-01

Return to work after a leave on disability is a common phenomenon, but little is known about the attitudes of employees or their supervisors towards the disability management process. We report on employee and supervisor feedback from one disability management experience. 389 consecutive employees from the Ontario offices of a single private Canadian insurance company returning to work from short-term disability, and their supervisors. We surveyed employees and their supervisors about their experience with, and attitudes towards, the disability management process. Of those surveyed, 88 employees and 75 supervisors provided data (response rates of 22.6% and 19.3% respectively). The majority of respondents (79.1% of employees and supervisors) endorsed positive attitudes towards their disability management experience. More than 25% of employees disagreed with the following three items: case managers contributed to recovery, case managers removed barriers to recovery, and sufficient support was provided in the return to work process. More than 25% of employees and managers reported that a commitment to modify an unhelpful work situation was not followed through. The majority of participating employees returning to work from short-term disability, and their supervisors, reported a high level of satisfaction with the disability management process. Areas that may benefit from attention include some aspects of case manager-employee interaction and ensuring that support during the return to work process is provided, including modification to work situations when appropriate.

Returning to sports after a back injury

Science.gov (United States)

... medlineplus.gov/ency/patientinstructions/000518.htm Returning to sports after a back injury To use the sharing ... Back pain - returning to sports Which Type of Sport is Best? In deciding when and if to ...

Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India

Directory of Open Access Journals (Sweden)

Surendra K Sharma

2017-01-01

Full Text Available Extrapulmonary tuberculosis (EPTB is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i use of Xpert MTB/RIF in diagnosis, (ii use of adjunct corticosteroids in treatment, and (iii duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

Health service providers in Somalia: their readiness to provide malaria case-management.

Science.gov (United States)

Noor, Abdisalan M; Rage, Ismail A; Moonen, Bruno; Snow, Robert W

2009-05-13

Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT) or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53.1% prescribed chloroquine as first-line therapy. 31.4% of

Health service providers in Somalia: their readiness to provide malaria case-management

Directory of Open Access Journals (Sweden)

Moonen Bruno

2009-05-01

Full Text Available Abstract Background Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Methods Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. Results There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53

Teaching clinical interviewing skills using role-playing: conveying empathy to performing a suicide assessment: a primer for individual role-playing and scripted group role-playing.

Science.gov (United States)

Shea, Shawn Christopher; Barney, Christine

2015-03-01

This article provides a useful introduction to the art of role-playing in both the individual format and the group format using scripted group role-playing (SGRP). Role-playing can provide powerful learning opportunities, but to do so it must be done well. This article imparts guidance toward this goal. SGRP may greatly enhance the acquisition of critical complex interviewing skills, such as suicide assessment and uncovering domestic violence, in health care providers across all disciplines, an educational goal that has not been achievable to date. Although research is at an early stage of development, the hope represented by SGRP is tangible. Copyright © 2015 Elsevier Inc. All rights reserved.

Temporal Oculomotor Inhibition of Return and Spatial Facilitation of Return in a Visual Encoding Task

Directory of Open Access Journals (Sweden)

Steven G Luke

2013-07-01

Full Text Available Oculomotor inhibition of return (O-IOR is an increase in saccade latency prior to an eye movement to a recently fixated location compared to other locations. It has been proposed that this temporal O-IOR may have spatial consequences, facilitating foraging by inhibiting return to previously attended regions. In order to test this possibility, participants viewed arrays of objects and of words while their eye movements were recorded. Temporal O-IOR was observed, with equivalent effects for object and word arrays, indicating that temporal O-IOR is an oculomotor phenomenon independent of array content. There was no evidence for spatial inhibition of return. Instead, spatial facilitation of return was observed: Participants were significantly more likely than chance to make return saccades and to refixate just-visited locations. Further, the likelihood of making a return saccade to an object or word was contingent on the amount of time spent viewing that object or word before leaving it. This suggests that, unlike temporal O-IOR, return probability is influenced by cognitive processing. Taken together, these results are inconsistent with the hypothesis that inhibition of return functions as a foraging facilitator. The results also provide strong evidence for a different oculomotor bias that could serve as a foraging facilitator: saccadic momentum, a tendency to repeat the most recently executed saccade program. We suggest that models of visual attention could incorporate saccadic momentum in place of inhibition of return.

"Apping Up": Prospects for Information Technology Innovation in Return to Work Communication.

Science.gov (United States)

Singh, Ripdaman; O'Hagan, Fergal

2018-03-21

Purpose During return to work (RTW), communication between health care providers and employers largely takes place through standardize paper-based forms. Information technology (IT) platforms may provide advantages in enabling information exchange and decision-making through sharing of guidelines and resources. We investigated stakeholder perspectives on the prospect of IT use for RTW communication in Ontario, Canada. Methods Consistent with the exploratory nature of the questions, qualitative methods were used. Primary data were interviews with health care providers (HCPs), employers, and workers with experience in RTW. The first portion of initial interviews elicited general perspectives and experiences related to RTW communication. Participants were then exposed to a prototype IT communication platform and elicited their feedback. Follow-up interviews with HCP's and EMP's were used to allow further reflection and clarification of data. We used progressive, thematic coding to analyze data. Results 12 HCPs, 7 employers, and 5 workers participated in the study. Five inter-related themes were obtained. Participants expressed no absolute objection to the use of IT for RTW communication but varying degrees of support. Participants revealed how media change depended on a prospective IT innovation's perceived usefulness, fit with current practices, capacity to gain buy-in from other stakeholders, and ability to demonstrate positive performance in actual practice. Conclusions Findings suggest that a transition to an IT-mediated tool for RTW communication is supported in principle; however, major caveats exist in relation to perceived value and fit with stakeholder practice. System support and stakeholder cooperation are likely necessary to adopt the change, yet IT-mediated communication has yet to demonstrate value. To avoid circularity, proof of principal needs to be established through an implementation trial of such technology.

Role of impact cratering for Mars sample return

International Nuclear Information System (INIS)

Schultz, P.H.

1988-01-01

The preserved cratering record of Mars indicates that impacts play an important role in deciphering Martian geologic history, whether as a mechanism to modify the lithosphere and atmosphere or as a tool to sample the planet. The various roles of impact cratering in adding a broader understanding of Mars through returned samples are examined. Five broad roles include impact craters as: (1) a process in response to a different planetary localizer environment; (2) a probe for excavating crustal/mantle materials; (3) a possible localizer of magmatic and hydrothermal processes; (4) a chronicle of changes in the volcanic, sedimentary, atmospheric, and cosmic flux history; and (5) a chronometer for extending the geologic time scale to unsampled regions. The evidence for Earth-like processes and very nonlunar styles of volcanism and tectonism may shift the emphasis of a sampling strategy away from equally fundamental issues including crustal composition, unit ages, and climate history. Impact cratering not only played an important active role in the early Martian geologic history, it also provides an important tool for addressing such issues

The role of communication and support in return to work following cancer-related absence.

Science.gov (United States)

Yarker, J; Munir, F; Bains, M; Kalawsky, K; Haslam, C

2010-10-01

Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post-return period; and second, by drawing on a research sample working in the United Kingdom. In all, 26 cancer survivors took part in a semi-structured telephone interview. Interviews were transcribed and analysed using thematic analysis. The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post-return to work. Third, during the post-return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow-up and monitoring, and the wear-off effect of empathy and support were highlighted as contributing to return-to-work difficulties. This qualitative study highlights the importance of communication within the workplace with regard to the return-to-work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return-to-work process. Copyright © 2009 John Wiley & Sons, Ltd.

Public informations guidelines

International Nuclear Information System (INIS)

1986-06-01

The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities

Public informations guidelines

Energy Technology Data Exchange (ETDEWEB)

None

1986-06-01

The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities.

28 CFR 42.404 - Guidelines.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Guidelines. 42.404 Section 42.404... Guidelines. (a) Federal agencies shall publish title VI guidelines for each type of program to which they extend financial assistance, where such guidelines would be appropriate to provide detailed information...

Stable Versus Unstable Grade II High Ankle Sprains: A Prospective Study Predicting the Need for Surgical Stabilization and Time to Return to Sports.

Science.gov (United States)

Calder, James D; Bamford, Richard; Petrie, Aviva; McCollum, Graham A

2016-04-01

To investigate grade II syndesmosis injuries in athletes and identify factors important in differentiating stable from dynamically unstable ankle sprains and those associated with a longer time to return to sports. Sixty-four athletes with an isolated syndesmosis injury (without fracture) were prospectively assessed, with a mean follow-up period of 37 months (range, 24 to 66 months). Those with an associated deltoid ligament injury or osteochondral lesion were included. Those whose injuries were considered stable (grade IIa) were treated conservatively with a boot and rehabilitation. Those whose injuries were clinically unstable underwent arthroscopy, and if instability was confirmed (grade IIb), the syndesmosis was stabilized. Clinical and magnetic resonance imaging assessments of injury to individual ligaments were recorded, along with time to return to play. A power analysis estimated that each group would need 28 patients. All athletes returned to the same level of professional sport. The 28 patients with grade IIa injuries returned at a mean of 45 days (range, 23 to 63 days) compared with 64 days (range, 27 to 104 days) for those with grade IIb injuries (P < .0001). There was a highly significant relationship between clinical and magnetic resonance imaging assessments of ligament injury (anterior tibiofibular ligament [ATFL], anterior-inferior tibiofibular ligament [AITFL], and deltoid ligament, P < .0001). Instability was 9.5 times as likely with a positive squeeze test and 11 times as likely with a deltoid injury. Combined injury to the anterior-inferior tibiofibular ligament and deltoid ligament was associated with a delay in return to sports. Concomitant injury to the ATFL indicated a different mechanism of injury-the syndesmosis is less likely to be unstable and is associated with an earlier return to sports. A positive squeeze test and injury to the ATFL and deltoid ligament are important factors in differentiating stable from dynamically unstable grade

Radiological risk comparison guidelines

International Nuclear Information System (INIS)

Hallinan, E.J.; Muhlestein, L.D.; Brown, L.F.; Yoder, R.E.

1992-01-01

An important aspect of DOE safety analyses is estimating potential accident risk. The estimates are used to: determine if additional controls are needed, identify Safety Class Items, and demonstrate adequate risk reduction. Thus, guidelines are needed to measure comparative risks. The Westinghouse M ampersand O Nuclear Facility Safety Committee and the Safety Envelope Working Group have developed radiological risk guidelines for comparing the risks from individual accident analyses. These guidelines were prepared under contract with the US Department of Energy. These guidelines are based on historical DOE guidelines and current requirements, and satisfy DOE and technical community proposals. for goals that demonstrate acceptable risk. The guidelines consist of a frequency versus consequence curve for credible accidents. Offsite and onsite guidelines are presented. The offsite risk acceptance guidelines are presented in Figure 1. The guidelines are nearly isorisk for anticipated events where impacts are chronic, and provide additional reduction for unlikely events where impacts may be acute and risk uncertainties may be significant. The guidelines are applied to individual release accident scenarios where a discrete frequency and consequence has been estimated. The guideline curves are not to be used for total risk assessments. Common cause events are taken into consideration only for an individual facility. Frequencies outside the guideline range are considered to be local site option (analyst judgement) as far as assessments of risk acceptance are concerned. If the curve is exceeded, then options include either a more detailed analysis or imposing additional preventive or mitigative features. Another presentation discusses implementation in detail. Additional work is needed to provide risk comparison guidelines for releases from multiple facilities and for toxic releases

Return to Experience and Initial Wage Level

DEFF Research Database (Denmark)

Sørensen, Kenneth Lykke; Vejlin, Rune Majlund

This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to nonparametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationship...

27 CFR 25.211 - Beer returned to brewery.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Beer returned to brewery..., DEPARTMENT OF THE TREASURY LIQUORS BEER Beer Returned to Brewery § 25.211 Beer returned to brewery. (a) General. Beer, produced in the United States, on which the brewer has paid or determined the tax may be...

Stochastic arbitrage return and its implication for option pricing

Science.gov (United States)

Fedotov, Sergei; Panayides, Stephanos

2005-01-01

The purpose of this work is to explore the role that random arbitrage opportunities play in pricing financial derivatives. We use a non-equilibrium model to set up a stochastic portfolio, and for the random arbitrage return, we choose a stationary ergodic random process rapidly varying in time. We exploit the fact that option price and random arbitrage returns change on different time scales which allows us to develop an asymptotic pricing theory involving the central limit theorem for random processes. We restrict ourselves to finding pricing bands for options rather than exact prices. The resulting pricing bands are shown to be independent of the detailed statistical characteristics of the arbitrage return. We find that the volatility “smile” can also be explained in terms of random arbitrage opportunities.

Going Back Part-time: Family Leave Legislation and Women’s Return to Work

Science.gov (United States)

2012-01-01

Using a multinomial logit model with data from the Survey of Income and Program Participation, this paper tests whether the implementation of the Family and Medical Leave Act (FMLA) is associated with an increase in return to work at part-time status among first-time mothers working full-time during their pregnancy. I find a statistically significant trend of increasingly higher odds of returning to work at part-time status relative to return at full-time status, beginning in 1993 (the year in which the FMLA is implemented). Furthermore, an additional week of either state or federal leave is significantly associated with a higher odds of return at part-time status. This article provides evidence that job protection and leave legislation may help facilitate higher levels of labor force participation among women with small children, through more flexible work arrangements. PMID:22685365

Return to experience and initial wage level

DEFF Research Database (Denmark)

Sørensen, K.L.; Vejlin, R.

2014-01-01

This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to non-parametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationshi...

Development of new canine and feline preventive healthcare guidelines designed to improve pet health.

Science.gov (United States)

2011-01-01

The American Veterinary Medical Association (AVMA) and American Animal Hospital Association (AAHA) have jointly introduced the first Canine and Feline Preventive Healthcare Guidelines. These consensus statements provide veterinarians with a new resource for improving patient care by emphasizing the value and scope of regular pet examinations. The two guidelines provide complete recommendations for comprehensive preventive healthcare programs, published as accessible, single-page documents. The guidelines are based on the subjective-objective-assessment-plan (SOAP) methodology of case management, a proven approach traditionally used with sick or injured patients. This logical and disciplined process is equally applicable to healthy patients and is designed to consistently deliver optimal patient care. The guidelines recommend visits for health examinations on at least an annual basis, recognizing that for many pets, more frequent visits may be appropriate, depending on the individual needs of the patient. The guidelines also provide detailed diagnostic, therapeutic, prevention, and follow up plans, to be accompanied by appropriate documentation. The inclusive content and concise format of the guidelines are designed to maximize their practical value and make them easy to implement.

Implementing a collaborative return-to-work program: Lessons from a qualitative study in a large Canadian healthcare organization.

Science.gov (United States)

Skivington, Kathryn; Lifshen, Marni; Mustard, Cameron

2016-11-22

Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers' and return-to-work-coordinators' views on the implementation of their organization's new return-to-work program. To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants' perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. We identified tensions evident in the early implementation phase of the organization's return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program.

[Implementation of Study Results in Guidelines and Adherence to Guidelines in Clinical Practice].

Science.gov (United States)

Waldfahrer, F

2016-04-01

Guidelines were introduced in hospital and practice-based otorhinolaryngology in the 1990s, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. The Society has cooperated in a further 34 guidelines. The quality of the guidelines has been continually improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany [Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.]. Since increasing digitalisation has made access to scientific publications quicker and more simple, relevant study results can be incorporated in guidelines more easily today than in the analogue world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines. © Georg Thieme Verlag KG Stuttgart · New York.

Experiences and concerns about 'returning to work' for women breast cancer survivors: a literature review.

Science.gov (United States)

Tiedtke, Corine; de Rijk, Angelique; Dierckx de Casterlé, Bernadette; Christiaens, Marie-Rose; Donceel, Peter

2010-07-01

To explore how female breast cancer patients experience work incapacity during the treatment and return-to-work phases and how interactions between patients and stakeholders affect this experience. Database search for full text articles published between January 1995 and January 2008 that focused on employed female breast cancer patients, factors related to work incapacity, and returning to work. Only results based on self-report data were included. Studies focusing on treatment, financial factors, rate of return, or absence were excluded. Six articles met the inclusion criteria. Women with breast cancer receive varied reactions but little advice about returning to work. Women were primarily concerned with disclosing the diagnosis to their employer and to relatives. Uncertainties about physical appearance, ability to work, and possible job loss affected the women's decisions about working during the treatment phase. After treatment, most women wanted to regain their 'normal life', but concentration and arm or fatigue problems potentially interfered. Although supportive work environments were helpful, the individual needs of women differed. Employers and employees need to find a balance in defining accommodating work. Many women received favourable support, but some reported feeling discriminated against. Many women re-evaluated the role of work in their lives after being confronted with breast cancer. Work adjustments could help women to keep their jobs during illness and recovery. To resolve women's concerns about returning to work, employers, physicians, and insurance institutions should consider increasing and improving communication with breast cancer patients and playing a more active and supportive role. Copyright (c) 2009 John Wiley & Sons, Ltd.

76 FR 36996 - Extension of Time for Filing Returns

Science.gov (United States)

2011-06-24

... less time to complete accurate income tax returns and to provide timely information to the trust's... either chapter 7 or chapter 11 of Title 11 of the U.S. Code that is required to file an income tax return... estate or trust income tax return or failure to pay the amount shown as tax on the return. (g) Effective...

Return to the workforce following infective endocarditis

DEFF Research Database (Denmark)

Butt, Jawad H.; Kragholm, Kristian; Dalager-Pedersen, Michael

2018-01-01

Background The ability to return to work after infective endocarditis (IE) holds important socioeconomic consequences for both patients and society, yet data on this issue are sparse. We examined return to the workforce and associated factors in IE patients of working age. Methods Using Danish...